[Congressional Record Volume 165, Number 115 (Wednesday, July 10, 2019)]
[Senate]
[Pages S4753-S4759]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Prescription Drug Costs
Ms. ERNST. Mr. President, I recently received a letter from a
gentleman living in Cedar Falls, IA, who suffers from Parkinson's
disease. As I speak, he is going without his $1,450-per-month LYRICA
prescription in order to keep a roof over his head. That is right,
folks. He must choose between making a mortgage payment and getting his
prescription.
Here is another story a woman from Davenport, IA, shared with me.
Last October, she was able to get a 3-month supply of blood pressure
medication for $17, but when she went to the pharmacy for her refill in
late December, she was told the price had nearly tripled to $55. She
wrote to me and said:
Thinking this was a mistake, I refused the refill and
checked online about the change in price and found I couldn't
get it cheaper anywhere else. So I went back in ten days and
thought I would just have to pay the new cost [which was
$55]. In that time . . . the prescription had gone up to
$130!
Whether I am talking to folks back home in my townhalls and other
events on my 99 County Tour or in meetings right here in Washington,
DC, the cost of prescription drugs is the No. 1 issue I hear about from
Iowans. Every day, I hear stories just like these about the outrageous
costs associated with their prescription medications.
For too long, hard-working Iowans have borne the brunt of
skyrocketing prescription drug prices. Stories like the man from Cedar
Falls and the woman from Davenport have become the norm. We have to
change that, and that is exactly what we are doing here in the Senate.
We have been hard at work in advancing bills to drive down drug
prices, increase competition, and close costly loopholes that are being
exploited by those bad actors. I am proud to lead on three such bills
that were recently approved in committee.
First, I have teamed up with Senator Cotton on a bill that aims to
eliminate an egregious loophole in the patenting process. This loophole
allows drug companies to take advantage of the well-intentioned concept
of sovereign immunity for Native American Tribes in order to dismiss
patent challenges and unfairly stifle competition.
Our legislation would put an end to this manipulative practice and
actually provide Iowans with access to cheaper options for their
prescription drugs. That is not all we are doing in the Senate to make
more low-cost generic drugs available to folks in Iowa. We have also
been working across the aisle on a bipartisan bill that would put a
powerful check on drug companies seeking to keep generics off the
market.
The bill would empower the makers of generic drugs to file lawsuits
against brand-name manufacturers if they fail to provide required
resources, such as drug samples, needed for generics to clear the
regulatory process. In turn, we would see cheaper alternatives
available for my folks in Iowa.
I am also working with my fellow Iowan, Senator Grassley, on a bill
that focuses on the middlemen behind some of the prescription drug
price hikes we have seen recently. The bill would direct the Federal
Trade Commission to examine anti-competitive behavior in the
prescription drug market. As mergers push drug prices higher and
higher, this bill will be instrumental in helping Congress develop
policies to increase competition and lower those costs for both
patients and our taxpayers.
Make no mistake. The rising cost of prescription drugs is an issue
that significantly impacts hard-working Iowans. We in Congress have a
responsibility to take action, to give folks a voice, and to make sure
no family is ever forced to choose between making a mortgage payment
and purchasing their medications.
That is what we are doing. We have some great bills in the Senate--
bills from both Republicans and Democrats--that can help lower those
drug prices, increase competition, and close loopholes. Let's build on
this effort and continue working together in a bipartisan way to get
these bills and others across the finish line and signed into law.
Iowans are counting on us.
I yield the floor.
The PRESIDING OFFICER (Mr. Perdue). The Senator from Florida.
Mr. SCOTT of Florida. Mr. President, as is now obvious to everyone,
ObamaCare made healthcare even more expensive. Premiums are up. Copays
are up. Deductibles are way up. ObamaCare has been a disaster, and even
the Democrats are admitting it.
Let's all remember, ObamaCare was sold and based on a bunch of lies.
You didn't get to keep your doctor, your health plan, and your premiums
didn't go down.
The Democrats want Medicare for All, which will absolutely ruin the
Medicare system and throw 150 million people off of the employer-
sponsored health insurance they like. That would be a disaster. There
is something we can do and must do right now to help American families:
We must lower prescription drug costs.
This is very personal to me. I grew up in a family without
healthcare. My mom struggled to find care for my brother who had a
serious disease. Eventually she found a charity hospital 4 hours away
for his treatment. I remember asking my mom how much lower drug costs
would have to be for her to consider changing pharmacies. Without
missing a beat, she said: a dollar.
This story is not uncommon. All over my State I hear the same thing:
Drug prices are rising, and we are having trouble affording the
lifesaving medication we need.
I recently met Sabine Rivera, a 12-year-old from Naples, FL, who was
diagnosed with type 1 diabetes more than 2 years ago. She is 12 years
old, and she is already worried about how she will
[[Page S4754]]
afford the rising cost of insulin--something no 12-year-old should ever
have to stress about.
Patients want to shop for better coverage and lower costs, but too
often they can't or don't know how. At the same time, pharmaceutical
companies are charging low prices for prescription drugs in Canada,
Europe, and Japan but charging American consumers significantly more.
Why? Because for too long politicians have done nothing.
American consumers are subsidizing the cost of prescription drugs in
Europe and Canada and all over the world. Why should we be doing that?
That certainly is not putting America first, and that is not putting
American families first. That is why I am working with President Trump
and Republicans and Democrats in Congress to fix this problem.
I recently introduced the America First Drug Pricing Plan with
Senator Josh Hawley to take real steps to lower costs for patients and
put the consumers back in charge of their healthcare decisions. Part
one of my bill focuses on transparency.
First, pharmacies must inform patients what it will cost to purchase
drugs out of pocket instead of using their insurance and copays. If
patients choose to pay out of pocket, which is sometimes cheaper, the
total cost would be applied to their deductible.
Second, insurance companies should, and must, inform patients of the
total cost of their prescription drugs 60 days prior to open
enrollment. This allows patients to be consumers and shop around for
the best deal.
Finally, my bill would simply require that drug companies cannot
charge American consumers more for prescription drugs than the lowest
price they charge consumers in other industrialized nations.
I have found that provision to be controversial in Washington. Do you
know where it is not controversial? Everywhere else. In Tampa and
Orlando, Miami and Panama City, all over Florida, this just makes
sense. I don't spend a lot of time outside of Florida, but I would
wager and say that across the country my bill would make a lot of sense
too.
Why would we as American consumers, who make up 40 percent of the
market for prescription drugs, pay two to six times more for drugs than
consumers in Europe or Canada or Japan? That needs to change. My bill
takes real steps to change this, and I believe it should have
bipartisan support.
I also led seven of my colleagues in a letter to pharmaceutical
companies asking them to work with us on solutions to lower the cost of
prescription drugs. We are still waiting to hear back.
American consumers are facing a crisis of rising drug costs, and we
can't wait any longer. I will not and cannot accept the status quo of
rising drug costs. We need to get something done this year, and I am
fighting every day to make sure we do.
I yield the floor.
The PRESIDING OFFICER. The Senator from West Virginia.
Mrs. CAPITO. Mr. President, I am pleased to join my colleague on the
Senate floor to talk about an extremely important topic--that is,
lowering the cost of prescription drugs in this country. Just a few
weeks ago, on June 20, West Virginia celebrated our 156th birthday.
There is plenty to celebrate about West Virginia, from its breathtaking
beauty and wonderful families to our kind and hospitable West Virginia
spirit.
Unfortunately, West Virginia has its challenges, too, including
health challenges. We have some of the highest rates in the Nation for
heart disease, diabetes, cardiovascular disease, cancer, and arthritis.
While there are many nonpharmaceutical steps people are taking to
prevent and control diseases, for many, their prescription medicine is
the difference between wellness and illness or even between life and
death.
That is why it is so important that West Virginians are able to
secure their medications and that we as a Congress make sure they are
not paying too much for those medications. Of all the issues that my
constituents come to me with--whether it is a phone call, a letter, or
casually running into them at the grocery store--this is the issue I
hear most about because it is something that affects so many West
Virginians' way of life, and it is something that affects them every
day. If it doesn't affect them, it affects somebody in their family.
The same can be said for Americans across this country, and that is
why it has become one of our Nation's top priorities, one that is
shared by Republicans and Democrats and one that is a significant
bipartisan focus of this administration and this Congress. It is a far-
reaching problem with many different factors contributing to it, and
that is why we have to address it on many different fronts.
The chairman of the HELP Committee is here today. He has worked
through his committee diligently, and I applaud him for his efforts and
look forward to joining him on the floor in support of those efforts.
As we all know, the path a medication takes from the manufacturer to
the patient is very complex, with many factors impacting the price a
consumer pays. While making changes to this pathway is very important,
my constituents really don't care about the pathway. They are more
concerned with the total on their bill that their pharmacist is ringing
up. That is why I have focused a lot of my personal efforts on the
important role that our pharmacists play in lowering drug costs.
In many small towns and rural communities--which is my entire State--
pharmacists are the healthcare providers people go to quite regularly,
and they are often some of the most trusted, friendly, and welcoming.
It is essential that patients, especially seniors, are able to access
the local pharmacy.
West Virginians and Americans across the country should be able to
trust that their pharmacist is not being restricted about telling them
how to get the best prescription drug prices. They need to know they
aren't facing higher cost sharing for drugs and being accelerated into
the coverage gap or the doughnut hole phase of Medicare Part D due to
an overly complicated system of fees and price concessions that nobody
really understands--certainly not at the pharmacist's desk.
In order to ensure that seniors have access to a pharmacy of their
choice, Senator Brown and I introduced the Ensuring Seniors Access to
Local Pharmacies Act last Congress. We will be reintroducing this bill,
which requires that community pharmacists in medically underserved
areas be allowed to participate in the Medicare Part D preferred
pharmacy networks.
Why is this important? If a local pharmacy is not included in a
preferred network, a senior must either switch to a preferred network
pharmacy, which could be a lot farther away or less convenient, or pay
higher copayments and coinsurance to access their local pharmacy. In
some cities and towns, you can find a pharmacy on nearly every corner.
In rural areas, that is just not the case, and accessing a preferred
pharmacy could require significant time and difficult travel.
Additionally, many seniors rely on their local pharmacies not only to
access prescription drugs but also to receive those needed services
like preventive screenings and medication therapy management.
As important as access to a local pharmacy is, it is also essential
that patients can trust their pharmacists to let them know which
payment method provides the most savings when purchasing their
prescription drugs.
I was proud to join Senator Collins last year as a cosponsor of the
Patient Right to Know Drug Prices Act. This commonsense bill, which the
President signed into law in October, bans the use of the pharmacy gag
clause. It was hard to believe this still existed. These clauses were
put into place by insurers and pharmacy benefit managers, and they
prevented our pharmacists from proactively telling consumers that their
prescriptions could cost less--less--if they paid out of pocket rather
than relying on their insurance plan.
I am also currently working with Senators Tester, Cassidy, and Brown
on legislation that would help improve transparency and accuracy in
Medicare Part D drug spending. Our bill would reform the application
process of pharmacy price concessions, also known as direct and
indirect remuneration, or DIR fees, in the Medicare Part D Program. It
sounds complicated, but it is driving up the cost of our
pharmaceuticals.
[[Page S4755]]
This will ensure that our seniors are not facing higher cost sharing
for their drugs or, again, being accelerated into the coverage gap. It
will also help ensure that local pharmacies are able to stay open. This
is critical. We have to keep our local pharmacies open for a vast
majority of rural America and have them continue to stay open and
continue to serve Medicare beneficiaries and other communities that
rely on them. It would provide needed financial certainty for these
pharmacies, which are often small businesses.
My colleagues and I hope to see this legislation included in the
soon-to-be-released Senate finance package. These are just a few
examples of how we are working to lower prescription drug costs.
I have been listening to my colleagues and have heard a lot of other
ideas. They are small but much needed steps that can be, and already
are, making a real difference in our constituents' lives, but our work
is far from over. We have to continue looking at both commonsense and
complex solutions to the problem. This is a complex problem. While as a
Congress and a country we may not agree on the best way to do that, we
do all agree that it is a problem that needs to be solved.
I look forward to continuing to work with Senator Alexander and
Senator Lankford, who are on the floor here today, and my other
colleagues and the administration to find that pathway forward to
lowering the cost of prescription drugs.
I yield back.
The PRESIDING OFFICER. The Senator from Tennessee.
Mr. ALEXANDER. Mr. President, I thank the Senator from West Virginia
for working to reduce the cost of prescription drugs. That is the
question I hear most often in Tennessee: How can I reduce what I pay
for out of my own pocket for healthcare costs? The most obvious way to
reduce what you pay out of your own pocket for healthcare costs is to
reduce the cost of prescription drugs.
Shirley, from Franklin, TN, is one of those Americans who asked me
that question. This is what she said:
As a 71 year old senior with arthritis, I rely on Enbrel to
keep my symptoms in check. My copay has just been increased
from $95.00 to $170.00 every ninety days. At this rate I will
have to begin limiting my usage in order to balance the
monthly budget.
There has never been a more exciting time in biomedical research, but
that progress is meaningless if patients can't afford these new
lifesaving drugs.
Last month, as Senator Capito mentioned, our Senate Health Committee
passed legislation by a vote of 20 to 3 that included 14 bipartisan
provisions to increase prescription drug competition as a way of
lowering generic drug costs and biosimilar drugs that reach patients.
Here is what that includes: The CREATES Act--the Senator from Iowa,
Mr. Grassley, is on the floor. He, Senator Leahy, and many others have
proposed the CREATES Act, which will help bring more lower cost generic
drugs to patients by eliminating anticompetitive practices by brand
drugmakers. That is in the bill we approved. It also includes helping
biosimilar companies speed drug development through a transparent,
modernized, and searchable patent database. That was proposed by
Senators Collins, Kaine, Braun, Hawley, Murkowski, Paul, Portman,
Shaheen, and Stabenow. This legislation we have was approved 20 to 3.
There are 55 different proposals by 65 different U.S. Senators--about
the same number of Republicans and Democrats--all to reduce healthcare
costs.
Here are some other examples. The bill improves the Food and Drug
Administration's drug patent database by keeping it more up to date to
help generic drug companies speed product development, a proposal
offered by Senator Cassidy and Senator Durbin.
Another provision is it prevents the abuse of citizens' petitions.
These are used to unnecessarily delay drug approvals. This was proposed
by Senators Gardner, Shaheen, Cassidy, Bennet, Cramer, and Braun.
President Trump included that in his 2020 budget.
Another provision is it clarifies that the makers of brand biological
products, such as insulin, are not gaming the system to delay new,
lower cost biosimilars. That came from Senators Smith, Cassidy, and
Cramer.
Another provision is it eliminates exclusivity loopholes. These allow
drug companies to get exclusivity and delay patient access to less
costly generic drugs by just making small tweaks to an old drug. That
came from Senators Roberts, Cassidy, and Smith, which President Trump
also proposed in his budget.
Another provision prevents the blocking of generic drugs. This is
done by eliminating a loophole that allows a first generic to submit an
application to FDA and block other generics from the market. Again, the
President included this in his budget.
Another provision in our bill prevents delays of biosimilar drugs by
excluding biological products from compliance with U.S. Pharmacopeia
standards. That sounds pretty complicated, but what it means is that it
could delay patient access and lower the cost of drugs. Again, that is
another proposal by President Trump.
Another provision is it increases transparency on price and quality
information by banning the kind of gag clauses Senator Capito talked
about. These are gag clauses in contracts between providers and health
plans that prevent patients, plan sponsors, or referring physicians
from seeing price and quality information.
Another provision bans pharmacy benefit managers from charging more
for a drug than it paid for the same drug.
Instead of remaining stuck in a perpetual partisan argument over
ObamaCare and health insurance--and I can guarantee you that is going
to continue to go on for a while--we have Senators on that side of the
aisle and Senators on this side of the aisle working together to lower
the cost of what Americans pay for healthcare out of their own pockets.
Since January, Senator Murray and I have been working in parallel
with Senator Grassley and Senator Wyden of the Finance Committee. They
are continuing to work on their own bipartisan bill. Last month, the
Senate Judiciary Committee also voted to lower the cost of prescription
drugs. In the House, the Energy and Commerce, Ways and Means, and
Judiciary Committees have all reported out bipartisan bills on the cost
of prescription drugs.
As I have mentioned, President Trump and Secretary Azar have been
focused on this. Last year, the administration released a blueprint on
steps the President would take to lower prescription drugs. Last year,
the Food and Drug Administration set a new record for generic drug
approvals. Generic drugs can be up to 85 percent less expensive than
brand drugs.
So I believe the cost of prescription drugs is an area where
Democrats and Republicans in Congress and the administration can find
common ground to help Americans reduce the cost of healthcare that they
pay for out of their own pockets.
I am very hopeful that our bill, with 55 proposals from 65 Senators,
which has been reported to the Senate floor, will be placed by the
majority and minority leaders on the Senate floor before the end of the
month. We can pass it, the House will do their job, and we can send it
to the President to lower prescription drug costs.
I yield the floor.
The PRESIDING OFFICER. The Senator from Oklahoma.
Mr. LANKFORD. Mr. President, I rise to talk to this body again about
healthcare and the cost of healthcare. This has been an issue and an
ongoing dialogue for a long time around the Senate and around Congress.
It is an issue that was supposedly settled when the Affordable Care
Act was passed, but, ironically enough, my Democratic colleagues have
now joined Republicans in saying they want to repeal and replace the
Affordable Care Act. They are not using the term ``repeal and
replace''; they are just saying they want to do Medicare for All. Built
into that is completely taking out the Affordable Care Act and
replacing it with something different.
So, ironically, in some ways, we are in the same spot. We have both
come to the same realization that the Affordable Care Act didn't pass--
it actually did pass, but it is not working. So now the challenge is
what to do with healthcare.
[[Page S4756]]
We are now trying to break into pieces what we can actually do
together to get this done, beginning with the cost of prescription
drugs.
I continue to hear from Oklahomans all over the State about how hard
it is to deal with the cost of prescription drugs, how rapidly the
costs are increasing, and how sporadic the cost changes really are.
They will have a drug that costs a small amount one month and come back
a month later and find a dramatic increase for the exact same drug.
They can go pharmacy to pharmacy and find a different price for the
exact same drug or find that the pharmacy closest to them doesn't offer
that drug, and a different pharmacy is the only one that is allowed to
have that drug. The complexity is driving them crazy and rightfully so.
As we peel back the layers on pharmacy issues, we are finding that
the complexity is that cost overruns being built in are too high.
For the past few months, we have looked at every step in the drug
process, from the approval to research and development, to try to
figure out how the cost is actually getting to the consumer.
Along the way, several things have occurred. The administration has
aggressively been approving generics. In fact, the administration has
approved a record number of generics. Those generic pharmaceuticals are
much less expensive than the branded pharmaceuticals. Many of those
have been waiting a very long time at the Food and Drug Administration
to actually be approved. The Food and Drug Administration is rapidly
getting those out the door, and that helps consumers.
Something else we have done in Congress is to try to address
something called the gag clause. The gag clause is one of those things
that was behind the scenes that no one knew about except for the
pharmacists because, if you came in with your insurance card to pick up
your prescription, the pharmacist knew the actual cost you would pay if
you paid in cash. Often, you could get that same prescription for less
by paying in cash than you could if you were to pay with your insurance
card, but the pharmacist was prohibited from actually telling you that.
We have addressed that in Congress, in a bipartisan way, to release
that gag clause and allow pharmacists to actually tell people their
options on pricing.
You might say: That is an absolutely crazy thing. Who put that gag
rule in?
Well, the system, and the structure behind the scenes that negotiates
all of it, said: If you want to be a pharmacy that sells these drugs,
you have to submit to these rules. As we found, the culprit behind many
of these issues is a group called pharmacy benefit managers. You will
hear it referred to as just the PBMs.
Those pharmacy benefit managers are supposed to negotiate between the
manufacturers and the insurance plans to lower the prices. In many
areas, they have lowered prices, but they have also given preferred
formulary placement to some of their preferred pharmacies so some
pharmacies get that drug and other pharmacies that are competing with
them don't get access to that drug. Often, it is the drug that is the
highest margin drug only their pharmacies will get and other pharmacies
will not.
It has become an anti-competitive piece in the background, when it
was supposed to be something that was a highly competitive piece to
actually help the consumer.
Unfortunately, PBMs have created one of the most elaborate, complex,
and opaque system of pricing, which has a tremendous amount of market
distortion and at times has limited patients' access to those drugs.
Oftentimes, it is a system they have been able to take advantage of and
have created financial incentives to help their bottom line in the
process rather than actually help the consumer.
Many consumers have heard about rebates, but they wonder who is
getting a rebate. They go to their pharmacy to pay for their drugs, and
they are not getting the rebate. There is a rebate going somewhere,
just not to them.
Here is the challenge. We are trying to peel back with greater
transparency what is happening in the pharmacy benefit manager world
and figure out how a small group--it is actually three companies that
have 90 percent of the market nationwide, how that middleman in the
process actually handles pricing and negotiation.
If you talk to any pharmacist anywhere in the country--and certainly
across my great State--who is an independent pharmacist, they will all
express their frustration with pharmacy benefit managers and their
access to some drugs and not others and the stipulations they
deliberately put there to hurt them and help others.
I have joined my colleague Senator Cantwell in trying to shine some
light on the operations of PBMs within the drug chains. Consumers
deserve greater transparency. That will help us understand the actual
cost of drugs and how those costs are actually getting to consumers or
not to consumers in the process. The PBMs need greater examination, and
we are finally taking that up to walk through the process.
On the Finance Committee, we are dealing with several issues. Led by
Senator Grassley, we are walking through Part B of Medicare, Part D of
Medicare, and trying to examine what can be done to help the actual
consumer. Our goals are how do we actually increase the options in
drugs that are out there, how do we stop the cost increases, and how do
we decrease out-of-pocket costs for pharmaceuticals.
In Part B--these are drugs that are often intravenous, but they are
done in a hospital setting or in an inpatient setting. As we are
working through that process, we are trying to find the perverse
incentives that are built in because, right now, physicians are
actually paid a percentage of the medicine they prescribe in Part B.
That means if there are three medications that are out there, if a
doctor prescribes the highest cost medication, they get a much higher
reimbursement. It is not a flat amount. Now, all three may be
intravenous, but whichever is the most expensive actually helps the
doctor the most. I am not challenging doctors and saying they are
always prescribing the branded drugs and the most expensive in the
process--that is between the doctor and the patient to determine--but
there is no doubt a perverse incentive is built into this; that if they
prescribe a more expensive drug, the doctor and his office actually
benefit from it. We need to fix that.
In Part D, there are reforms that can actually slow the growth in
cost increases and allow people to have greater access to drugs. We are
not interested in some kind of formula where we are actually going to
decrease the patients' options of what drugs they can actually get in
their formulary. That is a great thing about being an American; that we
don't have limited formularies. It is very open in the process so
Americans can try different pharmaceuticals to see which one works best
for them. That is not chosen by government; it is chosen by them and
their doctors. The Part D definitely needs a redesign of the benefit
structure because right now things like the doughnut hole drive up
costs for consumers. We are exploring a way to limit the out-of-pocket
costs for beneficiaries so there is a lifetime cap sitting out there.
There is an opportunity to know that if I end up with cancer or some
other rare disease, I am not going to have these out-of-control costs
on the pharmaceutical side and know there is not a doughnut hole
waiting for me, where when I get a couple thousand dollars in, I am
suddenly going to have a very expensive time. So I can afford my
insurance in January, February, and March, but from April to August, I
can't afford prescriptions anymore. We can't have that. We have to
address those issues because that dramatically affects the out-of-
pocket costs.
There are lots of other options we are looking at while working
through this process, like the rebates, as I mentioned before, actually
getting to the consumer, not to the companies behind the scenes, and
dealing with how to take greater advantage of biosimilar drugs--very
similar to the generic drugs but just in a different category and at a
reduced cost--to allow them to have opportunities to get to those drugs
faster. We have to deal with some of the patent issues to make sure
drug manufacturers can't hold on to their patents abnormally long so
the generics can't actually get out to people or bundle them together
to restrict their patents.
We have to end this practice of surprise medical bills. Some folks
have no
[[Page S4757]]
idea what that is, and other folks know all too well. They look at
their insurance. They go to a hospital that is in network, and their
doctor is in network. So they go to a hospital that is in network, and
they go to a doctor who is in network, but they get a giant bill from
an out-of-network anesthesiologist, or the lab is out of network and
the hospital is in network, and they get a giant bill from the lab. We
are working to end the practice of having labs that are out of network
or certain specialists a doctor has sent them to--the patient assumes
they are in network, but then they find out that certain individuals
who have taken care of them are out of network.
We are also dealing with the issue of air ambulance surprise bills,
which has been a great challenge for those folks in rural America who
are having to be transferred long distances to get to a hospital and
then are getting an enormous bill for an out-of-network air ambulance
as a surprise billing. There are ways we can address this to deal with
the out-of-pocket costs.
We are focused on areas where we can find agreement and things we can
do to work through this process.
There is much to be done in the area of prescription drugs and in the
area of in network, out of network, and surprise medical bills. We
should be able to find common ground, and I am grateful I am part of
this dialogue to help try to find ways we can come together, get this
resolved, and get a better situation for American consumers and
patients in the days ahead.
With that, I yield the floor.
The PRESIDING OFFICER. The Senator from Iowa.
Mr. GRASSLEY. Mr. President, I want to update my colleagues and the
American people about efforts to reduce the cost of prescription
medicine.
Last week, our country and the American people celebrated
Independence Day, marking 243 years of self-government. As elected
representatives, it is our job to make the government work for the
people, not the other way around.
For more than two centuries, our system of free enterprise has
unleashed American innovation, investment, and ingenuity. Robust
competition incubates advances in science and medicine. It leads to
lifesaving cures and promising treatments for cancer, Alzheimer's,
diabetes, and other debilitating diseases.
However, prescription medicine too often smacks consumers with
sticker shock at the pharmacy counter. The soaring prices leave
taxpayers with a big tab--particularly under the Medicare and Medicaid
Programs--and they weigh heavily on the minds of moms and dads all
across the country.
Last week, I held meetings with my constituents in 12 counties across
Iowa. The cost of prescription drugs comes up at nearly every single Q-
and-A county meeting that I hold. Iowans want to know why prices keep
climbing higher and higher. They want to know why the price of insulin
keeps going up and up and up--nearly 100 years after the lifesaving
discovery was made. They want to know what can be done to make
prescription drugs more affordable.
I am chairman of the Senate Finance Committee, and in that position,
I have been working with Ranking Member Wyden from Oregon on a
comprehensive plan to do just that. We have held a series of hearings
to examine the drug price supply chain. We are working on a path
forward. We are taking care to follow the Hippocratic Oath: ``First, do
no harm.'' In other words, let's be sure we don't try to fix what is
not broken. Americans don't want to give up high-quality lifesaving
medicine. That is why I support market-driven reforms to boost
competition and transparency, because with transparency brings
accountability and the marketplace working more free of secrecy.
Congress needs to get rid of perverse incentives and fix problems
that undermine competition in the drug pricing system, including
withholding samples by brand-name pharmaceutical companies, pay for
delay, product-hopping, and rebate-bundling. There is too much secrecy
in the pricing supply chain. Consumers can't make heads or tails of why
they are charged what they pay for their medicine.
President Trump has made reducing drug prices a top priority of this
administration, and they have taken several steps under various laws--
including even under ObamaCare--to do things that give more freedom to
consumers of medicine and on other healthcare priorities.
In another instance, on Monday, the Federal court took a negative
move, knocking down a rule that would require drug companies to
disclose the price of their drugs in television ads. This is very, very
disappointing. Senator Durbin and I worked on this in the last
Congress, and I am going to continue to work with Senator Durbin to get
this job done. Congress must correct what the Federal court said the
administration didn't have the authority to do. I disagree with the
court, but Congress can fix that. Big Pharma is already required to
disclose side effects in their ads. Consumers ought to know what the
advertised drug will cost. Today, I call upon my colleagues to climb
aboard that effort Senator Durbin and I will be pursuing.
Let's pass the bipartisan healthcare bills thoughtfully crafted in
various committees. The previous three speakers spoke to some of those
issues. Let's get these various bills correcting some of these problems
over the finish line. Working together, we can drive down the price of
prescription drugs without derailing quality and without derailing
innovation, all of which saves lives and improves the quality of life
for the American people.
I yield the floor.
The PRESIDING OFFICER. The Senator from Indiana.
Mr. BRAUN. Mr. President, Senator Grassley and I attended the rollout
of President Trump's Executive order to get the healthcare industry on
the move. The chairman of the Finance Committee, the chairman of the
Health, Education, Labor, and Pensions Committee, and Senators like
me--I am a mainstream entrepreneur--came to the Senate to discuss
issues just like this.
I have probably been on the floor more than any other Senator, and
every time I do it, I tell the industry: Wake up. I took you on 10, 11
years ago, in my own business, to give good healthcare coverage to my
employees. Year after year, it was a litany of, you are lucky your
premiums are only going up 5 to 10 percent this year. You have all
heard it before. It took risk, and it took some novel thinking, but it
can be done. Most entrepreneurs aren't going to put the time I put into
it to make it work for my own employees.
When you hear Democrats, Republicans, three or four committees, and
the President of the United States talking about a healthcare system
that is broken, you should get it through your thick head that there
need to be changes made. It shouldn't be coming from Congress, even
though it will keep coming.
I think the message is out loud and clear: Wake up and start fixing
these things, or you are going to have a business partner whose name is
Bernie Sanders and another idea of Medicare for All that we would
regret once we got it. But, like most things here, like most big
problems in this country, we wait too long to solve the issue.
To give you a few things on what led me to be passionate about it,
when I had to give up my own company's good health insurance, I had a
very generic prescription that I needed to get renewed. There were
eight pharmacies in the little town of Jasper, roughly, so I knew I
would be able to get quotes. I had no health insurance. I was in
between being a CEO of a company and a Senator. I said, I am going to
try to see what this is going to be like. I knew it should cost 20 or
25 bucks, maybe a little less.
The first place I called, they stumbled around and couldn't even give
me a quote on a common prescription. Finally, after about 3 to 4
minutes, they said $34.50. I called another place that I thought would
be a little quicker on its feet. It took 10 seconds, I got a quote for
$10, and they said: By the way, you can pick it up in 10 minutes.
That is more the way the rest of the economy works, but healthcare
consumers have gotten used to not doing any of that heavy-lifting
themselves. And believe me, the industry has evolved from Big Pharma,
to big hospital chains, to the health insurance industry, which is in
the middle of all of it. There are pharmacy benefit managers, and the
drug companies give
[[Page S4758]]
them $150 billion worth of rebates, and through their costs and
profits, less than half of that makes it to the consumer or to the
pharmacy.
The case is out there. We, as Senators and Congressmen on the other
side, shouldn't need to be going to the floors of our Chambers to tell
you the obvious: If you don't do these things, I don't believe we
here--at the speed at which we normally operate--can do it quickly
enough for you to save yourselves from that other business plan, which
is Medicare for All.
So what do we do to prevent that? No. 1, the industry should be out
there doing what all other companies do--be transparent. In any other
part of our economy, where do you not ask for and have plenty of
information to work with. What does it cost, and what is the quality? I
know that where I live, people would drive 60 miles to save 50 bucks on
a big-screen TV that costs a thousand bucks.
When I instituted a plan in my own business that encouraged my
employees to do that, to have skin in the game, amazing things
happened. Every time you pick up the phone or get on the web and look
for that comparison, it is kind of hard to find, but it is there. The
industry just needs to give more of it and not hide behind a system
that has benefitted them. When we created that in my own business,
people shopped around for prescriptions and routinely saved 30 to 70
percent, as they do on MRIs, CAT scans, and most other procedures.
I put the time and effort into it. Most CEOs--and you always hear
about how employees are happy with their employer-provided insurance.
That is because the employers are generally paying for anywhere from 85
to 100 percent of it. So folks working somewhere don't really have skin
in the game.
Consumers of healthcare need to do what they do in all other
industries and in all other things that they buy--take the time to ask
how much it costs, what is the quality, and then the industry get with
it so that we can fix the system before the other option actually takes
place. There aren't enough CEOs and there aren't enough legislators to,
I think, get the industry in shape, and the industry itself knows what
these problems are. Get with it before you have a different business
partner whom you won't like.
I yield the floor.
The PRESIDING OFFICER. The Senator from Louisiana.
Mr. CASSIDY. Mr. President, I, too, come to speak today regarding
pharmaceutical costs and what we can do to make lifesaving
medications--and sometimes these medications make our lives a little
bit better--more affordable to the average American.
I happen to be a doctor, and I will approach these remarks as a
fellow who has seen medicine evolve, who has seen the incredible,
positive benefits of pharmaceutical innovation, but also as a doctor
who sometimes saw that patients were unable to afford innovation. The
question in my mind is, How do we give the patient the power to afford
these innovative medicines, because if she cannot afford them, it is as
if the innovation never occurred, and for her, it never did occur. So
give the patient power.
Let me make some remarks about pharmaceutical companies. There are
some incredible examples.
When I was in medical school, cutting away a part of one's stomach--
not the belly but part of the stomach; as I would tell patients, where
the food goes after you swallow it--cutting away a part of the stomach
because of ulcerative disease was one of the most common procedures
done in surgery. Then histamine blockers came along, H2 blockers.
Cimetidine was the first. All of a sudden, a surgery that was done
multiple times a week was scarcely ever done. Those medicines are now
sold over the counter.
This morning, I got a little bit of arthritis, so I took my
nonsteroidal anti-inflammatory, which used to be sold by prescription
and now is over the counter, along with my H2 blocker, my Pepcid, which
used to be sold by prescription but now is over the counter. I take
them in the morning, and my back feels better. All of these are
medicines that are generic, routine, and we almost--in fact, we indeed
take the innovation for granted.
I can go on. I am a liver doctor. Hepatitis C used to be an incurable
disease which, in a certain percentage of those affected, would lead to
cirrhosis, vomiting blood, liver cancer, and death. Now hepatitis C is
cured by taking pills for several weeks. Amazing.
Human immunodeficiency virus, AIDS. When I was in residency, if you
got HIV, you died. There was no cure whatsoever. Now people live with
it for decades. It is a disease you live with but do not die from. We
speak of actually now developing cures for HIV.
That is the promise of a vibrant pharmaceutical industry--people who
not only live when otherwise they would have passed away but who also
have a better quality of life.
Now, that said, if the patient doesn't have the power, the patient
has no leverage in this situation.
I was recently with others in a conversation with the new head of the
Congressional Budget Office. The CBO head said: You know, everybody has
leverage in the healthcare marketplace except the patient. Everybody
has leverage but not the patient.
That is so true. Let me give some examples of how the patient lacks
leverage in the pharmaceutical marketplace.
First, I will say, if I go to church--and I do go to church
regularly--and there is a Bernie Sanders supporter yanking on this
lapel and a Donald Trump supporter yanking on this lapel and they are
complaining about the same thing, they are talking about either
surprise medical bills or the high cost of drugs. It is something that
touches each American, but it doesn't have to be that way.
Consumer Reports did an article over 1 year ago now in which they
sent secret shoppers out to retail pharmacies to buy five generic
medications, a prescription for each type--again, generic, like the
over-the-counter pills I am taking. They went, and they paid anywhere
from $66 to $900 for the same five drugs. Now, we can assume that the
acquisition cost was about 60 bucks, because you could buy it
someplace--an independent pharmacy or online--for $66, but three or
four chain pharmacies were charging $900 for medications that they
could acquire for less than $60.
You could argue, why did the patient pay? Because we have so little
advertising, if you will, cost competition, on what a generic medicine
would cost. So imagine you have a health savings account, and you are
going to buy your prescriptions, and you get charged $900 for something
that should cost $60. This is the situation in which the patient has no
leverage.
By the way, you can ask, why didn't insurance cover it? It is because
these patients were posing as uninsured. So the chain pharmacy figured
out that it is the uninsured who do not have somebody working on their
behalf who are going to be the most ripe for the picking for the high
prices. The uninsured are the ones we are going to exploit, the ones
paying cash. That is wrong. That is not the patient having the power;
it is the patient being used as a victim.
There are other things we can see. One is called evergreening. You
have a drug, and you make just a little bit of a tweak to it that
doesn't improve its importance or the efficacy of the drug--no clinical
benefit--but it extends the intellectual property protections. Now laws
that were conceived of and passed by Congress to reward innovation and
to encourage creativity are instead being used to stifle competition
and to extend patent lives so that we, the patients and the taxpayers,
have to pay more--not for innovation but, rather because, somebody
figured out how to evergreen it.
So on the one hand, I am going to praise pharmaceutical companies for
lifesaving drugs that have meant so much to me, my family, and everyone
who is listening today, but I must also ask, why should we reward that
which is not innovative but which is merely arbitraging laws meant to
encourage innovation? We should not encourage arbitraging laws.
There are other issues, such as patent abuse, where companies file
large numbers of patents on parts of their drugs that are not
innovative but are byproducts of the production process in order to
keep out competition; citizen petitions, which typically come on 6
months before a drug is about to become generic, so all of a sudden, we
have all these petitions that must be navigated by the companies
seeking to
[[Page S4759]]
introduce the generic; and the rebate system, which works to preserve
market share but also to increase prices and to keep them high so
patients do not benefit from competition.
If we are going to say the patient should have the power in order to
have lower prices, we can say right now that the system seems to be
aligned against the patient.
What can we do? Well, my office and others have several proposals in
the current pieces of legislation going through, such as the so-called
real-time benefit analysis. A prescription is ordered for a patient.
The patient scans a barcode, and it would say: At this point, with your
deductible and your copay, this is how much this drug is going to cost
you, but there is a generic available, and you can get that generic
instead. That would be a real-time benefit analysis that would save the
patient money.
We just talked to the folks at Blue Cross California. They are coming
up with so-called gainsharing. If a patient selects a lower cost
medication, the patient receives some of the savings that would
otherwise have all gone back to the insurance company--another great
idea. Senator Braun was speaking about the patient having skin in the
game. In this case, there will be skin in the game because the patient
shares the benefit with the payor for being cost-conscious. That is the
patient having the power.
We can also add value-based arrangements, which pharmaceutical
companies, to their credit, have proposed. If you are the
pharmaceutical company, you get paid only if the medicine works. If the
medicine doesn't work, you don't get paid. If it does work, you do.
That is a value-based arrangement. We have a bill with Senator Warner
that would do that.
I would also mention attempting to cap Part D exposure. If there is a
senior citizen who is in the catastrophic portion of her policy, then
you can cap the amount the senior might be exposed to. Under current
law, she might be paying 5 percent of $100,000 worth of medicine. She
is taking an essential drug to treat cancer, and she is paying 5
percent of that $100,000, in addition to 5 percent of the other
medications she is receiving. This is something many seniors cannot
afford and this is something we as Congress can find mechanisms by
which we can cap that exposure but still hold taxpayers whole.
We have to enhance existing markets. As you might guess, my theme is
that we should enhance it in terms of giving the patient the power, but
we also have to preserve the innovation that has led to the great drugs
I spoke about earlier. If all we do is steal intellectual property from
the pharmaceutical companies, we will lose these innovative drugs. But,
again, we need to have the drugs affordable for the patients. This is
the tension--promote innovation but ensure affordability.
We have a number of solutions, such as those I have just mentioned,
in the HELP Committee and now in the Finance Committee. Republicans
have solutions. My office continues to work on those. I look forward to
working with my colleagues on their implementation.
Mr. President, I yield the floor.
____________________