[Congressional Record Volume 165, Number 35 (Tuesday, February 26, 2019)]
[Senate]
[Pages S1458-S1459]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                        Prescription Drug Prices

  Madam President, this morning, the Senate Finance Committee held the 
second in a series of hearings on prescription drug pricing. We all 
know that across the country, the rising costs of prescription drugs is 
placing a strain on families.
  A survey last summer found that many Texans are struggling to afford 
the rising cost of healthcare, and three out of five people surveyed 
reported foregoing or postponing care because of the cost. That 
includes cutting pills in half, skipping or rationing doses, or not 
filling a prescription because they simply can't afford to do so. Some, 
though, are taking even more drastic steps.
  Last year, a widow in Austin considered selling her house to pay for 
the expensive drugs she needed to treat hepatitis C, which had killed 
her husband years earlier. Many Texas families have begun the dangerous 
practice of buying their drugs in Mexico--even though they may be 
counterfeit--because they think they are more affordable than filling a 
prescription in the United States.
  With healthcare costs continuing to press more and more of our hard-
working families, things aren't expected to get any easier any time 
soon. The Centers for Medicare and Medicaid Services estimated that 
between 2018 and 2027, consumers could expect to see prescription drug 
spending increase by an average of 6.1 percent a year. That is a

[[Page S1459]]

faster increase than hospital stays, doctors' visits, or any other cost 
in the healthcare sector.
  This spending doesn't just have an impact on patients. It accounts 
for a large portion of our national economy. In 2017, the national 
health expenditures totaled $3.5 trillion. That is 18 percent of our 
gross domestic product. Prescription drugs account for 10 percent of 
our total health expenditures, more than $330 billion. They have an 
impact on our entire country.
  The Senate Finance Committee is digging into the reason behind those 
rising costs. The journey a drug takes from research and development to 
the manufacturing plant, to pharmacy shelves, and to our medicine 
cabinet is enormously complicated. I wonder whether it is complicated 
by design. Once a consumer has purchased a drug, figuring out who gets 
each dollar spent practically requires the forensic skills of a 
Sherlock Holmes.
  What I find particularly concerning, and something we spoke about at 
length today, are the rebates and other discounts provided by 
manufacturers. Pricing from one pharmacy to another can be wildly 
inconsistent, and rebates are often the root of the problem. In another 
context, what is now called a rebate might be called a kickback. 
Rebates are the key to determining if a particular drug is covered by 
your insurance, and that can impact therapies that you have access to. 
Despite the impact they have, the terms of rebates are mostly cloaked 
in secrecy. I don't think that is an accident. If you ask pharmacy 
benefit managers and plans about rebates, they will argue that overall 
they are a good thing and can help lower insurance premiums across the 
board. The issue, though, is that the extra money has to come from 
somewhere. So list prices are often raised to cover the difference. 
When that happens, the consumers are the ones who take the hit. For 
everything you pay within your deductible--and many deductibles in this 
post-Affordable Care Act era are up in the thousands of dollars--you 
pay 100 percent of the retail cost. You get zero benefit from the 
rebate. As the list price goes up, your out-of-pocket costs go up. That 
is why the stories of families struggling to cover costs are becoming 
more and more prevalent.
  Some of the people who suffer the most from the rebate system are 
people who take insulin. Diabetes is one of the most common and 
pernicious illnesses in our healthcare system in America today. Because 
we eat too well and exercise too little, many people develop diabetes, 
and the only treatment is to take insulin. Unlike most of the 
prescription drugs out there, insulin is a biologic, meaning it is 
generally more expensive to make and more expensive to buy.
  A few weeks ago, I spoke here on the Senate floor about a woman from 
Indiana who came to the first hearing we had on prescription drug 
costs, Kathy Sego. She told us about her family's struggle to pay for 
her adult son's insulin. Even though this drug has been around for 
nearly a century, a 1-month supply for Kathy's son Hunter costs her 
family $1,700 out of pocket.
  Unlike many brand-name prescription drugs that have lower-cost 
alternatives, like a generic, insulin does not. Part of our discussion 
at today's hearing was the topic of ``biosimilars,'' or what could be 
considered a generic version of a biologic type of drug. As the FDA is 
moving to make insulin subject to biologic competition in the future, I 
asked our witnesses about this move and how it could potentially serve 
as a solution for families like Kathy's, who struggle with the out-of-
pocket costs and copays as a result of the insulin with which they 
treat their diabetes.
  As part of that effort, last week, Chairman Grassley and Ranking 
Member Wyden launched a bipartisan investigation into insulin prices. 
In letters to leading insulin manufacturers, they requested information 
on the recent price increases--some as high as 585 percent.
  As I expressed today to one of the representatives from the drug 
company, I understand the need for drug companies to do research and 
development and that because they are granted patents for these 
innovative cures that they come up with, they have the exclusive right 
to sell those drugs during the terms of the patents. Yet I don't 
understand why a drug that has been around for decades, like insulin, 
still costs $1,700 for somebody to pay each month on an out-of-pocket 
basis, and where we have seen recent price increases as high as 585 
percent, it makes absolutely zero sense to me. I am eager to hear from 
these manufacturers and other players in the pharmaceutical system 
about why these prices are rising so rapidly and how we, in working 
together, can provide relief to families who bear the brunt of 
manufacturers' decisions.
  I conclude by saying that I also had an interesting conversation with 
one of the witnesses from the drug companies, the manufacturer of 
HUMIRA. HUMIRA is one of the best-selling drugs in the world for the 
treatment of rheumatoid arthritis and other things. The company that 
makes HUMIRA earns $18 billion a year in revenue from the sale of 
HUMIRA. When I asked why it was necessary for the company to have more 
than 100 different patents to cover that drug when the drug is 
essentially the same molecule, the gentleman representing the drug 
company did not give me a satisfactory answer.
  I can understand the importance of recouping those R&D costs and the 
benefits of providing a patent for a reasonable period of time to 
recoup those costs and make a profit. I am OK with that. Yet, when you 
see the patent system being manipulated in a way that maintains that 
exclusive right to sell that best-selling drug by a drug company, that 
causes me grave concern. I have talked to Chairman Graham of the 
Judiciary Committee, which has jurisdiction over patent-related issues, 
and he told me he would work with me to find a solution to gaming the 
patent system in order to protect that exclusive right to sell a drug 
beyond the normal patent period because it is, ultimately, the 
consumers who are being cheated and being denied access to the lower 
cost drugs.
  As with insulin, there is no good reason why, after all of these 
years, consumers have to see price increases approaching 585 percent. 
We need answers to those questions, and we will get answers to those 
questions.
  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. DURBIN. Madam President, I ask unanimous consent that the order 
for the quorum be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.