[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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