[Congressional Record Volume 165, Number 170 (Monday, October 28, 2019)]
[House]
[Pages H8516-H8519]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PUBLIC DISCLOSURE OF DRUG DISCOUNTS AND REAL-TIME BENEFICIARY DRUG COST
ACT
Ms. SCHAKOWSKY. Madam Speaker, I move to suspend the rules and pass
the bill (H.R. 2115) to amend title XI of the Social Security Act to
provide greater transparency of discounts provided by drug
manufacturers, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 2115
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Public Disclosure of Drug
Discounts and Real-Time Beneficiary Drug Cost Act''.
SEC. 2. PUBLIC DISCLOSURE OF DRUG DISCOUNTS.
Section 1150A of the Social Security Act (42 U.S.C. 1320b-
23) is amended--
(1) in subsection (c), in the matter preceding paragraph
(1), by inserting ``(other than as permitted under subsection
(e))'' after ``disclosed by the Secretary''; and
(2) by adding at the end the following new subsection:
``(e) Public Availability of Certain Information.--
``(1) In general.--In order to allow the comparison of
PBMs' ability to negotiate rebates, discounts, direct and
indirect remuneration fees, administrative fees, and price
concessions and the amount of such rebates, discounts, direct
and indirect remuneration fees, administrative fees, and
price concessions that are passed through to plan sponsors,
beginning January 1, 2020, the Secretary shall make available
on the Internet website of the Department of Health and Human
Services the information with respect to the second preceding
calendar year provided to the Secretary on generic dispensing
rates (as described in paragraph (1) of subsection (b)) and
information provided to the Secretary under paragraphs (2)
and (3) of such subsection that, as determined by the
Secretary, is with respect to each PBM.
``(2) Availability of data.--In carrying out paragraph (1),
the Secretary shall ensure the following:
``(A) Confidentiality.--The information described in such
paragraph is displayed in a manner that prevents the
disclosure of information, with respect to an individual drug
or an individual plan, on rebates, discounts, direct and
indirect remuneration fees, administrative fees, and price
concessions.
``(B) Class of drug.--The information described in such
paragraph is made available by class of drug, using an
existing classification system, but only if the class
contains such number of drugs, as specified by the Secretary
(but not fewer than three drugs), to ensure confidentiality
of proprietary information or other information that is
prevented to be disclosed under subparagraph (A).''.
SEC. 3. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS TO INCLUDE
REAL-TIME BENEFIT INFORMATION AS PART OF SUCH
SPONSOR'S ELECTRONIC PRESCRIPTION PROGRAM UNDER
THE MEDICARE PROGRAM.
Section 1860D-4(e)(2) of the Social Security Act (42 U.S.C.
1395w-104(e)(2)) is amended--
(1) in subparagraph (D), by striking ``To the extent'' and
inserting ``Except as provided in subparagraph (F), to the
extent''; and
(2) by adding at the end the following new subparagraph:
``(F) Real-time benefit information.--
``(i) In general.--Not later than January 1, 2021, the
program shall implement real-time benefit tools that are
capable of integrating with a prescribing health care
professional's electronic prescribing or electronic health
record system for the transmission of formulary and benefit
information in real time to prescribing health care
professionals. With respect to a covered part D drug, such
tools shall be capable of transmitting such information
specific to an individual enrolled in a prescription drug
plan. Such information shall include the following:
``(I) A list of any clinically-appropriate alternatives to
such drug included in the formulary of such plan.
``(II) Cost-sharing information for such drug and such
alternatives, including a description of any variance in cost
sharing based on the pharmacy dispensing such drug or such
alternatives.
``(III) Information relating to whether such drug is
included in the formulary of such plan and any prior
authorization or other utilization management requirements
applicable to such drug and such alternatives so included.
``(ii) Electronic transmission.--The provisions of
subclauses (I) and (II) of clause (ii) of subparagraph (E)
shall apply to an electronic transmission described in clause
(i) in the same manner as such provisions apply with respect
to an electronic transmission described in clause (i) of such
subparagraph.
``(iii) Special rule for 2021.--The program shall be deemed
to be in compliance with clause (i) for 2021 if the program
complies with the provisions of section 423.160(b)(7) of
title 42, Code of Federal Regulations (or a successor
regulation), for such year.
``(iv) Rule of construction.--Nothing in this subparagraph
shall be construed as to allow a real-time benefits tool to
steer an individual, without the consent of the individual,
to a particular pharmacy or pharmacy setting over their
preferred pharmacy setting nor prohibit the designation of a
preferred pharmacy under such tool.''.
SEC. 4. SENSE OF CONGRESS REGARDING THE NEED TO EXPAND
COMMERCIALLY AVAILABLE DRUG PRICING COMPARISON
PLATFORMS.
It is the sense of Congress that--
(1) commercially available drug pricing comparison
platforms can, at no cost, help patients find the lowest
price for their medications at their local pharmacy;
(2) such platforms should be integrated, to the maximum
extent possible, in the health care delivery ecosystem; and
(3) pharmacy benefit managers should work to disclose
generic and brand name drug prices to such platforms to
ensure that--
(A) patients can benefit from the lowest possible price
available to them; and
(B) overall drug prices can be reduced as more educated
purchasing decisions are made based on price transparency.
The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from
Illinois (Ms. Schakowsky) and the gentleman from Texas (Mr. Burgess)
each will control 20 minutes.
The Chair recognizes the gentlewoman from Illinois.
General Leave
Ms. SCHAKOWSKY. Madam Speaker, I ask unanimous consent that all
Members may have 5 legislative days in which to revise and extend their
remarks and include extraneous material on H.R. 2115.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from Illinois?
There was no objection.
Ms. SCHAKOWSKY. Madam Speaker, I yield 4 minutes to the gentlewoman
from Virginia (Ms. Spanberger), an author and supporter of this bill.
[[Page H8517]]
Ms. SPANBERGER. Madam Speaker, I rise in support of my bill, H.R.
2115, the Public Disclosure of Drug Discounts Act.
First, I thank my colleagues Congressman Arrington and Congressman
Boyle for their partnership on this bipartisan legislation. I thank
Congresswoman Slotkin for her cooperation and commitment to our
efforts. And I thank Congresswoman Schakowsky for her work here today.
Madam Speaker, if we are going to make substantial long-term progress
on the issue of prescription drugs, we can't be afraid to work in a
bipartisan manner, and I thank my colleagues for joining me in this
fight.
I also thank Chairman Pallone and Chairman Neal for their dedicated
work on tackling prescription drug costs and the Committee on Energy
and Commerce and the Committee on Ways and Means for voting to advance
our bill and making this floor vote possible.
This bipartisan bill would help address the number one concern facing
central Virginia's working families, chronically ill, and seniors--the
rising cost of healthcare.
In every community in the Seventh District of Virginia, from
Chesterfield to Culpeper, the extremely personal effects of rising
prescription drug costs are on full display. Whether at a coffee shop,
town hall, or street fair, I always hear yet another heartbreaking
story from a mother, a father, a grandparent, or a young adult
struggling to afford their prescription drugs. People genuinely feel
helpless, and it is due to no fault of their own.
In many cases, steep costs have forced them to make nearly impossible
decisions. A costly, lifesaving medication could mean buying fewer
groceries for their family. It could mean reluctantly selling their
home. It could mean saving less, or nothing at all, for their
retirement or their kids' education. And even for those who are
healthy, there is an overwhelming fear: What if I get sick, or what if
a loved one gets sick, and we can't afford the medication?
Back in August, I held a roundtable with patients, pharmacists, and
healthcare providers in Henrico County to discuss this community-wide
issue. Together, we talked about the financial challenges caused by
overpriced drugs, but we also discussed the issue of pharmacy benefit
managers, PBMs.
To those in the healthcare industry, PBMs are known as the middlemen
between drugmakers, health insurers, and pharmacies. But for many
Americans, PBMs remain a mysterious player within the prescription drug
marketplace.
Operating in the murky world of drug negotiation, there are few
windows into the value of the rebates and discounts PBMs receive from
drug companies. Effectively, they are a black box in the long supply
chain from the pharmaceutical company to the patient.
During our roundtable in Henrico, one local pharmacist described how
PBMs continue to enjoy record profits thanks to the pharmaceutical
industry, while patients and pharmacists get stuck with unsustainable
costs.
Right now, the three largest PBMs control three-quarters of the U.S.
prescription drug market. There seems to be little transparency. And
where there is zero transparency, there is rarely room for
accountability or oversight.
If we don't cast sunlight into this black box, patients will continue
to be left in the dark about the effect of PBMs on the prices of
specific drugs. The Public Disclosure of Drug Discounts Act would be a
step toward bringing greater transparency to this broken system.
The principle behind my bill is simple. Let's take the information
already provided to the Federal Government and make it public.
PBMs are already required to declare rebate data, discounts, and
generic dispensing rates to HHS, but under my bill, this information
would be posted publicly for the general public to see.
Beyond the principle of my bill, the goal is even simpler: lowering
drug costs for our neighbors.
By sharing this information online with American consumers and
businesses, we would give seniors, families, and pharmacists a better
sense of how PBMs could be influencing excessive prices. And we would
start to address one of the root causes of our prescription drug
affordability crisis.
In central Virginia and across the country, families should not be
racked by a constant uneasiness about their financial well-being simply
due to rising drug costs. They shouldn't be forced to accept silently
the undisclosed results of PBM negotiations that could be bankrupting
them.
We need to show the American people that we want to see progress on
this vital economic issue and that we are hearing their stories, seeing
the problems that exist, and actually moving to reform a prescription
drug marketplace that too often seems to be working against the best
interests of American patients.
Today, I call on my colleagues to pass the Public Disclosure of Drug
Discounts Act because we are long overdue for meaningful actions that
can turn the tide.
Mr. BURGESS. Madam Speaker, I yield myself such time as I may
consume.
Madam Speaker, I rise to speak in support of H.R. 2115, the Public
Disclosure of Drug Discounts and Real-Time Beneficiary Drug Cost Act.
This bill includes three provisions that passed through the Committee
on Energy and Commerce in July as part of a larger transparency
package, at that time called the METRIC Act.
The first provision aims to hold pharmacy benefit managers
accountable in the negotiation of rebates by requiring the Secretary of
the Department of Health and Human Services to make rebates, discounts,
direct and indirect remuneration fees, and other information available
on a public website. This policy includes a requirement that this
information be displayed in such a way that it maintains the
confidentiality of individual drugs and plans.
What I believe is the most important provision is the one that
requires prescription drug plan sponsors to include real-time benefits
information in electronic prescribing in Medicare. As a physician, I
recognize how important it is for doctors to have as much information
at their disposal in prescribing appropriate medications for their
patients.
Madam Speaker, I thank my fellow Texans, Jodey Arrington as well as
Pete Olson, for bringing forth this policy.
In the past few years, we have begun to see the success of the 21st
Century Cures Act actually come to life. New treatments and new cures
are coming to the market at an exciting pace, providing great promise
for America's patients.
It is important that doctors be able to see and compare the prices of
these medications so that they can help their patients assess their
options. Price transparency at the point of prescribing will provide
physicians with information regarding what would or would not be
covered under their patients' insurance and would help them discuss
what would be the most affordable options that are available to their
patients.
While there are a lot of factors that doctors must consider when
prescribing their patients' medications, medication adherence is
essential. If patients cannot afford their drugs, the stage is set for
a lack of adherence to the recommended regimen.
We have all heard the stories of patients showing up at the pharmacy
counter to pick up their prescriptions, at which point they learn it is
unaffordable. This policy would help reduce the number of prescriptions
left at the pharmacy counter, not picked up due to cost concerns.
The American Medical Association testified at our drug supply hearing
in May that ``access to accurate patient coverage and cost-sharing
information at the point-of-care would streamline the process, reduce
burden for the physician and the patient, and speed delivery of the
most appropriate care.''
I agree with that statement, and I am pleased this legislation would
improve access to real-time benefits data, further informing quality
and doctor-patient decisionmaking and improving patient access to
affordable medications.
Madam Speaker, I urge Members to support H.R. 2115, and I reserve the
balance of my time.
Ms. SCHAKOWSKY. Madam Speaker, I yield 3 minutes to the gentlewoman
from Michigan (Ms. Slotkin) on this legislation.
[[Page H8518]]
Ms. SLOTKIN. Madam Speaker, I thank Congresswoman Schakowsky and
Congresswoman Spanberger.
Madam Speaker, I rise today to speak in support of my bill, the Real-
Time Benefits Act, which has been incorporated into the bill before us
today.
The bill started with a very simple request from seniors in my
district. People want to know how much a prescription will cost before
they pick it up at the drugstore, and they deserve to know that it is
the best possible price that they can get.
This bill does that very thing. It provides Medicare patients with
the information they need about the cost of the prescription and
whether there are generic alternatives, as well as the best pharmacy
for the best deal before they even leave the doctor's office.
Right now, here is how the system works. A patient goes to the
doctor, gets a prescription, and walks out. Then they take it to a
local pharmacy, fill it, and pick it up. It is right then, at the
counter, in front of everyone else, that they actually find out the
price of their bill.
There is no advanced warning, no comparison shopping, no offer of
generics, and no way of knowing if a different pharmacy could have it
cheaper. By the time you get to the pharmacy, they have you over a
barrel. This bipartisan bill would fix that.
Here is how it works. Insurers would be required to provide
information to a common system, a real-time benefits tool, which
doctors would access through their electronic prescribing program.
Doctors and patients could then sit together to receive real-time
updates, right in the doctor's office, on the price of the drug based
on the patient's insurance plan, as well as the price of any other
cheaper drugs available.
This real-time benefits tools will also list the price differences at
each pharmacy--Rite Aid versus CVS--to allow physicians to make sure
that the patients are getting the lowest possible prices.
{time} 1830
This not only lowers out-of-pocket costs for seniors, but it
increases much-needed price transparency into our system.
Imagine if, every time you went to the doctor, both you and your
physician could see the differences in the prices of drugs. This is the
kind of all-American competition we need when it comes to our
prescription drugs.
To be clear, the cost of prescription drugs is the number one issue I
get asked about in my district. People come up to me in the grocery
store. They grab my arm. They ask me why their medication has increased
by 200 percent in cost in the past 5 years.
Connie, a constituent of mine in Brighton, spends $10,000 a year on
Humira for her Crohn's disease, even though she is on Medicare.
Joanna, who lives in my hometown of Holly, Michigan, was hospitalized
for several days due to complications because she could not afford her
inhaler. Her complex health needs require a number of medicines, so she
literally rations her medicines in order to keep them manageable, and
she still spends hundreds of dollars each month.
This is wrong, and our constituents, regardless of party, are asking
us to do something about it.
Democrats and Republicans have both said the right things about the
cost of prescription drugs. They have talked the talk. They now must
walk the walk.
I am incredibly proud to have brought forth this bipartisan
legislation tonight. I urge my colleagues to join me in voting ``yes''
to promote transparency and competition.
Mr. BURGESS. Madam Speaker, I yield 3 minutes to the gentleman from
Georgia (Mr. Carter), a pharmacist by profession and a very valuable
member of the Health Subcommittee of the Committee on Energy and
Commerce.
Mr. CARTER of Georgia. Madam Speaker, I thank the gentleman for
yielding.
I rise to speak in support of H.R. 2115, the Public Disclosure of
Drug Discounts Act. I am very glad to see this bill, which was part of
the METRIC Act Representative Schakowsky and I passed out of Energy and
Commerce, being moved through the House floor. This is important
legislation that brings desperately needed transparency to our drug
supply chain.
So much of the debate around how we can lower drug prices in this
country has been focused on drug manufacturers. This bill highlights
the need for reforms throughout our entire drug supply system.
Specifically, this bill shines a spotlight on the middlemen in our drug
supply chain: the pharmacy benefit managers, or PBMs.
For context, three PBMs control almost 80 percent of the marketplace,
and while originally designed to primarily process claims data, these
companies are now some of the largest corporations in the country. For
the year 2019, the major PBM companies had a higher projected revenue
than Facebook, Amazon, Apple, Netflix, and Google combined.
Again, for this year, 2019, the major PBM companies had a higher
projected revenue than Facebook, Amazon, Apple, Netflix, and Google
combined.
In a time where patients are facing higher and higher drug costs, it
is clear that more transparency of these middlemen is desperately
needed, at the very least. This bill, H.R. 2115, will require PBMs to
report information on all of the rebates, fees, and discounts they
extract before a drug ever reaches patients.
PBMs argue that it is actually better for patients that the PBMs
extract all of these increasingly high rebates and fees because they
pass those discounts on to the insurance plans to lower premiums.
While I completely disagree with that premise, this bill will finally
allow all of us to see for ourselves exactly how much of a cut these
middlemen are taking out of the system.
Transparency is absolutely critical if we are going to lower drug
prices for patients, and this bill is a big step in the right
direction.
I applaud Representatives Spanberger, Arrington, and Boyle for their
leadership on this bill, as well as my Energy and Commerce counterpart,
Congresswoman Schakowsky.
Madam Speaker, I urge my colleagues to support H.R. 2115.
Ms. SCHAKOWSKY. Madam Speaker, I am prepared to close now just by
saying the cost of prescription drugs is an issue on the minds of all
of our constituents, in a bipartisan way, all across the country, and
this bill will provide much-needed transparency around the activity of
pharmacy benefit managers, or PBMs.
You heard very eloquent statements from our colleagues on this issue.
I am going to close now and just say I hope that all of our colleagues
will vote for this legislation.
Madam Speaker, I yield back the balance of my time.
Mr. BURGESS. Madam Speaker, I yield 3 minutes to the gentleman from
Texas (Mr. Arrington), coauthor of this legislation.
Mr. ARRINGTON. Madam Speaker, I thank my friend and fellow Texan, Dr.
Burgess, for yielding me time to speak.
Madam Speaker, I rise today in support of H.R. 2115, legislation I
was proud to help lead and support, alongside Congresswoman Spanberger,
which will provide greater transparency to the discounts negotiated
between insurance companies and drug manufacturers through what are
known as pharmacy benefit managers, or PBMs.
One of the reasons why drug costs have spiraled out of control is
because discounts negotiated by PBMs are shrouded in secrecy. Americans
are left in the dark about the rebates, and we have no idea where the
value of those rebates go.
But we know this: We know they are not going to our seniors. We know
they are not going to them at the point of sale. This has created a
system that is confusing and overly complicated, particularly for our
seniors.
My greatest concern is that the value, again, of these rebates is
being passed to our seniors, who need the relief desperately.
The answer to this drug affordability crisis is not to impose more
government control, which would only further distort the market,
further confuse our seniors, and increase costs on all Americans.
Instead, we need to activate the forces of competition and provide
patients with more transparency in this process so that they are
empowered to know exactly what their options are and what they are
paying for each time they visit the pharmacy.
[[Page H8519]]
This legislation will help ensure that rebates go toward reducing the
cost of drugs for our seniors as well as the cost to the American
taxpayer.
Additionally, I am thankful this legislation includes the text of my
bill, the Shop Rx Act. This provision, which I carried in committee
with the support of both Republicans and Democrats, requires drug plans
for seniors to offer realtime information regarding the various options
of drugs and their associated costs.
By providing seniors with access to the readily available and
relevant information they need in order to be real consumers, we will
empower them with the knowledge to choose the options that best fit
their needs and their budget. Once consumers have more information,
they will have more choices, and insurers will have to actually compete
for their business, which will ultimately bring down the cost of drugs.
Madam Speaker, I believe this legislation will help transform the
system from one in which patients are often powerless victims to one in
which they have true bargaining power and real control over their
healthcare needs. I am proud to support it, and I encourage my
colleagues to do the same.
Mr. BURGESS. Madam Speaker, I yield 3 minutes to the gentleman from
Montana (Mr. Gianforte), a valuable member of the Health Subcommittee.
Mr. GIANFORTE. Madam Speaker, I thank the gentleman for yielding.
Far too many Montanans can't afford the prescription drugs they need.
They shouldn't have to leave the pharmacy counter empty-handed because
costs are too high. Montanans need access to affordable medications,
which is why reducing drug prices is one of my top priorities.
To lower costs, we need more transparency in our healthcare system.
We need to shine a light onto the opaque drug pricing process. Our
commonsense, bipartisan bill before the House today will shine that
much-needed light.
The Payment Commission Data Act gives Congress' nonpartisan think
tanks MedPAC and MACPAC greater access to drug pricing data. Armed with
this data, they can better advise Congress about who is being a bad
actor in the drug supply chain. It will help Congress address
prescription drug prices more effectively.
We all want to ensure the American people can buy more affordable
prescription drugs. I believe the bipartisan approach we have here
should be a working model for how to move forward, not simply ramming
through partisan bills.
Madam Speaker, I urge my colleagues to vote ``yes'' on this
commonsense reform to lower drug prices.
Mr. BURGESS. Madam Speaker, I urge passage of this bill, and I yield
back the balance of my time.
Mr. SCHRADER. Madam Speaker, I rise today in support of H.R. 2115,
the ``Public Disclosure of Drug Discounts Act'' introduced from my
friend and colleague, Ms. Spanberger.
While I believe something must be done to bring down the cost of
drugs, I also know that unless we have a better view into the process
of how a patient's cost is calculated, we will continue to struggle to
address the problem. That's why I support this important piece of
legislation that requires PBMs to report on all the price concessions
and factors that contribute to determining the net cost of a drug.
PBMs play an important role in our healthcare system as the
intermediary negotiating drug prices in the current marketplace. But
only if we understand the actual cost of the drug can we ensure that
consumers are getting a fair shake. The bill before you today is
comprehensive, as it requires PBMs to report the amount of rebates,
discounts, direct and indirect remuneration fees, administrative fees,
and any other price concessions. The Secretary will make this
information available publicly in a way that aggregates the information
by class of a drug to protect the negotiation process but also provide
insight into any discrepancy between the negotiated drug's net cost and
the price a patient pays for that drug.
Addressing any healthcare problem requires a comprehensive approach.
There is no one entity that is solely responsible for the high cost of
drugs. We need transparency in our healthcare system. This bill had
bipartisan support throughout the Committee process and similar
measures have had support in the Senate. I am proud that we continue to
work on measures that will help address one of the most concerning
issues of our time, the exorbitant price of prescription drugs, and I
thank leadership for bringing this measure to the floor today.
The SPEAKER pro tempore. The question is on the motion offered by the
gentlewoman from Illinois (Ms. Schakowsky) that the House suspend the
rules and pass the bill, H.R. 2115, as amended.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds
being in the affirmative, the ayes have it.
Ms. SCHAKOWSKY. Madam Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this motion will be postponed.
____________________