[Congressional Record Volume 153, Number 10 (Thursday, January 18, 2007)]
[Senate]
[Pages S727-S728]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                           PRESCRIPTION DRUGS

  Ms. STABENOW. Mr. President, I rise today to speak to the Medicare 
prescription drug benefit. I have a different view, and the Michigan 
seniors and people with disabilities who are trying to access this 
program have a different experience and view than my friend from Texas.
  As I said yesterday, I think it is incredibly important that we join 
with the House of Representatives to do the first step, which is to 
require negotiation for the best price on prescription drugs through 
Medicare. I also know there is incredible confusion, that seniors have 
been offered a variety of private choices but not the one that most 
seniors asked for, which is to be able to go through Medicare and sign 
up as they do for Part B and the rest of Medicare and get a good price. 
I also know there is great concern from seniors who find themselves in 
this gap, somehow being called a doughnut hole, but the gap in coverage 
where you continue to pay a premium but don't receive any help. There 
are a number of concerns I hope we are going to address.
  Number 1 needs to be to say clearly that we want the Secretary to 
negotiate the best price for people. Right now, as we know, the law 
actually prohibits, actually stops the Secretary from using the 
bargaining power of all of the seniors and the people with disabilities 
on Medicare to be able to get the best price. Why in the world does 
that make sense? In fact, it doesn't make sense--particularly for 
something that is lifesaving; it is the major way we provide health 
care today from a preventive and maintenance standpoint, as well as in 
a crisis.

  There are huge differences between the way the Veterans' 
Administration successfully serves our veterans and what is being done 
through, unfortunately, inflated prices through the Medicare system 
that not only seniors are paying, disabled are paying, but taxpayers 
are paying as well.
  Yesterday, I talked about a report--and I want to talk to that 
today--from Families U.S.A. released last week, which looked at 20 
prescription drugs commonly used by seniors. The results are startling. 
The report compares the prices the private Medicare Part D plans charge 
and the prices obtained by the VA, which negotiates for low drug prices 
on behalf of America's veterans.

[[Page S728]]

It showed, again, what we have been seeing over the past year: For each 
of the top 20 drugs prescribed to seniors, the lowest prices charged by 
any of the top private Part D providers are higher than the price 
secured by the VA. It is not just a little bit higher, but in many 
cases it is astoundingly higher.
  Let's look at some examples. I am mentioning specific drugs, not to 
pick on particular drugs, but we talked about the fact in the committee 
that transparency, the ability to compare price, and the ability for 
people to know what they are purchasing is very important. This is 
something we want the Secretary, on behalf of the people of America, to 
be doing--looking at the differences in these prices, and the 
particular points where there is a wide disparity, using their 
negotiating power to be able to step in on behalf of seniors and the 
disabled.
  When we look at Zocor, which I mentioned yesterday--the drug many 
seniors use to control their cholesterol levels--the lowest VA price 
for a year is just over $127. The lowest price under a private plan is 
$1,485.96--over a 1,066-percent difference. That is astounding. I argue 
that you could still continue to work with the Federal Government and 
partner to do research and bring that price down.
  Why should seniors pay $1,359 more in a year for this particular 
prescription drug than veterans do? It is exactly the same drug.
  Now, I also mentioned Protonix yesterday. It is the same thing. We 
are looking at $214.52 for a year, the VA price, negotiating the best 
price, and $1,148.40 with the lowest Part D plan, a difference of 435 
percent.
  It is the same thing as we go through the next one, which is Fosamax, 
which is a 205-percent difference, and on down.
  We are talking about substantial differences in price--some smaller 
than others. But the reality is negotiation works. All we have to do is 
look at the fact that, on average, we are seeing a price difference of 
58 percent between the Veterans' Administration and what is happening 
from the lowest possible plan with the top 20 most prescribed drugs for 
our seniors. In other words, for half of the drugs our seniors need 
most, the lowest price charged is almost 60 percent higher, and it is 
not demagoguery to say people are choosing between food and medicine. 
It is not. It is not an exaggeration to say that right now somebody is 
sitting down and deciding: am I going to pay the heating bill or get 
the medicine I need? That is the reality for people. We need to have a 
sense of urgency about fixing this.
  I also want to speak to the fact that we have heard a lot about the 
VA. Unfortunately, we have heard things that are not true, according to 
information from the Veterans' Administration. Yesterday, I was asked 
if I knew there were well over 1 million veterans who moved to Medicare 
Part D. The assertion was made that veterans were leaving the VA 
because the VA could not give them the drugs they wanted. I knew there 
were veterans who were adding Medicare Part D coverage. We went back to 
look and see what that was all about after I received that question. In 
fact, approximately 280,000 veterans have signed up for Medicare. They 
are not leaving the VA. In fact, it is not even clear that they are 
getting any drugs through Medicare at this point. They may have done it 
to add extra coverage. We are not sure what that mix is, but we are not 
talking about a million veterans or more running to leave VA because it 
is such a bad program.
  Moreover, according to both the Government Accountability Office and 
the Institute of Medicine, the VA system is working well. According to 
the GAO, an overwhelming majority of VA physicians report that the 
formulary, the grouping of drugs that are available, allows them to 
prescribe drugs that meet their patients' needs.
  The Institute of Medicine has reported that veterans believe their 
needs are being met. Access to drugs is an issue in less than one-half 
of 1 percent of the complaints about the VA health system. One-half of 
1 percent relate an inability to be able to get the medicine they need.
  I also need to point out that at our Finance Committee hearing last 
week it was mentioned that there are fewer drugs available to our 
veterans. In fact, we have heard it today on the floor. That is exactly 
the opposite of what is true. The VA actually has more drugs on its 
formulary, its list of available drugs. I have not heard anybody say, 
first of all, that we should take the VA system and impose it on 
Medicare. But there is a lot of misinformation about what is happening 
in the VA and what is happening for our veterans, and there is a lot we 
need to do to focus on the reality and the facts of the huge 
disparities, an average of 58 percent, and the highest is over 1,000 
percent.
  I find it very interesting that, on the one hand, we hear two 
different kinds of arguments occurring. One is that negotiation will 
make no difference in price. On the other hand, we hear we will lose 
lifesaving research because of negotiation. Those two arguments don't 
fit together, even though they are being made by the same people. We 
don't have to worry about research and development if, in fact, 
negotiation doesn't lower prices. I argue--and I think common sense 
dictates--that when you are looking at a 1,000-percent difference in 
price, at the fact that the American taxpayer is contributing, on 
average, at least as many dollars for research as the brandname 
industry is--overall, at least contributing that, because we want the 
lifesaving drugs--when you look at all of the facts, it doesn't add up; 
it doesn't add up for anybody but the industry itself to be able to 
argue that they want to keep the prices this high. I appreciate that. 
Any industry that has such a significant advantage certainly wants to 
fight to keep it. But I am very hopeful we will join with the House in 
saying this is lifesaving medicine, it is not an optional product, and 
we have to get the best price for our seniors and for the disabled in 
America.
  I thank the Chair.
  The PRESIDING OFFICER. The Senator from Colorado is recognized under 
a unanimous consent agreement for 10 minutes.

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