[Congressional Record Volume 165, Number 60 (Monday, April 8, 2019)]
[Senate]
[Pages S2286-S2287]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                        Prescription Drug Costs

  Madam President, the Senate Finance Committee will continue with 
hearings tomorrow on the high cost of prescription drugs. I hear a lot 
about this back home in Texas. Whether they are seniors who struggle to 
cover the costs of the prescriptions they have been taking for years or 
will be taking for the rest of their lives or whether they are parents 
who face tough financial decisions to make sure their children receive 
the medications they need, their stories can be heartbreaking. I have 
no doubt that all of my colleagues here in the Senate and in Congress 
hear the same things back home from their constituents.
  A February Kaiser Family Foundation poll found that nearly 80 percent 
of Americans believe that the cost of prescription drugs is too high, 
and nearly 30 percent of adults, because of the cost, report their not 
taking their medications as prescribed. In other words, they are self-
rationing, and it can be dangerous.
  Without intervention, I don't expect these prices to drop anytime 
soon. In fact, the Centers for Medicare & Medicaid Services has 
estimated that between 2018 and 2027, consumers could expect to see 
their prescription drug costs increase by an average of 6.1 percent 
each year. That is faster than the increase in doctors' visits, 
hospital stays, or any other aspect of healthcare.
  What exactly is behind these high prices? That is exactly what the 
Senate Finance Committee is going to find out. Over the last few 
months, we have been looking at every step a drug takes when it is en 
route from research and development to the bottle in your medicine 
cabinet, and we have been asking a lot of questions along the way. We 
have heard from patients, health economists, and pharmaceutical 
companies.
  We will be talking tomorrow mainly to pharmacy benefit managers, or 
PBMs, who are the intermediaries between the manufacturers, consumers, 
and health plans. They negotiate with manufacturers to secure rebates, 
which should lower the price of the prescription drugs for patients, 
but many times they do not. The size of a rebate could mean the 
difference between a drug's being covered by your insurance or not.
  There are a lot of financial incentives in healthcare and 
prescription drug pricing that we need to peel back, like one would the 
layers of an onion, so that we will know exactly what is going on. What 
I find so surprising is that for as big a role as PBMs play, we know 
surprisingly little about how they operate.
  The terms of these rebates, including dollar amounts and incentives, 
are cloaked in secrecy. Since there is no paper trail or standard 
procedure on how these rebates or discounts are determined, it is 
nearly impossible to follow the money. I have always told people that I 
am not sure why prescription drug pricing is so complex. I don't know 
whether it is by design or if it is unintentional, but it certainly 
exists. This lack of transparency for the consumer is concerning, as it 
should not take an advanced degree to figure out

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where your money is going when you buy your prescription drugs.
  I am eager to question these PBMs tomorrow and to hopefully begin to 
remove the shroud of secrecy surrounding these rebates and prescription 
drug prices. Finding out what has led to these rising prices is 
critical to ensuring that Americans are able to receive the drugs they 
need at prices they can afford.