[Congressional Record Volume 148, Number 53 (Thursday, May 2, 2002)]
[Senate]
[Pages S3793-S3795]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PRESCRIPTION DRUGS
Ms. STABENOW. Mr. President, I rise to speak specifically to another
proposal on principles that was released yesterday in the House of
Representatives. We have been urging now, since I came to the Senate
over a year ago, and certainly before that time, that our colleagues
from the other side of the aisle join with us to act to get action in
two areas related to critical health care and prescription drugs: One,
a comprehensive Medicare prescription drug benefit. Modernize Medicare,
update it. Everyone knows that it was written in 1965 and covers the
way health care was provided in 1965. It needs to be updated to cover
prescription drugs, the primary way that we provide health care today.
Second, we know there are important actions we can take right now to
lower the cost of prescription drugs for every family, not only for our
seniors who use the majority of prescriptions--on average 18 different
prescriptions a year--but also for those families who have a disabled
child or another family member who is ill. We need to lower the costs
now. We need to lower them for small businesses. We need to lower them
for larger businesses. Our farmers are struggling with higher costs. We
can do that.
Certainly we appreciate that our colleagues have come together with
fanfare to talk about four principles: One is lowering the cost of
prescription drugs now. I suggest that putting those words on paper
does not lower the cost of one pill. It does not make one more
prescription available to our seniors.
I welcome the words, but our seniors and our families have had enough
words. They are interested in action. We have to be working in a
bipartisan way. We come as Democrats to say: Work with us; let's get
beyond the words, beyond the principles and get something done.
We are interested in lowering the cost of prescription drugs, and we
have numerous proposals. I will speak to those for a moment before
speaking about Medicare prescription drug coverage.
We know, for instance, if we allow the normal course of patents to
run out and for the process to work where lower cost generic drugs can
be used, we can dramatically cut costs immediately. We have
colleagues--Senator Schumer and Senator McCain--who are putting forward
an important bill to close loopholes that the drug companies have used
to block generic drugs from going on the market and to block the
lowering of the cost of drugs. We can pass that bill right now and drop
the cost. We can open our borders to Canada. Senator Dorgan, of North
Dakota, has introduced a bill; he is in the Chamber, and I am sure he
will speak to that shortly. I am pleased to join him.
This is an effort in which I have been involved since being in the
U.S. House of Representatives. I have taken two bus trips to Canada
with our seniors to demonstrate that by working through the Canadian
Medical Society we can lower the cost of prescription drugs. It is
astounding. These are American-made drugs. I am proud they are made in
America. I am proud we have invested in the research and technology--
taxpayers, private companies, biotech companies, biomedical companies,
drug companies. But when all is said and done, if no one can afford to
get the medicine, what have we done?
We now find ourselves in a situation where we subsidize and pay for
the research from which the world benefits; yet our borders are closed
and our own people cannot go across the border to get the same drug at
half the price.
Mr. KENNEDY. Will the Senator yield for a question?
Ms. STABENOW. I will be honored to yield.
Mr. KENNEDY. Is the Senator aware that under the House Republican
plan, senior citizens would have to spend $670 before they received a
dime of benefits? This is the cost of the premiums of $420, and the
deductible which is $250. That comes to $670 before they get a dime of
benefit.
Is the Senator familiar with the fact that the average senior
citizen's income is only $15,000, and the average prescription drug
need is $2,200?
Ms. STABENOW. Yes.
Mr. KENNEDY. We all want to find common ground and work together.
Requiring the seniors to pay $670 before they get a dime of benefits
does not seem to me to fulfill the commitment this country made to our
seniors when we passed Medicare and said: Pay in, and we are going to
help relieve the anxiety you have about quality health care. I am
interested in whatever comment the Senator wishes to make.
Ms. STABENOW. I thank the Senator. As the Senator from Massachusetts
has indicated, the Medicare proposal that we believe is coming--again,
we only have principles. We do not have the specifics. We are piecing
together from news stories and other sources what it appears to be. In
fact, going beyond what the Senator from Massachusetts has said, not
only are we talking about the premium, the deductible, the copays--and
there are two different levels of copays--but nothing is covered once
you reach $2,000 until you have spent $5,000. So there is a huge gap in
the middle.
If we take the example of a senior who is spending $300 a month on
prescription drugs--and that is not unusual. It might be a breast
cancer patient who is purchasing tamoxifen, which in Michigan is $136 a
month. If you add to that blood pressure medication or cholesterol
medication or another drug, the amount could easily come to $300 a
month. If you add that up and look at all that it appears from that
proposal, Mr. President, of the $3,600 a year that one would be paying
out of pocket, one would still spend $2,914.
If someone is paying $300 a month now in prescription drug costs,
less than 20 percent of that would be covered under the Republican
proposal.
Mr. KENNEDY. Will the Senator be good enough to yield for another
question? Does not the Senator think then we have to deal with the
substance and the reality rather than the cliches and the slogans?
Ms. STABENOW. Absolutely.
Mr. KENNEDY. I am sure we are going to hear from the other side: We
have a prescription drug proposal. Does the Senator agree with me that
is really a misrepresentation? If we accept that as a concept, it will
do people in my State little good.
I understand the Senator is a strong supporter, and I see in the
chair the Senator from Georgia who has worked very closely with the
Senator from Florida on an excellent program, and I commend him for it.
Does the Senator agree if we are going to do something, let's help
our seniors and not misrepresent what we are trying to do for them?
Ms. STABENOW. Absolutely. I add also, one of my deep concerns is that
in order to pay for this, they are talking about Medicare ``reforms.''
Unfortunately, the reforms we are hearing about are proposals such as
adding the cost of home health care, requiring a
[[Page S3794]]
copay for home health care. Our seniors who are now struggling to live
at home, families who are struggling to make sure someone can live in
dignity in their home as long as possible, have home health care. Part
of that is their prescription drugs, and to pay less than 20 percent of
the cost of prescription drugs, one of the things they are talking
about is a copay for home health care. So they will be adding other
costs to this process as well.
I suggest: Beware of what is coming. It is very clear when the only
people who are advocating for the proposal put forward by the House
Republicans are the drug companies, that should tell us something. When
they have fought every proposal for comprehensive prescription drug
coverage, every proposal to lower the cost of prescription drugs,
whether it is expanding generic drugs, opening the borders, lowering
advertising costs--every single effort to get some control and
accountability in this system so that our seniors can afford
prescription drugs they have opposed.
Mr. KENNEDY. Will the Senator yield one more time and give me her
reaction?
Ms. STABENOW. I will be happy to yield.
Mr. KENNEDY. Is the Senator aware that the Bush budget allocates only
$190 billion over the next 10 years for prescription drugs and Medicare
reform, and the House Republican budget allocates $350 billion, but the
cost of drugs for senior citizens during this same period will be $1.8
trillion--$1.8 trillion? Does the Senator conclude from that, this is
going to be a very inadequate response to a major health challenge for
our seniors?
Ms. STABENOW. I absolutely agree. With all due respect to our
colleagues on the other side of the aisle, the math does not add up. It
is time to get beyond principles and rhetoric and say to those watching
this morning sitting at their kitchen table, seniors who are sitting
down right now deciding, Do I eat today or take my medicine, that we
are going to step up to the plate, do what is right, and do what is
long overdue.
I see my colleague from North Dakota. I would very much like to yield
to him. He has been such a leader on this issue. We share, as border
States, the frustration of citizens from our States who can easily go
on a short trip across the border and pay lower prices for American-
made drugs.
The Senator has been a real leader in this effort.
Mr. DORGAN. Mr. President, how much time remains in morning business?
The PRESIDING OFFICER. Six minutes 20 seconds.
Mr. DORGAN. May I be recognized?
The PRESIDING OFFICER. The Senator from North Dakota.
Mr. DORGAN. I appreciate the conversation about the prescription drug
issue. It is important. There are two pieces to it. One is coverage for
those who do not have access or the resources to get the prescription
drugs they need. These are lifesaving medicines that can only save
lives if you have access and can afford them.
The second issue is price. That is an important issue. If we talk
only of coverage, and not price, we break the bank. Connecting the hose
between the prescription drug and the Federal tank means we will suck
money out of the tank forever. We will break the bank if we do not do
something about prices.
Last year, the cost of prescription drugs increased 17 percent in
this country. Year after, the cost increases have been double digit.
There has been both utilization and price inflation, double-digit
increases in the cost of prescription drugs for 5 years in a row. It
will continue into the future unless we do something.
We have to deal with coverage. We also have to be concerned about
price: What kinds of approaches can we implement that put downward
pressure on prices?
I ask unanimous consent to show bottles on the floor of the Senate
that have contained prescription drugs.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. DORGAN. Mr. President, I have introduced a bipartisan piece of
legislation supported by Republicans and Democrats that allows
pharmacists, licensed distributors, and wholesalers in our country to
access prescription drugs in Canada--same drug, in the same bottles,
made by the same company, sold in Canada and North Dakota, with
radically different prices.
This is a drug called Celebrex, which is used for arthritis. It is
sold in identical bottles, except one cap is blue and one is white--
same pill, put in the same bottle, made by the same company, sold in
Canada and the United States. The Canadian pays 79 cents per tablet,
and the American pays $2.20 per tablet--same drug, same company, same
pill bottle, but a huge difference in prices.
Here are two additional examples. Most everyone knows that Lipitor
lowers cholesterol. But we have two different prices for the same pill,
put in the same bottle, and made by the same company. It is $1.01
wholesale in Canada and $1.86 per tablet to the United States consumer.
One more example is Paxil which is used to treat depression. Paxil is
packaged in a bottle that is identical whether you get it in Canada or
in the United States. The only difference with Paxil is the difference
in price--as in the case of most drugs. It costs 97 cents per tablet
for the Canadian, $2.20 per tablet for the American consumer. The U.S.
consumer pays the highest prices in the world for the prescription
drugs. It is the same pill, made by the same company, put in the same
bottle, for which there is a radical difference in cost.
I use one other example without a bottle. It is called tamoxifen,
which is used to treat breast cancer. For every 10 cents charged to a
Canadian, $1 is charged to an American consumer. If you are buying
tamoxifen, you can buy it in Canada for one-tenth the price charged in
this country.
With respect to these prices, there is a little town in North Dakota
called Michigan, not so far from the Canadian border. At the end of a
meeting one night, a woman, perhaps in her late seventies, came to me
and said: Mr. Senator, can you help me? I said: What is the problem?
Her eyes began to well with tears, and her chin began to quiver. She
said: I have heart disease and diabetes; my doctor prescribes a great
deal of medicine I must take, and I don't have the money to purchase
the drugs. The doctor says I must have these drugs in order to continue
to live a good life.
That is the problem. We need prescription drug coverage. We also need
restraint on pricing. The two, together, can help the American people
access lifesaving drugs. Miracle drugs can only provide miracles if
people can afford them. That is why we are fighting to make some sense
of this policy.
What I have tried to do, on a bipartisan basis, with Republicans and
Democrats supporting this reimportation bill that we have now
introduced, is to allow pharmacists and distributors to access those
same drugs that are sold at much lower prices in our neighboring
country of Canada.
I yield for a question.
Mr. SCHUMER. I thank my colleague from North Dakota for his eloquent
exposition.
We are working on the same track. The Senator from North Dakota has a
bill to lower prices by allowing reimportation. Senator McCain and I
have a bill to extend generic drugs. We have to deal with both: Getting
prescription drugs as part of Medicare, but also lowering the cost. As
the Senator from North Dakota has said over and over again, we are not
going to get the one without the other.
I bring to his attention and ask if the Senator saw an article in the
Wall Street Journal on the front page, another way the drug companies
are going way overboard. They are getting lists from pharmacists of
people who have a prescription for a certain drug and then are writing
those people and saying: Why don't you switch to this drug? Do you know
why they ask them to switch? The generic drug is coming on board for
their original drug, and now they are trying to manipulate the generic
drug law.
The drug company is extending the dosage, going for a weekly pill
rather than a daily pill.
Mr. DORGAN. I ask unanimous consent for 5 additional minutes, and I
yield to the Senator from New York.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. SCHUMER. The drug company's applying for a new patent because the
daily pill--same medicine--expires.
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The drug industry has some good arguments. I don't disagree with
their argument that they need money for research. And these new pills
have helped people. But faced with all of these blockbuster drugs that
are going off patent, and the companies being so used to the high rate
of return they have had--higher than any other American industry--they
are pushing the envelope way too far in terms of trying to keep that
level of profitability.
They ought to understand--and I ask my colleague from North Dakota to
comment on this--their job is to go back into the laboratories, come up
with real new drugs, and work on those--not extend the patent--or, in
the case of what the Senator from North Dakota has discussed, make the
U.S. price above all the other prices. This involves lots of work and
lots of focus.
Every time I read one of these articles, it makes my blood boil. When
I came here, I was not regarded as a hardliner on this issue. I have a
great deal of respect for companies that research and produce these
drugs. However, the limits they are going to, with the advertising on
television--and I know my colleague from Michigan is working on this--
with the huge price differential where the United States consumer pays
for all the research, yet around the world the costs are much lower--I
know my colleague from North Dakota is looking into this--to the
manipulation of the generic drug law, which Senator McCain and I are
looking at, something is rotten in Denmark.
I thank my colleague his remarks and his persistent leadership on
this issue and ask him what he thinks of what is going on, and has he
seen this change over the years?
Mr. DORGAN. Mr. President, I chaired a hearing recently at which
Senator Schumer testified and Senator McCain, as the ranking member,
attended. Generic drugs are a very important issue.
I push for price restraint because I think it is very important with
respect to what is happening to price increases of prescription drugs.
However, I bear no ill will toward this industry. I think the drug
industry is a remarkable industry. It does some remarkable things. We
should compliment them for some of the programs they have initiated in
recent weeks, for the low income senior citizens. That is a good step.
They do some awfully good work. Tamoxifen costs one-tenth the price in
Canada; you pay 10 times more if you are an American, that drug
resulted from public funding and public research at the National
Institutes of Health.
So I worry very much that what is happening is that the public is
paying for research in some areas and, when the drugs are privatizing,
a price is affixed to them that is way out of bounds.
I bear no ill will towards this industry. I want them to do well and
to continue to search for lifesaving drugs. But I think it is important
to point out that, when we talk about miracle drugs, Americans who need
them will get their lifesaving benefits only if they can have access to
them, and can afford them. There are so many Americans who cannot chase
double-digit price increases every year. That is why we deal with this
issue. The issue I have been concerned about is reimportation from
Canada. Not because I want anybody to have to go to Canada to buy
prescription drugs, that is not my goal. My goal, of course, is the
repricing of those drugs in this country because, if distributors and
pharmacies can go to Canada and access the same drugs, it will force a
repricing of those drugs here.
I want to have a prescription drug benefit in the Medicare Program
but I don't want to break the bank. If we do that and do nothing about
price restraint and downward pressure on prices we will break the bank
of this Government. We must address both issues, coverage and price.
Ms. STABENOW. Will the Senator yield for a moment? I just wanted, as
we conclude this time, to thank my colleagues for their continued
leadership and to, once again, call upon our colleagues across the
building, in the other Chamber, the Speaker of the House of
Representatives and his colleagues, to go beyond the principles that
were put out yesterday and join with us in the concrete proposals that
we have.
We have the ability to act now. We could do it this month if they are
willing to join with us. We ask them to get beyond the words and let's
get together and let's do the right thing.
The PRESIDING OFFICER. The Senator from Montana.
Mr. BAUCUS. Mr. President, I commend the Senator from North Dakota
who organized the preceding discussion with respect to the high price
of drugs and unavailability of prescription drugs. I asked the General
Accounting Office to do a study of coverage of prescription drugs in my
home State of Montana. The conclusions were for those seniors in our
State who are not covered by health insurance, those seniors pay more
for prescription drugs than do seniors anyplace else on the face of
this Earth. That is more than any other part of the United States and
certainly more than people overseas, as has been demonstrated ably by
the Senator from North Dakota. The same drug by the same company is
less expensive to someone overseas as compared with the United States.
This is a critical issue. I thank my friend from North Dakota as well
as the Senator from Michigan, Ms. Stabenow, and others.
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