[Congressional Record Volume 163, Number 185 (Monday, November 13, 2017)]
[Senate]
[Pages S7179-S7183]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Prescription Drugs
Ms. KLOBUCHAR. Mr. President, last month, President Trump said that
pharmaceutical companies are ``getting away with murder.'' Those were
his words, not mine. It is not the first time he has said it, and there
is some truth to it. So it is time to get specific and then question
why he just announced that the person who will be running the health
department for the United States of America has spent 10 years running
a pharmaceutical company.
Look at what is happening. When a company hikes the price of a
lifesaving drug by 5,000 percent overnight, he is right--that is
getting away with murder. When the price of 4 of the top 10 bestselling
drugs in this country goes up by 100 percent in the last few years--we
are not talking about one specific drug, a rare drug; no, we are
talking about 4 of the top 10 bestselling drugs going up 100 percent in
just the last few years--that is getting away with murder. When
Americans are forced to skip doses or split pills because they can't
afford their prescription, that is getting away with murder. When the
administration repeatedly delays penalties for drug companies that
intentionally overcharge hospitals for prescription drugs, that is
getting away with murder.
So what do we find out today? After the President has said that these
companies are getting away with murder, we find out that he has
nominated the former president of one of the country's biggest drug
companies as the Secretary of Health and Human Services, someone who
has been in that industry for 10 years running the biggest company. It
is happening again. They are getting away with murder.
In the United States--the biggest economy in the world, the frontier
for capitalism--drug prices are higher than any other developed nation.
That is outrageous. So, yes, they are getting away with a lot.
So here is my question: Why are we letting them? Why are we literally
putting former pharma executives in charge of healthcare policy for our
country? Why can't we get anything done to actually lower drug prices
in America?
I have often said that the pharmaceutical industry owns Washington.
Now, with this announcement today, they will actually be running it.
Lowering prescription drug costs is my top priority. Healthcare is
one-sixth of our economy, and prescription drug costs account for over
15 percent of all healthcare spending. This has a big impact on
families, on communities, on our economy, and on our country.
For most Americans, this is deeply personal. Everyone has their own
story. My daughter has a severe nut allergy. She keeps an EpiPen with
her at all times. So when the price of that particular prescription
drug went up and up and up, like parents across the country, I noticed.
I took action. I spoke out, moms and dads all across the country spoke
out, and we saw some reduction in those prices. But we shouldn't have
to have a social media campaign, a write-in campaign, and Members of
Congress giving speeches on the floor for every single drug to see a
reduction in prices.
Abigail just graduated from college. I don't want her to have to
think about this for the rest of her life when she is filling a
prescription. But what about the thousands of others like her, young
people just starting their careers who can't afford to pay these
skyrocketing prices? I don't want parents to worry about how to afford
the inhaler their kid relies on to get through the day. I don't want
seniors to worry about how they will be able to put food on the
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table and pay for the insulin they need. But that concern for so many--
for too many--is constant. As prescription drugs keep rising, so does
the worrying, so does the concern.
Over and over again, that is what I hear from my constituents. I
don't think one of them would tell me that they think the solution is
to do nothing legislatively and then put the head of one of the biggest
pharmaceutical companies in our country into the job of running
healthcare policy. No, I don't think they would think that is going to
fix everything. It is not fair, it is not right, and we need to do
something about it.
Look at the numbers. Why is it happening? Last year alone, the drug
companies spent $152 million lobbying Congress, and it is getting
worse. They are doubling down on their bets by betting on an
administration with big ties to pharma. There are more than 800
lobbyists working for the pharmaceutical industry, meaning that almost
every Member of Congress is double-teamed by the lobbying force. Every
Member of Congress now, when you look at the registrations, has two
lobbyists assigned to them from pharma. Is it no surprise that now we
are going to have the nominee as head of HHS, Health and Human
Services, someone directly out of pharma? I don't think so.
In my first run for the Senate, in 2006, I talked about how Medicare
should be able to negotiate drug prices on behalf of millions of
seniors. It was such common sense. In each Congress since 2011, I have
introduced bills to allow Medicare to do just that. Right now, Medicare
is barred by law from negotiating directly with the drug companies.
That seems pretty crazy to me. I think 41 million seniors would have a
lot of power. They are good at getting bargains. They want to get some
bargains on their prescription drugs. You harness that bargaining power
and allow the U.S. Government to negotiate on their behalf with the
pharmaceutical companies. By the way, that would not just bring drug
prices down under Medicare for seniors; it would bring drug prices down
for everyone because that is such a large chunk of the people who are
using prescription drugs.
This bill has not passed year after year. Why? Is it because the
people don't want it? No. A recent poll found that 92 percent of people
want the Federal Government to negotiate drug prices for Medicare
beneficiaries. Ninety-two percent of the public supports the bill, and
we have a growing number of sponsors. Right now, they are just on my
side of the aisle, but we have over 30 sponsors on that bill. We want
to bring that bill up for a vote.
My bill to allow Medicare to negotiate for prescription drugs,
however, has never been brought up for a vote. I introduced these bills
in 2011, 2013, 2015, and in 2017, and each time there was not a vote.
President Trump says he is a good negotiator. He says he is in favor
of this negotiation. He said it not just once, not just twice on the
campaign trail but many times. So I thought this is great. He is coming
in, and we are immediately going to see support for my bill and support
for negotiating prices under Medicare part D. No, we do not see that.
We have seen no action at all. Instead, what do I find out? When I woke
up this morning, I found out that he is putting the head of a big
pharmaceutical company in charge of Health and Human Services.
For those of us who have been doing this work for a long time now, it
is unsettling, but it is not that surprising. It is not just the
President literally nominating the head of a big drug company to be the
Secretary of Health and Human Services--we see this kind of thing all
the time--but since 2000, at least 56 officials from the DEA and the
Justice Department have gone to work for the pharmaceutical industry.
Basically, the industry buys the expertise they need to then gum up the
works so we can't get anything done. Former lobbyists and execs are
popping up all over this administration.
Joe Grogan works at the Office of Management and Budget. He led a
working group on pharmaceuticals that this administration convened. He
helped draft an Executive order on prescription drugs. The catch? Until
March of this year, he was a lobbyist for the pharmaceutical industry.
What does this mean? What this means is, you have this revolving door
where this is going on. You have two lobbyists for every Member of
Congress; just talk, talk about it. What does it really mean? Let me
tell you what it really means.
Insulin--the price of insulin has tripled in the last decade. A form
of insulin that was listed at $17 per vial in 1997 costs nearly $138 in
2016. That is a 700-percent increase. We have seen major companies jack
up their prices in near harmony.
In November 2015, NovoLog increased to $236.70. Within 14 days,
Humalog jumped to $237, and Eli Lilly and Novo Nordisk have raised
their prices for both even higher within the last year. Of course, one
of those companies is the company this HHS nominee ran in North
America.
Healthy competition usually doesn't involve price increases in almost
perfect sync among competitors. That is why I demanded an explanation
from these companies. I demanded answers on behalf of people like Kim
from Plymouth, MN. She just retired. She has diabetes. She keeps the
pen injectors after she uses them because they have small amounts of
insulin left, and she says it is too precious to throw them out.
This is in America, in 2017. Older people are keeping their insulin
injectors because there are a few drops in them--a drug that
historically has been incredibly inexpensive and cheap. There are not
new developments with this drug. It is insulin. There is no reason you
would see this dramatic price increase, except that it is price
gouging.
It doesn't have to be this way. Pharma often argues that these high
prices are necessary for research and development. As I mentioned,
insulin is an old drug. It is cheap to make. It has been around for
years. In fact, when insulin was discovered in 1921, the original
patent was sold to a university for just $3, for the whole patent. The
researchers who worked hard to develop this life-sustaining drug wanted
to make sure--are you ready for this--that no one else would turn its
production into a profitable monopoly. So those researchers, knowing
they had this incredible lifesaving drug, wanted to keep the prices
down and sold the patent for $3.
So then what happened? Well, they jacked up the prices over and over
again. As I mentioned, it was $17 per vial in 1997 to $138 in 2016--a
700-percent increase for insulin. They didn't need to jack up those
prices to develop a new form of insulin. It is the same insulin. They
did it to make money.
This isn't just a hit on consumers' pocketbooks. It is also becoming
a threat to public safety. One drug company, Kaleo, increased the price
of a two-pack of a device containing naloxone that treats life-
threatening opioid overdoses.
We passed a bill last year, with strong bipartisan support, to be
able to have a blueprint for this country to deal with opioid
overdoses. The President just declared this a public health emergency,
but what is going on with the one drug that we know saves people from
overdoses? Guess what. The drug companies said: Well, here is
something. More people are using this drug so let's jack up the prices.
This form of naloxone from Kaleo has gone from $690 to $4,500 during
the last 3 years. This is what they did for these opioid addicts. The
drug companies get people hooked to begin with. We all know those
stories are coming out right now. Then, when people get hooked and they
overdose, they increase the price of the drug you use to help them.
What a racket.
All of us know the opioid epidemic is becoming a bigger and bigger
public safety issue. In other words, there isn't a worse time to hike
the price up on a drug that helps first responders deal with the
national public health crisis. When I called the drug company out on
this earlier this year, that company used the same old playbook. Sure
as clockwork, they claimed that the prices you and I see might be high,
but they have special programs to make sure people don't actually pay
these absurdly high rates for lifesaving medicine.
You know what, I have heard from Minnesota law enforcement
officials--sheriffs, police chiefs--who are shocked because the cost of
naloxone increased by more than 60 percent in a single year. I have
heard from doctors who have told me their patients recovering
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from addiction can't afford the medication. So I can promise you that
the special discount programs and rebates don't apply to everyone,
despite what the drug companies say.
The role the drug companies are playing in the opioid epidemic
doesn't end with naloxone. That is just the beginning. In just the last
couple of weeks, we have seen report after report about how the greed
of the pharmaceutical companies, as I mentioned, led to the rise of the
epidemic to begin with. In Minnesota, 637 people died from opioid and
other drug overdoses last year alone. That is more than homicides and
car crashes combined. By the way, it is not just our States, it is
States all over the country. Ninety-one people die from this overdose
each day in our country. That is the reality of this crisis. Getting
away with murder? Well, now it is actually true.
Two weeks ago, The New Yorker and Esquire pulled back the curtain on
Purdue Pharma. The Sackler family, the family behind Purdue, is well
known for its generous donations to cancer research, medical schools,
art museums, universities. What is less well known is the role that
Purdue Pharma has played in the spread of OxyContin and opioid
addiction.
OxyContin, the drug at the heart of the U.S. opioid epidemic, is
regarded by many public health experts as one of the most dangerous
products ever sold on a mass scale. If people have not read this
article in The New Yorker, you can get it online. You can read it, and
you better read it so you will understand why I am so mad while I am
giving this speech today and why I am so angry that the administration
has just put a pharma executive in charge of the HHS. It is not a
pharma executive, from Purdue Pharma, but this whole culture where they
have been allowed to do whatever they want and no one is holding them
accountable is what has led to where we are today.
Purdue Pharma aggressively marketed OxyContin to physicians as a
painkiller and claimed that the drug's delayed release mechanism would
limit the risk of addiction. Instead, OxyContin led to many new
addictions, and, as we all know, many addicted patients eventually
turned to heroin.
Here is what is so stunning and what is so obvious in this well-
researched article. The company knew OxyContin was addictive all along.
It knew its marketing campaign was misleading people. Steven May
started at Purdue Pharma as a sales rep in 1999, and years later went
on to allege fraud against Purdue in a whistleblower lawsuit. He was
trained to market the drug as one ``to start with and to stay with,''
despite knowledge of its addictive potential. The hits just keep
coming--but that happened. When you read that article, you find out
there were so many signs that this was addictive; that they were seeing
it all over the country and they kept selling it. They kept telling
people it was good for them, they should have no pain, and it would be
fine if they took this drug, even if they were getting one wisdom tooth
out, whatever it is.
That is what happened in our country. That is how people got addicted
on opioids. Now we see lawsuits. Yes. OK. That will hold them
accountable, to a certain degree, but do we see any action from
Congress at all to reduce the pharmaceutical prices or to do anything
about this? Are there any votes in this Chamber? No, there are not.
CNN just released an investigation on how Endo Pharmaceuticals
prioritizes profits over people's lives. One of their best selling
drugs was an opioid called OPANA ER. The drug was often abused. Addicts
would crush it and snort the pills, which could increase the risk of an
overdose, so Endo Pharmaceuticals had to pull the drug off the market,
but that is not the whole story. Endo made a newer, more addictive
version of the drug, which President Trump has called ``truly evil.''
The FDA got involved, for one of the first times ever, to force Endo to
stop selling the new truly evil drug earlier this year.
What did Endo then do? The company then cut a deal with a generic
drug company to split the profits on the sales of the original version
of the drug--you know, the one with the history of abuse. It is
unbelievable the company will now profit off a highly dangerous opioid
it once pulled from the market for being unsafe.
The FDA has linked Endo drugs to serious public health problems, such
as outbreaks of HIV and hepatitis C, in addition to addictions and
overdoses, but the company doesn't think those risks are good enough
reasons to stop selling these opioids.
I don't think there are better examples of how greed trumps
everything else. That is what we are talking about here. There are good
people who work in the pharmaceutical industry. We have always been
proud to have innovation in America. Innovation is great, but greed
unchecked is not. You can literally trace this opioid epidemic, where
now four out of five of those people who originally got hooked on legal
pharmaceuticals are now turning to heroin. You can literally trace it
back to these very companies. That happened. Then, just when the
epidemic gets bad and we figure out that at least you can stop drug
overdoses with naloxone, those companies jack up those prices.
This is not a free market right now. This is a monopoly market that
is getting people sucked into their products, either with advertising
on TV or with addictions to drugs, like opioids, then getting them into
their nets, and then charging them enormous amounts of money. That is
what is happening right now.
The examples do not end.
The price of Daraprim, a drug that treats malaria and other
infections, went up 5,000 percent overnight. The price for a multiple
sclerosis drug went up 21 times in a decade. ARIAD Pharmaceuticals
raised the price for a leukemia drug four times in 1 year alone. Now it
costs nearly $199,000 a year. The only people who can afford that drug
are the executives at the company.
It is no wonder that people like President Trump are starting to say
a little bit more about the rising costs of prescription drugs. OK.
That is good. That is a start in talking about it, but we need action.
For years, the pharmaceutical lobby bought Washington's silence, but
now, in being faced with a nationwide crisis brought on by that silence
and in being confronted by constituents who all agree that this is a
problem, many are feeling that they have to do more than just talk
about it. Talking and tweeting are different from doing, and actions
speak louder than words. There is a saying that you cannot just talk
the talk; you need to walk the walk. Well, it is time to walk the walk.
By the way, putting someone who ran a pharmaceutical company for 10
years in charge of HHS, the Nation's healthcare Department for the
entire United States of America, is not called walking that walk. There
are actions we can take right here, right now, because the solutions
are right here on the table.
Here we go.
First and foremost, let's finally take up that bill that would
harness the negotiating power of 41 million seniors who are on Medicare
and bring drug prices down. My bill would repeal the law that bans
Medicare from using that market power to negotiate prices. Literally,
Medicare is banned by law from negotiating prices. There are 33
Senators who have joined me on this bill. We could pass this if we
could just get a vote.
Second, as the ranking member of the Judiciary Committee's
Subcommittee on Antitrust, Competition Policy and Consumer Rights, I
cannot stress enough that competition is the best way to ensure that
prescription drugs are affordable. Where there is a lack of
competition, price increases often follow.
A recent poll found that 87 percent of the public agrees that we need
to increase competition. Senator Grassley and I, the Republican of
Iowa, have a bill that, for years, we have tried to push ahead. It
calls for a stop to this outrageous play called pay for delay, where
big pharmaceutical companies actually pay off generic companies--their
competitors--in order to keep their products off the market.
So the pharma companies go to a generic and say: Hey, I know that you
are going to compete with me, but I will give you a little money so
that you can keep that product off the market for a little while, and
that will be better for both of us. We will give you more money than
you will make off the product.
According to the nonpartisan Congressional Budget Office, putting an
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end to this ridiculous practice would save taxpayers $2.9 billion over
10 years. Guess what. That is just the government's piece of it. It
would also save consumers because they are paying the copay money as
well. Once again, I cannot imagine any of my colleagues voting against
this legislation if it were to actually come to a vote on the Senate
floor. So let's let it come for a vote and see how people vote.
I also have a bipartisan bill with Senators Grassley, Leahy,
Feinstein, Lee, and several others called the CREATES Act. It would put
a stop to other pharmaceutical companies' tactics, like refusing to
provide samples or to share important information about how to
distribute a drug safely, which delay more affordable generic drugs
from getting to the market.
The FDA has received over 100 complaints about these tactics, and
according to the Congressional Budget Office, this legislation would
save $3.6 billion. Even if the drug companies are not headline grabbers
like Martin Shkreli, many pharmaceutical companies are using tactics to
prevent competition. It is not just one bad guy who goes to jail. It is
a common practice. In fact, it is legally allowed right now for them
not to share those samples, for them to make payments to their
competitors to keep the products off the market. We need to end those
practices, and we do it by having a vote on these bills.
Finally, we should look beyond our borders. We should know that our
friends right across the border in Canada often pay less--much less--
for prescription drugs than we do.
For example, in the United States, a 90-day supply of an anti-
inflammatory drug called Celebrex can cost more than $1,000. Canadian
pharmacies sell it for only $220. That is just one example. I could
spend all night giving examples of where the prices in the United
States are more than double what they are in Canada.
Senator McCain and I have a bill to allow Americans to bring in
safe--they have to be safe--and less expensive prescription drugs from
Canada. Our neighbors to the north have similar quality and safety
standards as those in the United States. Our bill has strong safety
measures, too, so as to make sure that we protect American consumers
from scammers or counterfeit drugs. Senator Sanders has also been a
leader on this issue.
Why do we care about this, Senator McCain, Senator Sanders, and I, in
our coming from such different perspectives? We know that we only allow
importation from pharmacies that have existed for 5 years, so they are
safe, and then have a brick-and-mortar store, not just some fly-by-
night website.
Just like Medicare negotiation, the public is overwhelmingly on our
side, with 72 percent of people who support allowing Americans to buy
prescription drugs that are imported from Canada, including 66 percent
of Democrats, 77 percent of Independents, and 75 percent of
Republicans. So why can't we get it passed? We need to.
Beyond Canada, Senator Lee and I have a bill, another bipartisan
bill, that would allow for the temporary importation of safe drugs that
have been on the market in another country for at least 10 years when
there is not healthy competition for that drug in this country.
We have all heard the drug companies and others say that the FDA
approval process can take a long time, and that results in a lack of
options in the marketplace and higher prices. When it comes to drugs
that have already been sold safely in other countries for years, why
should we force American consumers to wait for the same options? It
doesn't make sense. This bill would let patients access these safe,
less expensive drugs at the same time that they are going through the
full FDA approval process.
So the idea is to, one, allow negotiation for our biggest negotiating
bloc--41 million seniors. That would bring prices down. The President
said that he knows the art of the deal, that he is the negotiator. Well
then, let's get that negotiation in place and get some big-time
lobbying for this bill instead of putting pharmaceutical executives in
charge of Health and Human Services.
The second set of ideas is about bringing in more competition. You
can do it with safe drugs from overseas. I think that if some of the
drug companies that have a monopoly on our consumers' drugs knew that
competition might come in, maybe they would want to bring those drug
prices down. In fact, I know that they would because that is how
capitalism works. A high school economics class could tell you that.
The other idea is more generics. Keep competition going by making it
easier for generics to get their products out to market, and please
stop the practice where the big pharma companies are paying their chief
competitors, the generics--great for both of them--to keep their
products off the market. Who are the losers? Americans are the losers.
The administration actually has the authority to take action now.
Under current law, we could allow for the temporary importation of less
expensive drugs from Canada tomorrow. What are we waiting for? I urge
the administration to act now. If the administration will not act,
Congress must. We need to have those Medicare negotiations. There is so
much that we could do here if we could just get a vote. Yet we cannot
stop with just passing legislation to lower pharmaceutical prices. We
have to stop pharmaceutical companies from rigging the system in the
first place or else we are just going to get back to where we started.
We have to give ethics watchdogs in Washington, like the Office of
Government Ethics, real teeth. We need to overturn Citizens United and
undo the outside influence of special interests on our elections. We
have given them this carte blanche to come in and influence people, and
look at what is happening. There is an opioid epidemic; the price of
insulin has gone up multiple times; four of the top 10 best-selling
drugs in America have gone up over 100 percent in the last 10 years.
All of that has happened because we have said: Come on in with all of
your special money. Influence people. Hire two lobbyists for each
Member of Congress.
Guess what we have. That is what we have.
I will just remind my colleagues to talk to their constituents
because I can tell you what you will find. You will find what I found--
a woman in Duluth who chose not to fill her last prescription because
that one medicine would cost a full 25 percent of her income; someone
in Saint Paul who even with Medicare cannot afford $663 a month for the
drug; a woman from Crystal, MN, who told me ``I am practically going
without food'' to pay for her prescriptions.
It is heartbreaking that this is happening in America. Washington has
to stand up to the pharmaceutical industry.
It took a while and a lot of lawsuits and some brave people coming
forward, but eventually, Washington stood up to Big Tobacco, and States
stood up to Big Tobacco. They started suing. They started requiring
labels. They started doing more for kids so they wouldn't get hooked.
It made a difference.
It is time to take this on. There are a lot of good things that
pharmaceuticals can do to save people's lives. We know that--that is
important--but what we cannot do is let them wreak havoc on people's
budgets. What we cannot do is give them unfettered monopoly power to
jerk us around with prices to start an opioid epidemic and then
increase the prices for the very drugs that can help prevent people
from dying.
If we work together, we can get this done. Most of the bills that I
have mentioned are bipartisan. In fact, every one that I mentioned on
the Senate floor is bipartisan except for the negotiation of Medicare
Part D, and that is the one that the President wants to see happen. So
I don't understand. This is not just my standing here alone on this
side of the aisle. There are people of good faith who want to move on
this, but I can tell you that you don't move on it by putting a
pharmaceutical executive in charge of the biggest health Department in
the United States of America.
I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The senior assistant legislative clerk proceeded to call the roll.
Mr. TOOMEY. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
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The PRESIDING OFFICER. Without objection, it is so ordered.
____________________