[Congressional Record Volume 163, Number 187 (Wednesday, November 15, 2017)]
[Senate]
[Pages S7246-S7247]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                        Drug Price Transparency

  Mr. President, maybe it is the time I turn on my television, but it 
seems to me I just can't escape drug advertising on television. It just 
comes one after the other, all kinds of drugs--many of which I can't 
even pronounce their names, can't remember their names. I can't 
remember why they are being advertised, and then I listen to all of the 
things that follow when all these drug ads come on.
  My favorite--favorite of all time--is one of these drugs in which it 
says: Be sure to tell your doctor if you have had a liver transplant. 
Be sure to tell your doctor if you have had a liver transplant. Imagine 
going to your doctor for a checkup or physical and talking about your 
condition and failing to mention you had a liver transplant. That is 
what one of the ads say, and many of the ads are just as baffling as to 
the warnings and side effects.
  One ad says: Don't take Xarelto if you are allergic to Xarelto. Well, 
how do I know if I am allergic if I don't take it? So many questions 
and so many warnings.
  How many other countries in the world do you think go through this? 
How many other countries in the world are there where, when you turn on 
the television, you get ads for drugs? There must be a lot of them, 
right? No. It turns out there is only one other country in the world 
that does this--New Zealand. The United States of America and New 
Zealand are the only two countries in the world that allow direct-to-
consumer pharmaceutical advertising.
  You ask yourself, when did this come about? It seems relatively new, 
and it is. This direct-to-consumer advertising was legalized in 1985, 
but it didn't take off until 1997--that is about 20 years ago--when the 
Food and Drug Administration eased the requirements for detailing the 
side effects of the drugs that were being advertised.
  After the FDA made that ruling, the drug companies decided to dive 
into this in a big way. Now you see these fancy commercials with 
popular music, with celebrity actors, golf clubs, lofty treatment 
promises. Every hour on television--every hour on television--an 
average of 80 drug ads are aired. The average American sees nine of 
these pharmaceutical ads every day--nine of them. In fact, drug 
companies spend more each year on advertising and sales than the entire 
budget of the Food and Drug Administration. These ads saturate our 
airways so much that there is now a national conference on drug ads and 
a hall of fame for the best drug ads. Can you believe it?
  As common as these direct-to-consumer drug ads are, drug companies 
spend four times as much as the cost of these ads on an army of sales 
representatives who target doctors who write prescriptions. These 
companies in America spend $20 billion a year trying to get these drugs 
into the doctors' offices and to get the doctors to prescribe them.
  I once talked to a young lady who did that for a living for a while. 
I said: How does that work? She said: I knew the birthday of every 
nurse in every doctor's office in my territory. I had a standing order 
every day for birthday cakes, which I delivered on behalf of my drug 
company in the hopes that that nurse and that doctor would prescribe my 
drug, and therefore I would be financially rewarded.
  I said: How did you know if they ever prescribed it? Well, it turns 
out the drug companies can go to the local pharmacies, and although 
they can't get the names of people receiving them, they can test the 
volume of sales at each of the pharmacies close to the doctors' 
offices, and that is one of the ways they measure their success.
  So let me ask and answer an obvious question. Why do the biggest 
pharmaceutical companies in America spend billions of dollars to 
promote and advertise their drugs? For one reason--it increases sales. 
It increases their profits. You see, patients are more likely to ask 
their doctor for a specific drug

[[Page S7247]]

when they have seen the ad for it, whether they need it or not. That is 
why most countries have banned direct-to-consumer drug advertising. As 
I mentioned, only New Zealand and the United States make it legal.
  Why is that a problem? One reason is, it promotes overuse of 
medication for often benign conditions. That bit of dry skin that you 
have on your elbow, that little stiffness in your knee, hooray. There 
is a drug for it, and you are going to find out on your television set 
tonight exactly what it is.
  They push pills for every natural condition or cosmetic issue, and we 
waste money on unnecessary drugs, costs that every one of us pays for 
when the overall cost of healthcare goes up.
  Over the past 20 years, since these direct-to-consumer ads have been 
allowed, the number of people with five or more prescriptions--five or 
more in America--has nearly tripled. A primary problem with these ads 
is that they steer patients toward the most expensive drugs, and that 
raises the cost of healthcare.
  Drugs with ads have nine times more prescriptions than those without. 
It just stands to reason. What are the most advertised drugs? Let's 
take a look at a couple of them here.
  Humira--incidentally, a prescription for Humira, from the disclosure 
of the drug company, costs $3,743 a month.
  Here is one you probably had to write down three times before you 
could pronounce it, Xeljanz. That costs $3,100 a month, a Pfizer drug. 
Humira costs $3,700 a month; Xeljanz, $3,100. Both are for rheumatoid 
arthritis.
  The drug industry spent over $100 million in advertising for each of 
the top 16 brand-name drugs in 2015, which means 50 percent of all 
direct-to-consumer advertising was just for these 16 medications.
  Do you ever see an advertisement during the Super Bowl for a generic, 
lower cost medication? Of course not. It is the same story when it 
comes to the $20 billion the same companies spend to butter up doctors 
so that they will prescribe these drugs. Doctors are more likely to 
prescribe a specific brand-name drug if they have been marketed by drug 
companies, while they are more likely to prescribe cheaper generics if 
not targeted with these ads.
  These ads often urge patients to ``ask your doctor if this drug is 
right for you.'' Well, we asked the doctors whether direct-to-consumer 
drug advertising was right for America, right for the health of 
America. We went straight to the American Medical Association, the 
largest medical society in the United States. The American Medical 
Association has called for a ban on direct-to-consumer prescription 
drug advertising. Here is what they said: ``Direct-to-consumer 
advertising inflates demand for new and more expensive drugs even when 
these drugs may not be appropriate.''
  If a patient finally figures out how to spell Xeljanz or Xarelto on 
the third try and comes to the doctor demanding these drugs, the doctor 
often has a choice. He or she can spend valuable time explaining why 
the patient doesn't need the drug or why there is a cheaper generic or 
just write the prescription. It is sad that too many doctors just write 
the prescription.
  Sometimes, with these drug ads it is hard to tell whether the 
commercial is for a pharmaceutical or a sports car, except you know the 
price of a BMW before you go buy it. With billions in targeted spending 
on drug advertising, patients and doctors are bombarded with 
information--all of those side effects, and ``be sure and tell the 
doctor if you had a liver transplant''--but they are kept in the dark 
about one major, important element: What do these drugs cost? 
Ultimately, somebody is going to pay for them--maybe your insurance 
company, if you are lucky. If not, maybe it is you and your family. 
Price disclosure is absent from virtually all of these drug ads.
  So when a patient sees an advertisement for Xeljanz or Xarelto, or 
his family doctor writes a prescription for it, the moment of truth may 
only occur when the patient finally goes to the pharmacy and sees for 
the first time what they are facing. No other industry conceals its 
prices when it comes to consumer goods this way. I think that needs to 
change. I think American consumers have a right to know--in front, on 
the ads.
  That is why I will be introducing a bill, the Drug-price Transparency 
in Communications Act, or DTC Act, to require the disclosure of prices 
in direct-to-consumer ads and promotions to doctors.
  The American Medical Association recently adopted a resolution 
supporting me. In addition to that, my bill is endorsed by the American 
College of Physicians and the Consumers Union. It is a simple thing: Do 
American consumers have the right to know when it comes to the cost of 
these drugs? Do they have the right to know that if you take Xeljanz 
for rheumatoid arthritis, you are going to spend $3,100 per month? This 
bill would have the FDA and the Federal Trade Commission oversee these 
communications, requiring drug makers to disclose the wholesale 
acquisition cost, known as the WAC, of the drug.
  Now, I am sure the response from Big Pharma, which makes a lot of 
money, will be to say: Well, that is just not the right price for every 
patient.
  I agree, but when we ask the pharmaceutical companies for better 
price information, they clam up. They will not answer. As long as they 
refuse to disclose the true cost of drugs and refuse to provide any 
transparency in the shell games they run between charging different 
patients different amounts, we have to stick with the one industry-
reported, verified number--the WAC--and that price is what we have put 
in as the required advertising on each of these drug ads on television.
  I have asked a lot of stakeholders for their suggestions about other 
approaches. I am open to them, but everyone understands this price 
establishment--this price bottom line--and that is why we used it.
  Further, my legislation allows drug companies to explain that 
patients would pay less than the amount they advertise. But let's also 
remember that somebody has to pay this high cost. If patients don't pay 
the WAC price out-of-pocket to the pharmacy, their insurance company 
just might, which is why health premiums keep going up.
  Blue Cross Blue Shield of Illinois told me that they spend more on 
prescription pharmaceuticals than they do on in-patient hospital care. 
This is one of the big drivers in the cost of healthcare.
  Is it important that we disclose to consumers what the real costs are 
of the drugs they are being bombarded with on television? I think so. 
Doctors, patients, and families agree. If drug makers can fill the 
airways with pharmaceutical ads, then they should tell the whole story 
and provide clear information about drug costs.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER (Mr. Gardner). The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Mr. MERKLEY. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.