[Congressional Record Volume 165, Number 178 (Thursday, November 7, 2019)]
[Senate]
[Pages S6479-S6480]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. MERKLEY (for himself and Mr. Durbin):
  S. 2817. A bill to require the Secretary of Health and Human Services 
to establish an annual reference price for insulin products for 
purposes of Federal health programs, and for other purposes; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. MERKLEY. Mr. President, Canadian historian Michael Bliss wrote in 
his 1982 book, ``The Discovery of Insulin,'' that ``[w]ith insulin, the 
stone was rolled away, and diabetes became a matter of the quality of 
life, not speed of death.''
  For thousands of years, human beings have battled diabetes. When the 
pancreas stops producing insulin, all kinds of bad things happen--heart 
attacks, stroke, blindness, kidney failure, foot disease, foot 
amputations, small blood vessels throughout the body being impacted by 
that high blood sugar. In some cases, within months, individuals waste 
away, fall into diabetic comas, and die.
  All that changed about a century ago thanks to the work of four 
Canadian scientists--Frederick Banting, Charles Best, J.B. Collip, and 
John Macleod. These four men discovered how to extract, develop, and 
refine a pure form of insulin that could be injected into the human 
body. It changed the world.
  Thirty million Americans--almost 10 percent, 9.4 percent, of the 
American population live with type 1 or type 2 diabetes today. Of those 
30 million, 7.4 million depend on insulin for their survival, but one-
quarter of the people who depend on insulin for their survival have had 
to ration their insulin in the past year because of the extraordinary, 
over-the-Moon cost of this drug that was developed a century ago.
  Rationing the drug, and therefore producing episodes or enduring 
levels of high blood sugar, has extensive health consequences. It does 
a lot of damage. Diabetic Americans are being gouged by the drug 
companies, and it needs to stop.
  Today I am introducing, in partnership with Senator Durbin, the End 
Price Gouging for Insulin Act to end this egregious practice. I want to 
ensure that every single one of those 7.4 million Americans who need 
insulin to survive can afford it. I want to ensure that not a single 
person has to ration their insulin. I can tell you that vision of every 
person having affordable insulin is what the four scientists who 
invented it nearly 100 years ago envisioned. They didn't ask for great 
wealth from their work. They did receive recognition. A Nobel Prize 
went to two of them for their role in this. They certainly weren't 
asking for huge payouts or a high price. Do you know what they did? For 
the health of humanity, they sold their patent to the University of 
Toronto for $3 to make insulin available to the world. All they cared 
about was saving lives. They wanted everyone who needed it to have it.
  What do we see today? Almost a century later, the price of insulin is 
going higher and higher with the extensive greed of the companies that 
produce it. Over the last decade, the companies selling the four most 
popular types of insulin have tripled the price of their product--
essentially the same product. They tripled the price. Nova Nordisk has 
two of these drugs; Sanofi has one; Eli Lilly has another--and they all 
tripled the price.
  In 2012, the average price of insulin was about $234 a month. By 
2016, it was $450 a month. Now we have seen it continue to rise since 
2016. They have some explanations. There are some who say: Well, it is 
due to their vast input into research and development. Remember, these 
are drugs invented a century ago. Sure, there are slight variations, 
yes, but the money is going largely to profit.
  There are those who say the price is higher because more people need 
it. More people buying it means more efficiencies, which means the 
price should drop. The nonprofit Health Care Cost Institute looked at 
the rising cost of insulin and said the excuses given by the drug 
companies just straight out aren't true. ``It's not that individuals 
are using more insulin or that new products are particularly innovative 
or provide immense benefits. Use is pretty flat,'' said Ms. Fugelsten 
Biniek, one of the authors. ``And the price changes are occurring in 
both older and newer products.''
  The reason the prices are going up--the companies are charging more--
is because they can because we don't negotiate the price of drugs in 
America by law for Medicare.
  These companies have some tricks up their sleeve. One is that when 
the generic competition gets all lined up, they proceed to pay the 
generic companies not to produce the generic drug, resulting in 
sustaining the price gouging in America.
  Now, I think this practice is ``pay to delay.'' I think it is a 
horrific predatory practice. It is a noncompetitive practice. It should 
be against the law, but we are not doing our job to make it against the 
law, apparently.
  The other thing is they make slight changes. They produce a new 
patent on every tiny, microscopic change--it is called the evergreening 
of patents--so then they can line up a vast array of lawyers and say: 
If you produce generic insulin, we will go after you in every which 
way. We have more lawyers than you have, and we have deeper pockets 
than you have. So good luck.
  The result is a continuation of the extensive price gouging of 
Americans. A quarter of those 7.4 million Americans who need insulin to 
treat their diabetes are rationing their prescriptions. Sometimes that 
means just straight out skipping the doses altogether.
  Folks from Oregon have written to me, people like Richard from 
Beaverton, OR.
  Richard needs three lifesaving medications to get by, including the 
insulin Humalog, which costs over $1,800 a year. Richard doesn't have 
$1,800 to spare. He is 77 years old, blind, and recently finished chemo 
treatments for bladder cancer. Through it all, he has continued to work 
odd jobs to supplement his Social Security to be able to put food on 
the table for him and his wife, to be able to keep their house, and try 
to pay for those prescriptions.
  Another constituent whom I will call Antonio is 58 years old and is 
living with type 1 diabetes, but like so many others, he has trouble 
affording the prescription. Antonio either uses insulin samples that he 
finds in his truck, which are about 10 years old, or he rations out the 
insulin that he does have to make it last until his monthly disability 
check comes in, which is when he can afford to get a new refill on the 
prescription.
  This is a terrible strategy for managing an illness. It has led to 
hospital stays, diabetic ketoacidosis, kidney failure, visual 
impairment, and other diabetes-related ailments. Yet, from Antonio's 
perspective, what can he do? He can't afford the massive price 
increases these major drug companies have put on insulin. As for the 
generic he would like to buy, those same companies are blocking it from 
coming to market.
  There is also Maria. Maria has sores on her feet because of her 
diabetes. She has been to the emergency room several times for foot 
infections. It turns out that her feet keep getting infected because 
she is forgoing her insulin to be able to afford basic necessities for 
her family--food, the cost of her housing, and transportation.
  It turns out Maria's insurance doesn't cover the $50 copay on 
diabetic shoes or her insulin or the injection medication that she 
takes to reduce her insulin needs, all of which would have reduced or 
eliminated the need for Maria to go to the emergency room. Yet her 
insurance does cover the emergency room visits. So, time and again, 
with her not being able to afford the medicine, that is where Maria 
ends up.
  Another Oregonian whom I will call Phillip is living with type 2 
diabetes. He said he takes less insulin than his doctor has prescribed. 
Why? He isn't able to afford the prescription. Yet Phillip doesn't want 
his provider to know any of this, because he is embarrassed about it. 
So his blood sugars are

[[Page S6480]]

routinely at high levels and are doing a lot of damage to his body. It 
has led to the diabetic-related complications of severe kidney damage, 
visual impairment, peripheral vascular disease, and heart disease.
  Think about this for a moment. The pharmaceutical companies are 
gouging him on the price, but it is Phillip--he who has the diabetes--
who feels embarrassed. Shouldn't it be the other way around? Shouldn't 
the companies be embarrassed about gouging Americans? I think so. The 
drugmakers are profiting off of sick Americans, and their predatory 
practices are designed to keep competitors from coming to the market. 
These are American citizens who are being affected while living in one 
of the wealthiest nations on the planet--the United States of America. 
Yet they can't afford a century-old drug that is meant to be freely 
shared with the world.
  It doesn't have to be this way. The same kind of insulin that costs 
$373 here in the United States costs $47 in Australia. Why? The 
Australian Government negotiates the price. It is past time we stood up 
for the American people and put an end to the price gouging of 
Americans.
  In France, the drug Lantus is $47. In Australia, it is $54. In 
Germany, it is $61. In the United Kingdom, it is $64. In Canada, it is 
$67. In the United States of America, it is $373. That is six times the 
median price of the drug in these other developed nations.
  Why don't we insist that the companies that get all kinds of benefits 
from being here in America sell to Americans at the median price or at 
the average price--either one--which is what they sell to the rest of 
the developed world? Why is it a fair price for every other country, 
but it is gouging for Americans?
  Americans pay the price. Those who have diabetes but who cannot 
afford that insulin start rationing it and start to see the devastating 
impacts on their bodies--from the kidneys, to the vision, to the feet, 
to the heart disease. Then they end up in the hospital, as well, with 
there being more costs to the U.S. healthcare system. Don't we care 
about the health of Americans? Are we here to protect greed for these 
companies or the health of Americans?
  Senator Durbin and I have introduced a bill that says you can't 
charge more in America than the reference price that is charged in key 
developed countries around the world--Canada, Australia, Japan--or 
charge more than the median price in the group of eight of the largest 
European nations. It doesn't even have to be the lowest price in the 
world under this formulation. This is called a reference price bill, 
wherein we essentially attach ourselves to the fair prices charged to 
the rest of the world.
  The drug companies will say: We want to make more money so we can do 
more research.
  Well, raise your price on these other countries while you are 
dropping the price for the United States. That is a pretty simple 
solution that ends the price gouging in the United States of America.
  If a company violates this reference price, then it pays a fine of 10 
times the difference between the reference price and the price it 
charges Americans. Where does that money go? It goes to the research 
and development of new drug products in our bill.
  That is the vision. There is no reason that Americans should be 
paying six times the median price of other developed countries--six 
times. This is not 6 percent more or 60 percent more, which would be 
outrageous. This is six times the price charged to other developed 
countries.
  It is way past time that we stood up for the American people, not the 
greed of the pharmaceutical companies. It is way past time that we 
stood up for sick Americans like Richard and Antonio and Maria and 
Phillip and millions more in every one of our States. Millions of 
Americans are forced to ration their insulin or skip doses altogether 
because of corporate greed. It is way past time to end the price 
gouging of Americans.
  Let's put this bill on the floor, and let's pass this bill for our 
citizens across this great land.

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