[Congressional Record Volume 151, Number 30 (Monday, March 14, 2005)]
[Senate]
[Pages S2648-S2649]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SPECTER:
  S. 614. A bill to amend title 38, United States Code, to permit 
medicare-eligible veterans to receive an out-patient medication 
benefit, to provide that certain veterans who receive such benefit are 
not otherwise eligible for medical care and services from the 
Department of Veterans Affairs, and for other purposes; to the 
Committee on Veterans' Affairs.
  Mr. SPECTER. Mr. President, I have sought recognition to reintroduce 
the ``Veterans Prescription Drugs Assistance Act of 2005,'' a bill 
which seeks to assist Medicare-eligible veterans struggling with the 
costs of prescription medications.
  In the 108th Congress, I worked with my colleagues to provide a 
prescription drug benefit for all Medicare-eligible seniors. Today, I 
offer legislation to allow Medicare-eligible veterans to obtain 
prescription drugs from the Department of Veterans Affairs (VA) at the 
significantly discounted costs that VA, as a high-volume purchaser of 
prescriptions medications, is able to secure in the marketplace.
  On May 23, 2003, I introduced similar legislation--S. 1153 in the 
108th Congress. In my capacity as Chairman of the Veterans Affairs 
Committee in the 108th Congress, I held a hearing on June 22, 2004, and 
heard testimony from Senate colleagues, Veterans Administration 
officials, and various veterans service organizations on this important 
legislation. On July 20, 2004, the Committee on Veterans Affairs 
reported out S. 1153 by a vote of 10 yeas and 5 nays. Unfortunately, 
the full Senate did not consider this measure.
  In 2003, former Veterans Affairs Secretary Anthony J. Principi was 
forced to limit access to VA care--which continues to this day--by 
suspending new enrollments of non-service-disabled middle and higher 
income veterans who were not enrolled for care as of January 17, 2003. 
The Secretary was forced to so act because the number of patients 
provided care by VA had more than doubled in just five years and, as a 
result, VA's medical care system had been overwhelmed. As a 
consequence, VA was unable to provide timely access to healthcare for 
all veterans who had sought it and appointment waiting times had grown 
to alarming levels. But in almost every news story that followed the 
Secretary's difficult decision, it was noted that many of the new

[[Page S2649]]

enrollees who had overwhelmed VA's capacity to provide care were 
Medicare-eligible veterans who were able to get Medicare-financed care 
elsewhere but who were seeking access to the relatively generous 
prescription drug program provided to veterans under VA care.
  Currently, VA provides enrolled patients with prescription 
medications for $7 for each 30-day supply. But to get such 
prescriptions, the veteran must obtain the full range of medical care 
from VA. This fact, coupled with former VA Secretary Principi's 
decision to close enrollment, means that veterans who are now, or who 
will be, eligible for Medicare who had not enrolled for VA care prior 
to January 17, 2003, will be unable to access VA's generous 
prescription drug benefits. This legislation would provide some relief 
for those veterans. In addition, I anticipate that it may induce some 
VA-enrolled Medicare-eligible veterans--those who were happy with their 
Medicare-financed care but who enrolled for VA care to gain access to 
VA-supplied drugs--to return to non-VA care with knowledge that they 
will be able to get their non-VA prescriptions filled through VA. 
Enactment of this provision, then, would reduce--not exacerbate--VA 
patient backlog numbers.
  The premise of this legislation is straightforward. VA fills and 
distributes more than 100 million prescriptions each year for its 4.7 
million veteran-patients. As a result, it has significant purchasing 
power--power which, coupled with VA's formulary program, allows it to 
negotiate very favorable prices for prescription drugs. According to 
the National Association of Chain Drug Stores, the average ``cash 
cost'' of a prescription in 2003 was $59.28. The average VA per-
prescription cost in 2003 was just under $25--more than 50 percent 
less. This bill would allow veterans to access these significant 
discounts simply by providing a written prescription from any duly 
licensed physician, presumably one he or she has seen under the 
Medicare program.
  By reintroducing this legislation today, I seek to afford Medicare-
eligible veterans access to such discounts. I do not propose that VA be 
directed to supply drugs to all Medicare-eligible veterans at VA 
expense, or even with a partial VA subsidy. VA has stated that such a 
mandate would divert VA funding which, clearly, is already stretched to 
the limit--away from VA priority patients: the service-connected, the 
poor, and those with special needs. I accept VA's statement of concern. 
I accept and I insist that scarce funding be directed, first, to meet 
the needs of priority patients. This legislation, therefore, requires 
that VA recover the costs of drugs it supplies under this program from 
veterans who bring their prescriptions from outside doctors to VA.
  I do not propose to tell VA in this bill how to recover these costs. 
VA is better positioned than I to make such judgments. Thus, my 
legislation provides flexibility to VA to design and test payment 
mechanisms to best accomplish cost recovery while still easing 
veterans' access to the drugs they need. It might be that enrollment 
fees, a co-payment structure, or a simple ``cost-plus'' for 
administrative expenses pricing format, or some combination of those 
mechanisms works best. It might be that different approaches work best 
in different regions of the country. I intend for the VA to experiment 
with different pricing structures to determine what works best. 
However, I also intend that veterans get a break on prescription drug 
pricing.
  Those who would first benefit from this program are World War II and 
Korean War veterans who answered their country's call over 50 years 
ago. As they age, many desperately need relief from high drug prices. 
My purpose is not to minimize the work of the drug companies. Their 
discoveries have truly been marvels, but that is precious little 
comfort to a Medicare participant who, whatever the drug's overall 
utility might be, cannot afford both the drug and food or shelter or 
heat.
  The premise of this legislation is simple: veteran access to VA 
market-driven discounts. Yet, the assistance it could provide might be 
profound. I urge my colleagues to support this bill so that the problem 
might be solved, or at least reduced, for seniors who served. They 
deserve it, and we should do it.
                                 ______