[Congressional Record Volume 159, Number 29 (Thursday, February 28, 2013)]
[Senate]
[Pages S1015-S1019]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself, Mr. Reed, and Mr. Whitehouse):
  S. 408. A bill to amend title XVIII of the Social Security Act to 
deliver a meaningful benefit and lower prescription drug prices under 
the Medicare program; to the Committee on Finance.
  Mr. DURBIN. Mr. President, last week TIME Magazine published an 
extensive piece that took a close look at the hidden costs within our 
health care system and how the Medicare program, which is widely 
disparaged these days, is effective in controlling costs.
  We as a nation will spend $2.8 trillion this year on health care. 
That is on average 27 percent more than what is spent per capita in 
other developed countries.
  According to the TIME article, many hospitals routinely overcharge 
patients and reap profits at the expense of American families. As one 
former hospital billing officer put it, ``hospitals all know the bills 
are fiction.''
  Too many families are put on the path to financial ruin because of 
hospital bills.
  Another thing the TIME piece highlighted was that Medicare is much 
more effective at controlling costs than private sector providers, 
whether non-profit or for-profit.
  Because Medicare sets the prices it is willing to pay providers in 
advance, patients with Medicare coverage are charged substantially less 
than patients with private health insurance who have received the same 
services.
  In fact, projected Medicare spending over the 2011-2020 period is 
more than $500 billion lower since late 2010 than CBO projected.
  But we can do more. Every day, 10,000 Americans turn 65 and become 
eligible for Medicare. In 11 years, Medicare's hospital insurance fund 
will start paying out more in benefits than it takes in.
  Meaningful reforms that lead to better health care at lower costs are 
good for America's seniors--and for our entire health care system. And 
that should start with changes to Part D.
  Today, I am introducing with Senators Whitehouse and Jack Reed the 
Medicare Prescription Drug Savings and Choice Act.
  Our bill would save taxpayer dollars by giving Medicare beneficiaries 
the choice to participate in a Medicare Part D prescription drug plan 
run by Medicare, not private insurance companies.
  Seniors want the ability to choose a Medicare-administered drug plan, 
so let's give them this option.
  In 2010, Americans spent approximately $260 billion on prescription 
drugs. That figure is projected to double over the next decade. 
However, patients in the United States spend 50 percent more than other 
developed countries for the same drugs.
  The average monthly price of cancer drugs has doubled over the past 
10 years, from about $5,000 to more than $10,000.
  Of the 12 new cancer drugs approved by the FDA last year, 11 were 
priced above $100,000 a year.
  About 77 percent of all cancers are diagnosed in persons 55 years of 
age and older.
  As these people enter the program, Medicare should be allowed to 
control how much it pays for these prescription drugs.
  While the Affordable Care Act does a lot to control costs in the 
private insurance market, current law handcuffs Medicare beneficiaries 
from obtaining competitive prices for their prescription drugs.
  For all other Medicare programs, beneficiaries can choose whether to 
receive benefits directly through Medicare or through a private 
insurance plan.
  The overwhelming majority of seniors choose the Medicare-run option 
for their hospital and physician coverage.
  Our bill requires the Secretary of HHS to develop at least one 
nationwide prescription drug plan.
  Why? Because we should take advantage of the Federal Government's 
purchasing power.
  The Veterans Administration uses this type of negotiating authority 
and has cut drug prices by as much as 50 percent for our Nation's 
veterans.

[[Page S1016]]

  Savings from negotiating on behalf of seniors in Medicare could be 
used to further reduce costs in the program and ensure the program is 
there for future generations.
  America's health care system is burdening families and hindering our 
ability to invest in the future.
  The Affordable Care Act takes important steps to begin bringing down 
costs in the private market and in Medicare, but there is more we can 
do. This proposal is a simple and common sense option that should be 
available for seniors.
  Allowing Medicare to manage a prescription drug plan and negotiate 
prices, taxpayers will save money and seniors will get high quality 
drug coverage.
  Mr. President, I ask unanimous consent that the text of the bill and 
letters of support be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                 S. 408

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicare Prescription Drug 
     Savings and Choice Act of 2013''.

     SEC. 2. ESTABLISHMENT OF MEDICARE OPERATED PRESCRIPTION DRUG 
                   PLAN OPTION.

       (a) In General.--Subpart 2 of part D of title XVIII of the 
     Social Security Act is amended by inserting after section 
     1860D-11 (42 U.S.C. 1395w-111) the following new section:


           ``medicare operated prescription drug plan option

       ``Sec. 1860D-11A.  (a) In General.--Notwithstanding any 
     other provision of this part, for each year (beginning with 
     2014), in addition to any plans offered under section 1860D-
     11, the Secretary shall offer one or more Medicare operated 
     prescription drug plans (as defined in subsection (c)) with a 
     service area that consists of the entire United States and 
     shall enter into negotiations in accordance with subsection 
     (b) with pharmaceutical manufacturers to reduce the purchase 
     cost of covered part D drugs for eligible part D individuals 
     who enroll in such a plan.
       ``(b) Negotiations.--Notwithstanding section 1860D-11(i), 
     for purposes of offering a Medicare operated prescription 
     drug plan under this section, the Secretary shall negotiate 
     with pharmaceutical manufacturers with respect to the 
     purchase price of covered part D drugs in a Medicare operated 
     prescription drug plan and shall encourage the use of more 
     affordable therapeutic equivalents to the extent such 
     practices do not override medical necessity as determined by 
     the prescribing physician. To the extent practicable and 
     consistent with the previous sentence, the Secretary shall 
     implement strategies similar to those used by other Federal 
     purchasers of prescription drugs, and other strategies, 
     including the use of a formulary and formulary incentives in 
     subsection (e), to reduce the purchase cost of covered part D 
     drugs.
       ``(c) Medicare Operated Prescription Drug Plan Defined.--
     For purposes of this part, the term `Medicare operated 
     prescription drug plan' means a prescription drug plan that 
     offers qualified prescription drug coverage and access to 
     negotiated prices described in section 1860D-2(a)(1)(A). Such 
     a plan may offer supplemental prescription drug coverage in 
     the same manner as other qualified prescription drug coverage 
     offered by other prescription drug plans.
       ``(d) Monthly Beneficiary Premium.--
       ``(1) Qualified prescription drug coverage.--The monthly 
     beneficiary premium for qualified prescription drug coverage 
     and access to negotiated prices described in section 1860D-
     2(a)(1)(A) to be charged under a Medicare operated 
     prescription drug plan shall be uniform nationally. Such 
     premium for months in 2014 and each succeeding year shall be 
     based on the average monthly per capita actuarial cost of 
     offering the Medicare operated prescription drug plan for the 
     year involved, including administrative expenses.
       ``(2) Supplemental prescription drug coverage.--Insofar as 
     a Medicare operated prescription drug plan offers 
     supplemental prescription drug coverage, the Secretary may 
     adjust the amount of the premium charged under paragraph (1).
       ``(e) Use of a Formulary and Formulary Incentives.--
       ``(1) In general.--With respect to the operation of a 
     Medicare operated prescription drug plan, the Secretary shall 
     establish and apply a formulary (and may include formulary 
     incentives described in paragraph (2)(C)(ii)) in accordance 
     with this subsection in order to--
       ``(A) increase patient safety;
       ``(B) increase appropriate use and reduce inappropriate use 
     of drugs; and
       ``(C) reward value.
       ``(2) Development of initial formulary.--
       ``(A) In general.--In selecting covered part D drugs for 
     inclusion in a formulary, the Secretary shall consider 
     clinical benefit and price.
       ``(B) Role of ahrq.--The Director of the Agency for 
     Healthcare Research and Quality shall be responsible for 
     assessing the clinical benefit of covered part D drugs and 
     making recommendations to the Secretary regarding which drugs 
     should be included in the formulary. In conducting such 
     assessments and making such recommendations, the Director 
     shall--
       ``(i) consider safety concerns including those identified 
     by the Federal Food and Drug Administration;
       ``(ii) use available data and evaluations, with priority 
     given to randomized controlled trials, to examine clinical 
     effectiveness, comparative effectiveness, safety, and 
     enhanced compliance with a drug regimen;
       ``(iii) use the same classes of drugs developed by the 
     United States Pharmacopeia for this part;
       ``(iv) consider evaluations made by--

       ``(I) the Director under section 1013 of the Medicare 
     Prescription Drug, Improvement, and Modernization Act of 
     2003;
       ``(II) other Federal entities, such as the Secretary of 
     Veterans Affairs; and
       ``(III) other private and public entities, such as the Drug 
     Effectiveness Review Project and State plans under title XIX; 
     and

       ``(v) recommend to the Secretary--

       ``(I) those drugs in a class that provide a greater 
     clinical benefit, including fewer safety concerns or less 
     risk of side-effects, than another drug in the same class 
     that should be included in the formulary;
       ``(II) those drugs in a class that provide less clinical 
     benefit, including greater safety concerns or a greater risk 
     of side-effects, than another drug in the same class that 
     should be excluded from the formulary; and
       ``(III) drugs in a class with same or similar clinical 
     benefit for which it would be appropriate for the Secretary 
     to competitively bid (or negotiate) for placement on the 
     formulary.

       ``(C) Consideration of ahrq recommendations.--
       ``(i) In general.--The Secretary, after taking into 
     consideration the recommendations under subparagraph (B)(v), 
     shall establish a formulary, and formulary incentives, to 
     encourage use of covered part D drugs that--

       ``(I) have a lower cost and provide a greater clinical 
     benefit than other drugs;
       ``(II) have a lower cost than other drugs with the same or 
     similar clinical benefit; and
       ``(III) drugs that have the same cost but provide greater 
     clinical benefit than other drugs.

       ``(ii) Formulary incentives.--The formulary incentives 
     under clause (i) may be in the form of one or more of the 
     following:

       ``(I) Tiered copayments.
       ``(II) Reference pricing.
       ``(III) Prior authorization.
       ``(IV) Step therapy.
       ``(V) Medication therapy management.
       ``(VI) Generic drug substitution.

       ``(iii) Flexibility.--In applying such formulary incentives 
     the Secretary may decide not to impose any cost-sharing for a 
     covered part D drug for which--

       ``(I) the elimination of cost sharing would be expected to 
     increase compliance with a drug regimen; and
       ``(II) compliance would be expected to produce savings 
     under part A or B or both.

       ``(3) Limitations on formulary.--In any formulary 
     established under this subsection, the formulary may not be 
     changed during a year, except--
       ``(A) to add a generic version of a covered part D drug 
     that entered the market;
       ``(B) to remove such a drug for which a safety problem is 
     found; and
       ``(C) to add a drug that the Secretary identifies as a drug 
     which treats a condition for which there has not previously 
     been a treatment option or for which a clear and significant 
     benefit has been demonstrated over other covered part D 
     drugs.
       ``(4) Adding drugs to the initial formulary.--
       ``(A) Use of advisory committee.--The Secretary shall 
     establish and appoint an advisory committee (in this 
     paragraph referred to as the `advisory committee')--
       ``(i) to review petitions from drug manufacturers, health 
     care provider organizations, patient groups, and other 
     entities for inclusion of a drug in, or other changes to, 
     such formulary; and
       ``(ii) to recommend any changes to the formulary 
     established under this subsection.
       ``(B) Composition.--The advisory committee shall be 
     composed of 9 members and shall include representatives of 
     physicians, pharmacists, and consumers and others with 
     expertise in evaluating prescription drugs. The Secretary 
     shall select members based on their knowledge of 
     pharmaceuticals and the Medicare population. Members shall be 
     deemed to be special Government employees for purposes of 
     applying the conflict of interest provisions under section 
     208 of title 18, United States Code, and no waiver of such 
     provisions for such a member shall be permitted.
       ``(C) Consultation.--The advisory committee shall consult, 
     as necessary, with physicians who are specialists in treating 
     the disease for which a drug is being considered.
       ``(D) Request for studies.--The advisory committee may 
     request the Agency for Healthcare Research and Quality or an 
     academic or research institution to study and make a report 
     on a petition described in subparagraph (A)(i) in order to 
     assess--
       ``(i) clinical effectiveness;
       ``(ii) comparative effectiveness;
       ``(iii) safety; and

[[Page S1017]]

       ``(iv) enhanced compliance with a drug regimen.
       ``(E) Recommendations.--The advisory committee shall make 
     recommendations to the Secretary regarding--
       ``(i) whether a covered part D drug is found to provide a 
     greater clinical benefit, including fewer safety concerns or 
     less risk of side-effects, than another drug in the same 
     class that is currently included in the formulary and should 
     be included in the formulary;
       ``(ii) whether a covered part D drug is found to provide 
     less clinical benefit, including greater safety concerns or a 
     greater risk of side-effects, than another drug in the same 
     class that is currently included in the formulary and should 
     not be included in the formulary; and
       ``(iii) whether a covered part D drug has the same or 
     similar clinical benefit to a drug in the same class that is 
     currently included in the formulary and whether the drug 
     should be included in the formulary.
       ``(F) Limitations on review of manufacturer petitions.--The 
     advisory committee shall not review a petition of a drug 
     manufacturer under subparagraph (A)(i) with respect to a 
     covered part D drug unless the petition is accompanied by the 
     following:
       ``(i) Raw data from clinical trials on the safety and 
     effectiveness of the drug.
       ``(ii) Any data from clinical trials conducted using active 
     controls on the drug or drugs that are the current standard 
     of care.
       ``(iii) Any available data on comparative effectiveness of 
     the drug.
       ``(iv) Any other information the Secretary requires for the 
     advisory committee to complete its review.
       ``(G) Response to recommendations.--The Secretary shall 
     review the recommendations of the advisory committee and if 
     the Secretary accepts such recommendations the Secretary 
     shall modify the formulary established under this subsection 
     accordingly. Nothing in this section shall preclude the 
     Secretary from adding to the formulary a drug for which the 
     Director of the Agency for Healthcare Research and Quality or 
     the advisory committee has not made a recommendation.
       ``(H) Notice of changes.--The Secretary shall provide 
     timely notice to beneficiaries and health professionals about 
     changes to the formulary or formulary incentives.
       ``(f) Informing Beneficiaries.--The Secretary shall take 
     steps to inform beneficiaries about the availability of a 
     Medicare operated drug plan or plans including providing 
     information in the annual handbook distributed to all 
     beneficiaries and adding information to the official public 
     Medicare website related to prescription drug coverage 
     available through this part.
       ``(g) Application of All Other Requirements for 
     Prescription Drug Plans.--Except as specifically provided in 
     this section, any Medicare operated drug plan shall meet the 
     same requirements as apply to any other prescription drug 
     plan, including the requirements of section 1860D-4(b)(1) 
     relating to assuring pharmacy access.''.
       (b) Conforming Amendments.--
       (1) Section 1860D-3(a) of the Social Security Act (42 
     U.S.C. 1395w-103(a)) is amended by adding at the end the 
     following new paragraph:
       ``(4) Availability of the medicare operated prescription 
     drug plan.--A Medicare operated prescription drug plan (as 
     defined in section 1860D-11A(c)) shall be offered nationally 
     in accordance with section 1860D-11A.''.
       (2)(A) Section 1860D-3 of the Social Security Act (42 
     U.S.C. 1395w-103) is amended by adding at the end the 
     following new subsection:
       ``(c) Provisions Only Applicable in 2006 Through 2013.--The 
     provisions of this section shall only apply with respect to 
     2006 through 2013.''.
       (B) Section 1860D-11(g) of such Act (42 U.S.C. 1395w-
     111(g)) is amended by adding at the end the following new 
     paragraph:
       ``(8) No authority for fallback plans after 2013.--A 
     fallback prescription drug plan shall not be available after 
     December 31, 2013.''.
       (3) Section 1860D-13(c)(3) of the Social Security Act (42 
     U.S.C. 1395w-113(c)(3)) is amended--
       (A) in the heading, by inserting ``and medicare operated 
     prescription drug plans'' after ``Fallback plans''; and
       (B) by inserting ``or a Medicare operated prescription drug 
     plan'' after ``a fallback prescription drug plan''.
       (4) Section 1860D-16(b)(1) of the Social Security Act (42 
     U.S.C. 1395w-116(b)(1)) is amended--
       (A) in subparagraph (C), by striking ``and'' after the 
     semicolon at the end;
       (B) in subparagraph (D), by striking the period at the end 
     and inserting ``; and''; and
       (C) by adding at the end the following new subparagraph:
       ``(E) payments for expenses incurred with respect to the 
     operation of Medicare operated prescription drug plans under 
     section 1860D-11A.''.
       (5) Section 1860D-41(a) of the Social Security Act (42 
     U.S.C. 1395w-151(a)) is amended by adding at the end the 
     following new paragraph:
       ``(19) Medicare operated prescription drug plan.--The term 
     `Medicare operated prescription drug plan' has the meaning 
     given such term in section 1860D-11A(c).''.

     SEC. 3. IMPROVED APPEALS PROCESS UNDER THE MEDICARE OPERATED 
                   PRESCRIPTION DRUG PLAN.

       Section 1860D-4(h) of the Social Security Act (42 U.S.C. 
     1305w-104(h)) is amended by adding at the end the following 
     new paragraph:
       ``(4) Appeals process for medicare operated prescription 
     drug plan.--
       ``(A) In general.--The Secretary shall develop a well-
     defined process for appeals for denials of benefits under 
     this part under the Medicare operated prescription drug plan. 
     Such process shall be efficient, impose minimal 
     administrative burdens, and ensure the timely procurement of 
     non-formulary drugs or exemption from formulary incentives 
     when medically necessary. Medical necessity shall be based on 
     professional medical judgment, the medical condition of the 
     beneficiary, and other medical evidence. Such appeals process 
     shall include--
       ``(i) an initial review and determination made by the 
     Secretary; and
       ``(ii) for appeals denied during the initial review and 
     determination, the option of an external review and 
     determination by an independent entity selected by the 
     Secretary.
       ``(B) Consultation in development of process.--In 
     developing the appeals process under subparagraph (A), the 
     Secretary shall consult with consumer and patient groups, as 
     well as other key stakeholders to ensure the goals described 
     in subparagraph (A) are achieved.''.


                                  Alliance for a Just Society,

                                                February 28, 2013.
     Reduce Pharmaceutical Prices--Do Not Cut Benefits

       Dear President Obama and Senator/Representative: We have 
     noted with great concern that federal budget discussions have 
     included the possibility of cuts to Medicare and Medicaid. We 
     wish to be clear: We strongly oppose such an approach and 
     believe it to be both unnecessary and a no-growth policy for 
     an economy that remains stagnant.
       Medicare and Medicaid not only provide critical protections 
     against the economic deprivation caused by illness, 
     especially for older Americans; they also create jobs and 
     boost an economy that is slumbering. Cutting these programs 
     leads this country in the wrong direction.
       We cannot continue to unravel these critical programs for 
     working families, the elderly, and the poor. If the Congress 
     is unable to move forward without some compromise that 
     reduces our national commitment to quality Medicare and 
     Medicaid programs, there is a source for reductions that will 
     not harm beneficiaries: the cost of prescription drugs.
       The U.S. pays more for prescriptions than any nation in the 
     world. Medicare and Medicaid beneficiaries pay more for 
     medicines than do our veterans and the clients of the 
     National Indian Health Service. Why do these differences in 
     cost persist? They do so because other countries, the VA, and 
     the IHS negotiate the prices for prescriptions, while 
     Medicare and Medicaid programs do not.
       According to the Center for Economic and Policy Research, 
     savings to the federal government over the next decade would 
     be as high as $541.3 billion. The saving to the states would 
     be as high as $72.7 billion, and beneficiaries would save 
     $112.4 billion. These amounts are far in excess of the demand 
     for expenditure reductions being suggested by the most 
     strident deficit reduction advocates.
       We are more than 275 national and state organizations, and 
     we are opposed to cutting health care benefits for the 
     elderly and the poor. However, saving money by negotiating 
     drug prices would be beneficial to the entire health care 
     system, in addition to saving money for the federal 
     government and the states. We urge you to pursue this policy 
     as a major part of efforts to reduce health care costs.
           Sincerely,


                                National

       9to5, AFL-CIO, AFSCME (American Federation of State, County 
     and Municipal Employees), Alliance for a Just Society, 
     Alliance for Retired Americans, Association of Asian Pacific 
     Community Health Organizations, Campaign for America's 
     Future, Campaign for Community Change, Center for Popular 
     Democracy, Coalition on Human Needs, Community Action 
     Partnership, Community Organizations in Action, Grassroots 
     Policy Project, HCAN (Health Care for America Now!), 
     Institute for Policy Studies, Break the Chain Campaign, Jobs 
     With Justice, Leadership Center for Common Good, National 
     Domestic Workers Alliance, National Education Association.
       National Legislative Association on Prescription Drug 
     Prices--20 signers (see attached letter): Rep. Sharon Engle 
     Treat (ME), Rep. Nickie Antonia (OH), Rep. Sheryl Briggs 
     (ME), Sen. Capri Cafaro (OH), Rep. Michael Foley (OH), Sen. 
     Dede Feldman (NM), Assemblyperson Richard N. Gottfried (NY), 
     Sen. Jack Hatch (IO), Sen. Karen Keiser (WA), Sen. Sue Malek 
     (MT), Sen. Kevin Mullin (VT), Rep. Don Perdue (WV), Rep. 
     Elizabeth B. Ritter (CT), Rep. Cindy Rosenwald (NH), Rep. 
     Linda Sanborn (ME), Rep. Shay Shual-Berke (MD), Sen. Michael 
     J. Skindell (OH), Rep. Peter Stuckey (ME), Rep. Roy Takumi 
     (HI), Rep. Joan Welsh (ME).
       National Health Care for the Homeless Council, National 
     Health Law Program, National Korean American Service & 
     Education Consortium, National People's Action, National 
     Women's Health Network, New Bottom Line, PICO National 
     Network,

[[Page S1018]]

       Progressive Democrats of America, Racial and Ethnic Health 
     Disparities Coalition, Raising Women's Voices for the Health 
     Care We Need, Rights to the City, Service Employees 
     International Union, Social Security Works, UAW (United Auto 
     Workers), Universal Health Care Action Network, USAction, 
     Working America, AFL-CIO, Working Families Party.


                                Alabama

       Federation Of Child Care Centers of Alabama.


                                Arkansas

       Arkansas Community Organizations.


                               California

       9to5 California, Alliance of Californians for Community 
     Empowerment, Center for Third World Organizing, People 
     Organized for Westside Renewal, PICO California, San Diego 
     Organizing Project, California Childcare Coordinators 
     Association, California PIRG, Children's Defense Fund--
     California, Community Health Council, Elsdon, Inc., 
     Greenlining Institute, Molina Healthcare of California, 
     National Association of Social Workers, CA Chapter.


                                Colorado

       9to5 Colorado, Colorado Progressive Coalition, Colorado 
     Organization for Latina Opportunity and Reproductive Rights, 
     Together Colorado.


                              Connecticut

       Connecticut Citizen Action Group.


                                Florida

       Central Florida Jobs with Justice, Community Business 
     Association, Florida CHAIN, Florida Chinese Federation, 
     Florida Civic Rights Association--Asian American Affairs, 
     Florida Coalition on Black Civic Participation (FCBCP), 
     Florida Consumer Action Network, Florida Consumer Action 
     Network Foundation, Florida Institute for Reform & 
     Empowerment, Florida New Majority, Florida Watch Action, 
     Labor Council for Latin American Advancement of Central 
     Florida (LCLAA of CF), National Congress of Black Women, 
     Organization of Chinese Americans--South Florida Chapter, 
     Organize Now, South Florida Jobs with Justice, United Chinese 
     Association of Florida.


                                Georgia

       9to5 Atlanta, Georgia Rural Urban Summit.


                                 Hawaii

       Faith Action for Community Equity.


                                 Idaho

       Idaho Community Action Network, Idaho Main Street Alliance, 
     Indian People's Action, United Action for Idaho, United 
     Vision for Idaho.


                                Illinois

       AFSCME Council 31, Chicago Federation of Labor, AFL-CIO, 
     Citizen Action Illinois, Coalition of Labor Union Women 
     (CLUW), Illinois Alliance for Retired Americans (IARA), 
     Illinois Indiana Regional Organizing Network, Jane Addams 
     Senior Caucus, Lakeview Action Coalition, Northside 
     P.O.W.E.R., Public Action Foundation.


                                Indiana

       Northwest Indiana Federation of Interfaith Organizations.


                                  Iowa

       Iowa Citizen Action Network, Iowa Citizen Action Network 
     Foundation, Iowa Citizens for Community Improvement, Iowa 
     Main Street Alliance.


                               Louisiana

       Micah Project--New Orleans, PICO Louisiana.


                                 Maine

       Consumers for Affordable Healthcare, Maine Equal Justice 
     Partners, Maine People's Alliance, Maine People's Resource 
     Center, Maine Small Business Coalition, MSEA-SEIU Local 
     1989, Prescription Policy Choices.


                                Maryland

       Maryland Communities United.


                             Massachusetts

       Disability Policy Consortium.


                                Michigan

       Harriet Tubman Center--Detroit, Metropolitan Coalition of 
     Congregations, Metro Detroit, Michigan Citizen Action, 
     Michigan Citizen Education Fund, Michigan Organizing 
     Collaborative.


                               Minnesota

       AFSCME Council 5, CWA Minnesota State Council, Health Care 
     for All--Minnesota, ISAIAH, Jewish Community Action, 
     Minnesota AFL--CIO, Minnesotans for a Fair Economy, 
     Moveon.org Twin Cities Council, Physicians for a National 
     Health Plan--Minnesota, SEIU Local 284, SEIU Minnesota State 
     Council, Take Action Minnesota, UFCW Local 1189, Universal 
     Health Care Action Network--Minnesota.


                                Missouri

       Communities Creating Opportunity, GRO (Grass Roots 
     Organizing), Metropolitan Congregations United, Missouri 
     Progressive Vote Coalition, Missouri Citizen Education Fund, 
     Missouri Jobs with Justice, Missourians Organizing for 
     Change, Missourians Organizing for Reform and Empowerment, 
     Missouri Rural Crisis Center, Progress Missouri.


                                Montana

       AFSCME Council 9, Big Sky CLC--Helena, Greater Yellowstone 
     CLC--Billings, Indian People's Action, MEA-MFT, Missoula Area 
     CLC, Montana Alliance for Retired Americans, Montana 
     Organizing Project, Montana Small Business Alliance, MT AFL-
     CIO State Federation, MT-HCAN, SEIU Healthcare 775 NW, 
     Southcentral Montana CLC--Bozeman, Southwestern Montana CLC--
     Butte.


                                Nebraska

       Nebraska Urban Indian Health Clinic.


                                 Nevada

       Dream Big Las Vegas, Nevada Immigration Coalition, PLAN 
     Action, Progressive Leadership Alliance of Nevada, Uniting 
     Communities of Nevada.


                             New Hampshire

       Granite State Organizing Project, New Hampshire Citizens 
     Alliance, New Hampshire Citizens Alliance for Action.


                               New Jersey

       New Jersey Citizen Action, New Jersey Citizen Action 
     Education Fund, PICO New Jersey, New Jersey Communities 
     United.


                               New Mexico

       Organizers in the Land of Enchantment (OLE).


                                New York

       Center for Independence of the Disabled--NY, Citizen Action 
     of New York and Public Policy and Education Fund, Community 
     Service Society of New York, Health Care for All New York, 
     Institute of Puerto Rican/Hispanic Elderly Inc. Make the Road 
     New York, Medicaid Matters New York, Metro New York Health 
     Care for All Campaign, New York Communities for Change, New 
     Yorkers for Accessible Health Coverage, Professional Staff 
     Congress at CUNY Local 2334--AFT, Public Policy and Education 
     Fund of New York, Small Business United, Syracuse United 
     Neighbor.


                             North Carolina

       Action North Carolina, Disability Rights NC, North Carolina 
     Fair Share, North Carolina Justice Center, Unifour OneStop 
     Collaborative.


                                  Ohio

       Communities United for Action, Contact Center, Fair Share 
     Research and Education Fund, Mahoning Valley Organizing 
     Collaborative, Ohio Alliance for Retired Americans 
     Educational Fund, Ohio Organizing Collaborative, Progress 
     Ohio, Progressive Democrats of America--Ohio Chapter, The 
     People's Empowerment Coalition of Ohio, Toledo Area Jobs with 
     Justice & Interfaith Worker Justice Coalition, UHCAN Ohio.


                                 Oregon

       Asian Pacific American Network of Oregon, Center for 
     Intercultural Organizing, Fair Share Research and Education 
     Fund, Main Street Alliance of Oregon, Oregon Action, Oregon 
     Women's Action for New Directions, Rural Organizing Project, 
     Portland Jobs with Justice, Urban League.


                              Pennsylvania

       ACHIEVA, ACTION United, Be Well! Pittsburgh, Beaver County 
     NOW, Consumer Health Coalition, Lutheran Advocacy Ministry of 
     Pennsylvania, Maternity Care Coalition, New Voices 
     Pittsburgh: Women of Color for Reproductive Justice, 
     Pennsylvania Alliance for Retired Americans, Philadelphia 
     Unemployment Project, Women's Law Project.


                              Rhode Island

       Ocean State Action, Ocean State Action Fund.


                               Tennessee

       Tennessee Citizen Action, Tennessee Citizen Action 
     Alliance.


                                Virginia

       SEIU Virginia 512, Virginia AFL-CIO, Virginia New Majority, 
     Virginia Organizing.


                               Washington

       AFGE Local 3937, Asian Pacific Islander Americans for Civic 
     Empowerment, FUSE Washington, Health Care for All Washington, 
     Main Street Alliance of Washington, OneAmerica, Physicians 
     for a National Health Program--Western Washington, Puget 
     Sound Advocates for Retirement Action, SEIU Healthcare 
     1199NW, SEIU Local 6, SEIU Local 775, SEIU Healthcare 775NW, 
     Spokane Peace and Justice Action League, Washington CAN! 
     Education and Research Fund, Washington CARE Campaign, 
     Washington Community Action Network Education, Washington 
     Fair Trade Coalition, Washington State Labor Council AFL-CIO, 
     Working Washington.


                             West Virginia

       West Virginia Citizen Action Group, West Virginia Citizen 
     Action Education Fund.


                               Wisconsin

       9to5 Wisconsin, Citizen Action of Wisconsin, Citizen Action 
     of Wisconsin Education Fund, Coalition of Wisconsin Aging 
     Groups, M&S Clinical Services Assessment Center, Milwaukee 
     Teachers Education Association (NEA), SEIU Healthcare 
     Wisconsin, SOPHIA--Stewards of Prophetic, Hopeful, 
     Intentional Action (Gamaliel), Wisconsin Federation of Nurses 
     and Health Professionals (AFT).
                                  ____

                                    National Committee To Preserve


                                   Social Security & Medicare,

                                Washington, DC, February 28, 2013.
     Hon. Dick Durbin,
     U.S. Senate, Hart Office Building, Washington, DC.
     Hon. Janice Schakowsky,
     House of Representatives, Rayburn House Office Building, 
         Washington, DC.
       Dear Senator Durbin and Representative Schakowsky: On 
     behalf of the millions of members and supporters of the 
     National Committee to Preserve Social Security and

[[Page S1019]]

     Medicare, I am writing to express our support for the 
     Medicare Prescription Drug Savings and Choice Act. We applaud 
     this effort because it would improve the Medicare program for 
     beneficiaries and reduce federal spending on prescriptions 
     drugs.
       We understand that your legislation would create one or 
     more Medicare-administered drug plans with uniform premiums, 
     providing seniors with the opportunity to purchase drugs 
     directly through the Medicare program. In addition, your 
     legislation would require the federal government to use its 
     purchasing power to negotiate lower prices on prescription 
     drugs for beneficiaries who enroll in the Medicare-
     administered plan. The Department of Veterans Affairs and 
     many state governments are able to deliver lower drug prices 
     because of price negotiation, and we believe that the federal 
     government should be able to receive the best price available 
     for Medicare prescription drugs. Finally, we appreciate that 
     your legislation establishes an advisory committee to assess 
     a public formulary and streamlines the Medicare Part D 
     appeals process, which will help all beneficiaries.
       Thank you for your continued leadership on Medicare, 
     particularly for identifying ways to reduce Medicare spending 
     without shifting costs to beneficiaries. We look forward to 
     working with you to enact this important legislation.
           Sincerely,
                                                     Max Richtman,
                                                President and CEO.
                                 ______