[Congressional Record Volume 149, Number 86 (Thursday, June 12, 2003)]
[House]
[Pages H5346-H5348]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ADDRESSING THE HIGH COST OF PRESCRIPTION DRUGS
The SPEAKER pro tempore. Under a previous order of the House, the
gentleman from Minnesota (Mr. Gutknecht) is recognized for 5 minutes.
Mr. GUTKNECHT. Mr. Speaker, I rise again tonight to talk about the
high cost that Americans pay for prescription drugs. I am so lucky.
Today I got to spend a good part of my day with a true American hero.
Her name is Kate Stahl. For Members who have not seen it, I recommend,
and I will submit for the Record, a copy of last week's U.S. News and
World Report; and they did a story, the title of which is ``Health on
the Border, Elderly Americans head north and south to find drugs they
can afford.''
[[Page H5347]]
Featured in the story is this American hero. Her name is Kate Stahl.
She is an 84-year-old grandmother. She was here in Washington today.
She wore a little sign. It just said, ``Kate Stahl, Old Woman.'' In my
opinion, Kate Stahl is an American hero, and she is a patriot. She
stands on the shoulders of great patriots like the Sons of Liberty who
threw tea in Boston Harbor, because she has said in this article, and I
will quote, ``I'd like nothing better than to be thrown in jail.''
Kate Stahl has thrown herself into this fight for lower prescription
drug prices. She calls herself a drug runner. She goes to Canada
regularly to bring back prescription drugs for her friends and
neighbors who cannot afford them. She is a patriot. Recently, the
Kaiser Foundation did a study. They found that 29 percent of seniors
say that they have had prescriptions that have gone unfilled because
they could not afford them. I do not say shame on the pharmaceutical
industry. Shame on us. Because we have the power to change it. The
reason that we pay so much, and no one disputes this, and they have
charts in here and comparisons of what people pay in Canada, Mexico and
in Europe. No one disputes the charts. The numbers are always the same.
America, the world's best market for prescription drugs, pays the
world's highest prices. No one disputes that.
But the question is why. The answer I think is pretty simple. Because
we are a captive market. Because the FDA has literally said that
Americans, unlike most other people in the world, cannot take drugs
across the border.
I am a Republican, and I happen to believe that there is nothing
wrong with the word ``profit.'' But, ladies and gentlemen, there is
something wrong with the word ``profiteer.'' They have every right to
expect a reasonable rate of return on their investment and their
research, but they should not get it all from American consumers like
Kate Stahl. Kate Stahl, is she a common criminal? I do not think so.
But our own government treats her like a common criminal. In the end,
we are going to have a debate in the next several weeks about
prescription drugs; and in the end every one of us is going to have to
decide, will we stand with those brave patriots like Kate Stahl or will
we stand with the huge pharmaceutical industry? I hope we make the
right choice.
[From U.S. News & World Report, June 9, 2003]
Health on the Border
elderly americans head north and south to find drugs they can afford
(By Susan Brink)
It's become something of a joke along the Maine-Canada
border. So many busloads of retired people crisscross the
line looking for affordable drugs that the roadside stands
should advertise, ``Lobsters. Blueberries. Lipitor.
Coumadin.'' Except, of course, that such a market in
prescription drugs would be illegal.
These senior long-distance shopping sprees fall in a legal
gray zone. But as long as people cross the border with
prescriptions from a physician and have them filled for no
more than a three-month supply for personal use, customs and
other federal officials leave them alone. The trip might be
tiring, but people can save an average of 60 percent on the
cost of their prescription drugs. For some, that's the
difference between taking the drugs or doing without. ``The
last bus trip I was on six months ago had 25 seniors,'' says
Chellie Pingree, former Maine state senator and now president
of Common Cause. ``Those 25 people saved $19,000 on their
supplies of drugs.'' Pingree sponsored a bill known as Maine
Rx, which authorizes a discounted price on drugs for Maine
residents who lack insurance coverage. The law was challenged
by drug companies but recently upheld by the U.S. Supreme
Court. It hasn't yet taken effect.
For years, field trips of senior citizens who live near the
borders have been organized to roll north to Canada and south
to Mexico. People in the middle of the country sometimes
found, if their prescription drug costs were especially high,
that they could save money on medications even if they flew
to Europe. The Internet has made it even easier for people to
fill their prescriptions from mail-order pharmacies.
Figuring out ways to spend less on prescription drugs has
become a multi-faceted national movement of consumers,
largely senior citizens. The prescription drug bill in
America is $160 billion annually, and people over 65 fill
five times as many prescriptions as working Americans on
average. ``But they do it on health benefits that are half as
good and on incomes that are half as large,'' says Richard
Evans, senior analyst at Sanford C. Bernstein, an investment
research firm. What's more, seniors account for 20 percent of
the voting public.
Face-off. It's little wonder that the May 19 Supreme Court
ruling got the attention of drug manufacturers and
politicians across the country. The often-over-looked state
of 1.3 million tucked in the northeast corner of the country
became David to the pharmaceutical industry's Goliath. The
face-off began three years ago when state legislators like
Pingree began questioning why Maine's elderly population
had to take all those bus trips.
Americans who are elderly and uninsured pay the world's
highest prices for prescription drugs. That's because they
buy their drugs individually, without the bulk bargaining
power of an insurance company or the federal government.
Other industrialized countries, like Canada, France, Germany,
and Japan, have national healthcare systems and can use the
bargaining power of their entire populations to negotiate
drug prices and set limits on how much drug manufacturers can
charge.
Though Congress has been debating a prescription drug plan
for years, seniors today still have no drug coverage under
Medicare. The Maine plan does not provide a drug benefit.
Seniors and the uninsured would still purchase their own
medicines, but the plan helps them get a discounted price on
drugs similar to that available to Medicaid recipients, in
effect bringing hundreds of thousands of individual (and
powerless) consumers into a powerful negotiating block.
Teaming the elderly and uninsured with Medicaid recipients
gives them bargaining power they've never had before. Drug
manufacturers are required to give Medicaid a discount of
about 15 percent below the list price or match the lowest
price on the market. That creates an incentive to keep the
market price as high as possible, says Katharine Greider,
author of The Big Fix: How the Pharmaceutical Industry Rips
Off American Consumers. But most consumers don';t notice the
high drug prices, because with health insurance they only pay
a small copayment. Only those lacking prescription drug
coverage--including many elderly--end up paying full retail
price for drugs.
The law's leverage disturbs the drug industry. It would
create formulary, or list of preferred drugs, for this block
of patients, similar to those used by many managed-care
organizations. If a manufacturer did not lower its prices, it
would not be on the state's formulary. Drug companies oppose
the law as a quality-of-care issue. ``Under Maine's program,
government officials, rather than doctors and patients, would
effectively decide which medicines will be available for
Medicaid and non-Medicaid patients,'' says a statement
from Pharmaceutical Research and Manufacturers of America,
the industry's trade organization.
The Maine drug plan was crafted three years ago, and health
officials are now refining a draft of the law to send to the
Legislature. But the pharmaceutical industry is far from
ready to give up the fight. ``I don't go to any meetings that
don't have five lawyers sitting around the table,'' says
Peter Walsh, acting commissioner or the Maine Department of
Human Services. Even when it goes forward, one small New
England state's law won't solve the nation's prescription
drug crisis.
The greater hope for consumers--and the greater threat to
the industry--is the clout of about 18 other states that have
filed bills similar to Maine's. ``The point at which you get
half or more states to do this, it becomes a more and more
significant intrusion into the market. And it becomes harder
for the pharmaceutical industry to fight back. That's why
they had to fight so hard against Maine's law,'' says Sara
Rosenbaum, professor of health-policy law at George
Washington University.
Going south. Meanwhile, individual consumers are figuring
out their own ways to bypass steep American drug prices. For
example, Bill Goff goes to Tijuana, Mexico, four times a
year. He flies from his home in Reno, Nev., to San Diego,
stays in the Travelodge, rents a car for a day, and crosses
the border to visit Carlos Cortez of Farmacia Internacional
with a fist-full of prescriptions. He has a host of medical
disorders, including rheumatoid arthritis, diabetes, asthma,
glaucoma, and osteoporosis. He would spend $32,000 a year on
prescription drugs in the United States, but he has cut his
annual cost to $9,500, even including travel costs. ``It's
not a matter of saving money. It's a matter of living,'' says
Goff. ``If I didn't go to Mexico, I couldn't afford the
drugs. I'd be dead.''
Others are skipping the travel altogether, some with the
help of 84-year-old Kate Stahl. She is not above using the
``grandmother'' image to further a cause. ``I'd like nothing
better than to be thrown in jail. People would say, `Oh, the
poor, frail old granny,''' she says with a laugh. ``I can be
very frail if I have to.'' Stahl volunteers with the
Minnesota Senior Federation, helping people get the forms and
information they need to get mail-order prescription from
Canada. The plan, called the Canadian Prescription Drug
Importation Program (www.mnseniorfed.org), is open to anyone
in the United States. But while no one seems ready to throw
the likes of Stahl in the slammer, the program's legality is
murky.
Though the Food and Drug Administration says it cannot
guarantee the safety of imported drugs (even if they're
exported from the United States, then reimported, as many
are), individuals filling their personal prescriptions are
generally left alone. But the agency has sent warning
letters to profit-making drugstores in the United States
that
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help consumers get mail-order prescriptions from Canada,
saying that reimporting cheap drugs is a violation of the
law and a risk to public health.
Since Stahl and her organization do not profit from their
efforts, so far no one has hassled them. Rep. Gil Gutknecht,
a Minnesota Republican, is trying to pass legislation that
would make it easier for people to get their drugs from
Canada or overseas. Laws to that effect have passed twice
before, but both times the FDA protested that it could not
guarantee the safety of drugs reimported from Canada, and so
the law has not taken effect. Still, Gutknecht is not alone
in interpreting present laws in a way that allows people to
buy personal three-month supplies of drugs overseas without
problems.
Cortez has a conference table display of brand-name
prescription drugs in his Tijuana office. One by one he holds
them up. Pfizer's Lipitor, Eli Lilly's Prozac. Merck's
Fosamax. They're not loose pills; they are individually
bubble-wrapped within sealed boxes. ``We have no doubt that
what we're buying is what it is. It comes from world-class
labs,'' he says. And the 30 percent of his customers who are
American seem to agree.
He's aware of the irony: a businessman from the developing
world profiting on sales to desperate citizens of the
wealthiest country on Earth. ``It doesn't get more stark than
right here. You can see so clearly: Third World,'' he says,
pointing to the roadside squalor in Tijuana, the concrete
barriers at dusk crowded with men waiting for nightfall and a
risky dash across the border. ``First World,'' he finishes,
pointing toward the city of San Diego across the border. ``My
business thrives on people coming here from the States. But I
shouldn't have people thanking me for making it possible for
them to survive when they are from a country like the United
States.''
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