[Congressional Record Volume 148, Number 93 (Thursday, July 11, 2002)]
[Senate]
[Pages S6600-S6603]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PRESCRIPTION DRUGS
Ms. STABENOW. Mr. President, next week we begin one of the most
important debates that we will have, I believe, as a Senate, throughout
this session and possibly for years to come. That is a debate about
whether or not we are going to meet two goals that the American people
have been asking us to address. The first is a Medicare prescription
drug benefit for our seniors, for those who have disabilities--a
comprehensive Medicare prescription drug benefit. Second, we want to
lower prices--lower prices for everyone.
We know in fact not only do seniors, who use the majority of
prescriptions, have high prices, but everyone who has prescription
drugs does. If you are paying through insurance, you are paying higher
insurance rates. If you are a businessperson, you are seeing your
health care premiums rising. Small businesses--many in Michigan come to
me and talk about 30-percent, 35-percent, 40-percent increases. The big
three automakers are juggling between being able to afford new
materials for their automobiles and research and all the other costs
that they have, versus health care, most of which is prescription drug
increases. So everyone is paying.
We have two goals. We as Democrats are working very hard, and we
invite our colleague to join with us, to provide real coverage for
prescription drugs and lower prices for everyone.
It is incredibly important that we do that. I am concerned, as we
move into this debate, given what was done in the House of
Representatives and the efforts now on the airwaves by the organization
funded by the pharmaceutical companies that are talking about how what
was passed in the House was good enough, I am concerned that we really
do what is necessary and not just what is in the interests of the
drug companies.
The drug companies are here in force every single day. We know next
week and the week after, as long as we debate issues of lower prices
and real Medicare coverage, they will be here fighting everything--
unfortunately. They do wonderful work in research and development. I am
so pleased that we have so many that are out there doing good work. But
we see, as an industry now, their efforts to fight everything.
We are talking about corporate responsibility this week on the floor
of the Senate, the need for corporate accountability. We need corporate
accountability and ethics in the drug industry as well. I am deeply
concerned that we do not see efforts to work with us for something that
provides reasonable profit. We want them to succeed, but we do not want
to continue to see exorbitant price increases and profits on the backs
of our seniors, those with disabilities, our families, our small
businesses.
I am deeply concerned about what we were reading in the paper during
the House debate. Our Republican colleagues, in fact a senior House GOP
leadership aid said yesterday:
Republicans are working hard behind the scenes on behalf of
PhRMA [which is the drug industry lobby] to make sure that
the party's prescription drug plan for the elderly suits drug
companies.
This was in the Washington Post, June 19 of this year. They are:
. . . working hard behind the scenes to make sure that
their . . . plan . . . suits the drug companies.
I hope next week we will work just as hard in this body for a
prescription drug plan that suits the American people.
I am so pleased to see my distinguished colleagues from Georgia here,
one in the chair and the junior Senator who came into the Senate with
me, who is one of the lead sponsors of the bill that we have in front
of us along with the Senator from Florida, Mr. Graham.
We have a plan. We have a plan that works, that pays the majority of
the bills, that does the job, that brings together the collective
buying power of 39 million seniors, and which will require that prices
be lowered. We have the plan. Our plan is not the plan of the drug
companies. It is not the plan which drug companies are advertising
about--the pretty ads from Seniors United that are on the air from the
drug company, the front senior group that thanks the Republican
colleagues in the House for voting for their plan, the plan that
supports the drug companies.
We have a plan for the American people.
I would like to share for a moment two stories from the Web site
which I set up. I set up the Prescription Drug People's Lobby. There
are six drug company lobbyists for every one Member of the Senate. I
invited the people of Michigan to join with me to be part
[[Page S6601]]
of our people's lobby to make sure the real story gets heard. I would
like to share a story from Rochelle Dodgson of Oak Park, MI. I thank
her for being a part of our Prescription Drug People's Lobby.
She writes:
My mother is currently insured under COBRA after losing her
job in August 2001. While she has her basic Medicare
coverage, she will lose her supplemental medical coverage in
January 2003. She has recently been diagnosed with Multiple
Myeloma and will require treatment for this blood disorder
the rest of her life. The medications she was taking before
this new illness cost over $500 retail monthly. I have not
checked the prices of the `chemo' she takes monthly nor the
cost of the Procrit she takes weekly. I expect her monthly
out-of-pocket expenses to be around $700 a month. Her social
security is just over $800 monthly. I can't imagine having to
budget food and housing expenses along with medication on
that kind of income. My husband and I will try to find a way
to budget some of her medical costs into our own expenses but
we also care for my husband's mother.
My mother is still a viable part of society. She doesn't
deserve to be struggling just because she has chronic
illness.
Rochelle, thank you for your story. Your mother does not deserve to
struggle with $700 medical bills with a $700-a-month income.
I shared that one story today from Michigan. For those who want to
get involved, please go to my Senate Web site around the country at
Fairdrugprices.org. You can be involved and make your voice heard, and
the right thing will happen here in the Senate.
Thank you, Mr. President.
The PRESIDING OFFICER (Mr. Dorgan). Who seeks recognition?
The Senator from Georgia is recognized.
Mr. CLELAND. Mr. President, I echo the eloquent words of the
distinguished Senator from Michigan, who has done yeoman service for
this body, for seniors and the disabled of America in helping put
together and advocate for a meaningful drug benefit under Medicare. And
special kudos go to my colleague from Georgia, Senator Miller, and to
my distinguished friend from Florida, Senator Graham, for really taking
the lead in articulating a Medicare supplement that we can embrace in
this body and that the American people can embrace.
When I talk to my fellow Georgians about the issues that are most on
their minds, that most affect their lives, the one that I hear about
more often than any other is the high cost of prescription drugs.
Everywhere I go, people ask me, ``When are Congress and the President
going to make good on their promise to help us with prescription
drugs?'' And all I can tell them is, That's a fair question; I'd like
to know, too. Over the past couple of years, their comments have become
increasingly urgent. The cost of prescription medications rose a
staggering 19 percent in 2000, and another 17 percent in 2001. I can
assure you most people's incomes didn't rise by 17 percent in 2001. It
is an iron-clad law of economics that if you live on a fixed income,
and one portion of your monthly expenses rises dramatically, other
portions must be reduced. For many of those seniors whose budgets are
already stretched as thin as they can go, an increase in prescription
drug costs means that expenditures on the other necessities of life--
basics like groceries or rent--must be cut. The choice between
medically necessary, life-sustaining prescription drugs and the other
basics of life is an impossible one--and one that no American should be
forced to make.
The Medicare program has provided for many critical aspects of health
care for seniors over the course of its 36-year history, and by and
large it has been a great success. But it has been said that while
Medicare is a Cadillac program, its model year is 1965. Indeed, if we
are to claim that Medicare provides health care security for seniors,
we must update it to cover the component of health care that for many
has become more burdensome than any other--prescription medications.
People are desperate for any help they can get. Congress and the
President promised to deliver that help. If we can't, or won't, the
people ought to send this Congress home and elect one that will.
There are a number of options on the table right now. Some are
serious efforts to provide meaningful relief to seniors. Some are not.
No one in Congress wants to admit that they are against providing a
prescription drug benefit for seniors. And I don't blame them. That's
an indefensible position. So some, especially in the House, write weak
legislation that they call a Medicare prescription drug benefit but
which allows drug companies to charge whatever premiums they want,
leaves huge gaps in coverage, charges a high deductible, relies on
private insurers who have already told us they will not participate,
and will cover just 19 percent of seniors drug costs over the next
decade, according to the CBO. Such a proposal amounts to little more
than a ``legislative placebo,'' which its authors know has no chance of
really helping seniors, and no chance of passing this Senate. But they
draft such legislation not because they think it will help seniors but
so they can go back home and say that they supported a prescription
drug benefit for Medicare beneficiaries. They cynically believe that
people won't pay enough attention to the substantive differences
between a real proposal and theirs, enabling them to shirk the
responsibility that they rightly must bear if this Congress once again
fails to pass a Medicare prescription drug benefit. Where I come from,
when you promise people one thing and then try to give them another,
that's called a ``bait-and-switch'' scheme. And where I come from, we
have a saying: ``That dog won't hunt.''
President Bush has made it clear that, in the war against terror,
there are no shades of gray. Either you are for us, or you are for the
terrorists. The same clarity that exists in the Bush doctrine ought to
apply to the present debate on prescription drugs. Either you are for a
real prescription drug benefit for seniors, or you aren't. If you are
for a weak measure that purports to be a prescription drug benefit but
has no chance of ever benefitting anyone, you are not for a real
prescription drug benefit for seniors, and it is time to come clean and
say it. It is long past time to dispense with artful dodging and
equivocation. Just as no country that deals only halfway with
terrorists can be considered on our side in the war against terror, so
no one who proposes a halfway approach to prescription drugs under
Medicare can be considered to be for real help for seniors. If you
don't know whether or not the legislation you are for will provide a
real benefit for seniors, let me make it real clear for you: if it was
written by the insurance lobby and endorsed by the drug companies, you
can bet it is not a real benefit for seniors.
People are hurting. If you need proof, go back to your state or your
district and spend a day talking with seniors about their daily
struggles. You will find genuine hardships, and you will see that it is
the most vulnerable among us who are struggling the most. This is a
serious problem, and we need serious people who will work in good faith
toward a solution. In the Senate, I am pleased to have teamed up with
Senators Zell Miller and Bob Graham as an original cosponsor of the
Medicare Outpatient Prescription Drug Act of 2002, which will provide a
voluntary Medicare prescription drug benefit that will deliver real,
meaningful help to seniors. Under this proposal, which has received
high marks from the AARP, any Medicare beneficiary who chooses to
participate would, for a monthly premium of $25, receive drug coverage
from the very first prescription filled of the year. There is no
deductible, and there are no gaps in coverage. The lowest-income
seniors would receive full subsidies for premiums and co-payments, and
those who earn a little more would receive partial assistance. Our
proposal, if adopted, will dramatically reduce seniors' out-of-pocket
costs for prescription drugs, allowing them to use their food money for
food and their rent money for rent. It is with full confidence that I
say that this measure is the best proposal on prescription drugs I have
seen to date, and I commend Senators Graham and Miller in particular
for their leadership on it. I urge my colleagues in this body and in
the House to act favorably on it without delay.
I yield the floor.
The PRESIDING OFFICER. The Chair recognizes the Senator from North
Dakota.
Mr. DORGAN. Mr. President, I join my colleagues in saying that the
piece of legislation we are considering, authored by Senator Graham,
Senator
[[Page S6602]]
Miller, and others, is a good piece of legislation. I am proud to
support it. But let me talk just for a few minutes about this issue
that brings us to the floor of the Senate, the issue of prescription
drugs, and prescription drug pricing especially.
Last year, the cost of prescription drugs in the United States rose
18 percent; the year before that, 16 percent; the year before that, 17
percent. So 16, 17, 18 percent: relentless increases in the price of
the cost of prescription drugs.
What does that mean to the American people? It is devastating to all
Americans who must access these lifesaving, miracle prescription drugs
but cannot afford them. It is especially devastating to senior
citizens. They make up 12 percent of our population in this country,
and they consume one-third of all the prescription drugs. They have
reached those declining income years and discover that miracle and
lifesaving drugs they need to take are beyond their reach.
A woman in North Dakota, at a meeting 1 day, came up to me and said:
May I speak with you a moment? She was a thin, frail-looking lady close
to 80 years of age. She grabbed me by the arm and said: Could you help
me? I said: I'll sure try.
She said: I have problems--diabetes, heart disease--and need to take
medicine that the doctor has prescribed, but I can't afford that
medicine. Could you help me?
And then her eyes filled with tears and her chin began to quiver and
she began to cry.
All over this country there are men and women--particularly senior
citizens, but others as well--who need access to these prescription
drugs and cannot afford them.
We are going to pass a prescription drug benefit, and we are going to
put it in the Medicare Program. I support that. Senator Graham, Senator
Miller, and others have done wonderful work in that area.
We are going to do two other things as well. We are going to pass a
piece of legislation, I hope, that deals with the issue of generic
drugs, which is another way to bring down costs; for if we do not do
something about driving down costs, or at least putting downward
pressure on drug costs, then we will simply break the bank. We will
attach a drug benefit to the Medicare Program but if we don't lower
drug costs we will suck that tank dry, and break the back of the
American taxpayer. We have to put downward price pressure on
prescription drugs.
One other piece of legislation that we are going to consider next
week is the issue of reimportation. Senator Stabenow and I, and others,
have worked on the issue of reimportation, not because we want
Americans to buy their prescription drugs from Canada--and that is what
our bill will allow to happen; pharmacists and distributors will be
able to access from Canada the FDA-approved drugs and bring them to
this country and pass the savings along to the consumer--it is because
we want to use this mechanism to put downward pressure on drug prices
in this country and force the pharmaceutical manufacturers to reprice
their prescription drugs in the United States. That is exactly what
will happen.
With unanimous consent, I would like to show two pill bottles on the
floor of the Senate.
The PRESIDING OFFICER (Mr. Cleland). Without objection, it is so
ordered.
Mr. DORGAN. This is Celebrex, widely advertised, used for pain,
particularly arthritis. It is widely advertised all across this
country. The company that makes this markets it successfully, and good
for them for helping produce this medicine. But let me describe the
pricing strategy.
If you buy this medicine, Celebrex, in Canada, you get it in this
bottle, and it costs you 79 cents per tablet. Buy it in the United
States, and you get it in this bottle which is essentially the same.
So 79 cents for this prescription drug per tablet in Canada, but if
you are a U.S. citizen, you pay $2.22. It is the same pill, made by the
same company, put in the same bottle, FDA approved. The difference? The
price.
The U.S. consumer is told: You should pay nearly triple what a
Canadian consumer is charged by the same company.
Question: Why should we allow that to happen? Why should the U.S.
consumer pay the highest prices in the world for prescription drugs
that are sold at a fraction of the cost in virtually every other
country of the world?
The answer is: It should not continue to happen. We need to put
downward pressure on prices in this country on prescription drugs. This
is not about, as the pharmaceutical industry would allege, shutting off
research and development if you put downward pressure on prices. That
is nonsense.
The fact is, the Europeans pay lower prices--much lower prices--for
the same prescription drugs than we do, and yet there is more research
and development done in Europe than in the United States by the
pharmaceutical manufacturers.
My only point is this: The pharmaceutical manufacturers are good
companies. They are the most profitable companies in the world. Good
for them. I appreciate, and all Americans appreciate the research and
development they do. We, of course, do a substantial amount of it here
in the Federal Government that is federally paid for as well.
I am not suggesting there are bad actors here. I am suggesting the
pricing policy is wrong. The pricing policy is bad. It is not fair to
say to the American consumer: You pay the highest prices in the world
by far for the same drug. No American should have to go to Canada to
get a fair price on a prescription drug made in the United States. That
ought not happen. We aim to change it, even as we debate this issue of
a prescription drug benefit in the Medicare plan.
Why do we want to do that? Because I believe there should be a
benefit in Medicare for prescription drugs. But I believe if we do not
do something to put downward pressure on prices, we simply break the
back of the taxpayers and break the bank of the Federal Government.
That is why reimportation goes hand in hand with the underlying
legislation I am pleased to support, and I commend Senator Graham and
Senator Miller and Senator Stabenow and others for their leadership.
I yield the floor.
The PRESIDING OFFICER. The Senator from Georgia.
Mr. MILLER. Mr. President, first, I congratulate my colleague from
North Dakota on that very timely and very compelling message he has
just given.
I rise today, also, to speak, once again, about prescription drugs
and the struggle our seniors are facing each and every day.
We are on record as saying we will have a vote in this Senate before
the August recess on a prescription bill. I have always hoped that
meant adding a prescription drug benefit to Medicare. We must stick to
that schedule. We must honor that commitment.
We have kept our seniors waiting in line for too many years, and we
have bumped them too many times in the past. We have disappointed them
time and time again. We cannot make them wait through another election
cycle for who knows how many years. If that happens--and a lot of
political pundits are predicting it will--then we should be ashamed of
ourselves.
I am telling you, our seniors are not going to accept just a shrug of
the shoulders and a ``well, I tried'' explanation. I don't think that
is going to get it this time around.
There is a lot we can do to help seniors with the cost, as the
Senator from North Dakota has discussed, and also about the coverage of
their prescription drugs. I will work hard to make sure the bill we
pass in the Senate offers real help for our seniors, especially our
neediest seniors.
I recently saw the results of a new study that were shocking to me.
It said nearly 1 in 5 American women ages 50 to 64 did not fill a
prescription for needed medication because they could not afford it.
That is ages 50 to 64. Think what the number must be for those over 65.
Those are our mothers and our grandmothers. They are those women who
gave us life and tended to our needs who are now foregoing their needs
because they cannot afford medication. They are putting their health in
jeopardy. Their very lives are being endangered. Their years on this
Earth are being cut short. Make no mistake about it, if we allow that
to continue,
[[Page S6603]]
this Congress is an accessory to that crime.
I believe the bill I am a cosponsor of, along with Senator Graham and
Senator Kennedy and Senator Daschle and the senior Senator from Georgia
who is presiding, and about 30 other Senators, fulfills our promise to
all seniors and offers the most for our neediest seniors.
Our bill gives our neediest seniors their medicine for free. For
those who earn less than $11,900 a year--and that is about 12 million
seniors out there--there is no premium, there is no copayment. They
receive 100-percent coverage from the first prescription filled.
To that widow with trembling hands who is trying to cut that pill in
half so her medicine will last a little longer, I hope the Senate will
send a message to her that help is on the way. To that old man, proud
and self-sufficient all his life, who has to whisper to his pharmacist
that he doesn't have quite enough in his checking account and he will
have to come back later, I hope the Senate will send the message to him
that help is on the way.
I look forward to debating this provision of our bill and many others
when we take up the prescription drug legislation next week. I urge my
colleagues in both Houses and in both parties to keep this in mind: Our
duty to seniors is not to just debate an issue. They have heard all
that before. Our duty is to pass a bill, a meaningful bill.
I yield the floor and suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. GRAHAM. Mr. President, I ask unanimous consent that the order for
the quorum call be dispensed with.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. GRAHAM. Mr. President, I am pleased to join my colleagues today
in the discussion of pending legislation, as of next week, which will
relate to the long-held desire of senior Americans to have within the
Medicare Program a prescription drug benefit.
One of the key issues in the debate we will begin next week will be,
How will this benefit be administered? As we answer that question, we
need to ask some questions about what do older Americans want. Older
Americans want a plan that is straightforward, simple, a plan with
which they are familiar. Even more important, they want a plan that
actually works, that they can take to the local pharmacy or, if they
use a mail order pharmacy, that they can take to the post office box
and get their drugs.
That is why the Senate Democratic bill, which I am sponsoring with
Senator Miller, Senator Kennedy, and others, including the Presiding
Officer, uses the exact same system that America's private insurance
companies use. As an example, this happens to be the Blue Cross Blue
Shield service benefit plan, a plan which many of us as Federal
employees utilize. If you turn to page 119, you will see the outline of
what Blue Cross Blue Shield provides and how they provide it. It is
exactly the same structure we are proposing in our plan. It is a
structure with which older Americans, most Americans, are extremely
familiar. It is the same system that predominates in not only Blue
Cross Blue Shield but virtually every other major private insurance
plan.
These plans are based on the concept of using a pharmacy benefit
manager, or PBM, as the intermediary between the beneficiary and the
pharmaceutical companies.
What do these PBMs do? They negotiate directly with
the pharmaceutical companies in order to achieve the lowest prices.
They are held accountable for containing costs and providing quality
care and service. If they fail to do so, their payments are reduced or
can be eliminated.
To America's seniors, this plan would be like a pair of comfortable
old shoes, shoes they have been wearing for most of their lives. Would
it be fair to ask Medicare beneficiaries at the time of retirement to
suddenly change shoes? Even more significant, would it be appropriate
to ask them to put on shoes that don't fit very well? But even more
than that, is it fair to ask them to put on shoes of a design which has
never been worn by another American anywhere, any time?
That is what the House Republican plan runs on: An untried, untested
delivery system that would force our seniors to be the guinea pigs for
a social experiment.
Their plan would give to a different set of insurance companies
taxpayers' dollars as a subsidy to lure them into the market since
insurers have already said they don't intend to offer this benefit.
They do not believe it is an appropriate use of the insurance system.
Our plan would be easy and familiar. Let me briefly mention some of
the features of our plan. It would ask seniors who voluntarily elect to
participate--no senior would be required to participate unless they
chose to do so--to pay a $25 monthly premium. There is no deductible.
There will be coverage from the first pill purchased after you sign up.
There would be a copayment of $10 for generics, $40 for formulary
necessary drugs, and $60 for other drugs. There would be a maximum
payment out of pocket of $4,000 per year. Beyond that, there would be
no more copayments.
The plan says what it means and it means what it says for all seniors
all over America. Seniors with incomes below 135 percent of the poverty
level would not pay premiums or copayments. Beneficiaries with incomes
between 135 and 150 percent of poverty would pay reduced premiums. That
is the plan.
We would allow all seniors a choice of which PBM to use. It would be
required that there be multiple PBMs within every section of the
country. Those of you who live in Georgia would have a choice. Those of
us in Florida would have a choice. Those in North Dakota and Vermont
would have a choice.
The PBMs would be accountable to the Medicare Program, would be
required to prove their ability to contain costs, or else they wouldn't
be awarded a contract to participate. In fact, they would not even get
paid if they were unable to contain costs and provide the high-quality
service which our older Americans deserve. That is in the language of
the Graham-Miller-Kennedy-Cleland, and others, legislation.
The House Republican plan would leave all these choices in the hands
of an insurance company. The companies would be allowed to choose the
benefit for seniors. Why is that? The House plan only requires that the
individual plan meet a vague standard of actuarial equivalence. It does
not provide the certainty which American seniors deserve and which they
will receive in the Graham-Miller-Kennedy-Cleland, and others, plan.
I look forward to a full discussion of this beginning next week.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The assistant legislative clerk proceeded to call the roll.
Mr. REID. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
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