[Congressional Record Volume 165, Number 181 (Wednesday, November 13, 2019)]
[Senate]
[Pages S6525-S6527]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
Prescription Drug Pricing Reduction Act
Mr. GRASSLEY. Mr. President, polls show a surprising interest of
Americans in the high cost of prescription drugs. It seems to be an
issue that unites Americans. I often point out that Washington is an
island surrounded by reality. Here inside the Beltway, people are
obsessed with partisan impeachment proceedings. It seems like morning,
noon, and night, the relentless effort to unseat the President of the
United States is a toxic strain of Potomac fever infecting Capitol
Hill.
Now, if only Congress would channel every waking minute to fix
problems in the real world, wouldn't that be wonderful? So let me
provide a reality check. For people living in the real world,
impeachment inquiry is not what keeps Americans up at night. It is not
what wakes up moms and dads worried sick about paying for their child's
insulin. It is not what drains the pocketbooks of seniors and takes a
big bite out of people's paychecks. The issue that unites Americans
from Maine, to Iowa, to Oregon is the sky-high prices that Americans
and the taxpaying public are paying for prescription medicine.
As chairman of the Senate Finance Committee, I am working in a
bipartisan way to fix what is broken in our drug supply chain. In
February, we called the heads of Big Pharma to testify before the
Finance Committee. Next, we heard from the largest pharmacy benefit
managers to examine rebates and unravel the pricing supply chain. There
was an awful lot of finger-pointing between the various interests about
the soaring drug prices that Americans pay for pharmaceuticals. That
finger-pointing, we heard in our committee. Finger-pointing doesn't
decrease drug prices because the real problem is there is too much
secrecy and not enough accountability in the industry of pricing drugs.
When drug prices grow by leaps and bounds, year after year, it is
time to look under the hood. It is time to kick the tires along the
drug supply chain and check the gauge on the competition. Why in the
world is insulin, just as an example--a drug that has been on the
market for nearly 100 years--doubling or tripling in price for patients
in the United States? It is surely not that way in Europe.
We have gotten lots of feedback from patient advocates, healthcare
providers, and free market proponents. The pushback from Big Pharma
reveals that we are really on to something. Congress needs to take its
foot off the brake. It is time to deliver real savings, and our bill
will deliver real savings to consumers and to the taxpayers. It is time
to pass reforms that will cut prescription drug costs for the American
people.
Now, some of my colleagues may require a more blunt call to action so
I want to use the two-by-four illustration. Join us and score a win for
the American people. Otherwise, do nothing and risk being on the losing
side of the ballot box next November.
At my annual 99 county meetings where I always hold a Q&A with
whatever groups of constituents gather, I hear the same message from
people all across the State of Iowa. They have family members and they
have neighbors who struggle to pay for prescription management, to
manage chronic health conditions, and to treat diseases. Thanks to
breakthrough treatments and cures, Americans are living longer and
healthier lives.
Many are beating the odds of a diagnosis that would have been a death
sentence a generation ago. However, if a loved one is diagnosed with MS
or diabetes or cystic fibrosis, no miracle cure will help if Americans
can't afford to pay for their medicine. It will not help seniors if
sky-high prices drain taxpayer-financed health programs like Medicare
and Medicaid. Soaring drug prices are forcing too many Americans to
skimp on other necessities or even ration their doses of prescriptions
that they take.
Now, I just mentioned, as an example, cystic fibrosis. Last month,
the FDA approved a promising new treatment for this progressive genetic
disorder. Cystic fibrosis impacts about 30,000 Americans. There is
nothing parents will not do to advocate for their child living with
this condition. That is how I met one family from Iowa a few
[[Page S6526]]
years ago. That is when I launched the bipartisan Senate caucus on
cystic fibrosis, to add our voices for awareness and advocacy. Now, I
am told the price tag for the new drug is more than $300,000 per
patient, per year.
Without a doubt, this drug raises the roof of hope for tens of
thousands of families, but it also raises a red flag about drug prices.
If prices keep going through the roof year after year, how will
Americans who depend on prescription medicines afford them? America's
drug pricing regime is broken. It requires reform to sustain fiscal
sustainability and also to steer incubation and innovation forward. It
needs more transparency. It needs better incentives. It needs real
competition to drive down prices. So all 100 of us have our work cut
out for us.
Big Pharma doesn't want the pipeline to the Federal Treasury
tightened at all, and they will spend big money to scare people away
from reasonable solutions that will deliver real savings and get the
best deal for the taxpayers. I referred to our working in a bipartisan
way. So, in July, Ranking Member Wyden and I secured broad, bipartisan
support in our Finance Committee--19 denying vote.
Our bill would save taxpayers more than $100 billion. That is not
this Senate saying that. That is the Congressional Budget Office. The
bill caps out-of-pocket costs for seniors. The bill saves their
households more than $30 billion. We fine-tuned and improved our bill
to gain more momentum and more support. Part of that support and one of
the outstanding advocates for what we are trying to do doesn't happen
to be a member of the Finance Committee, but it is my good friend from
Maine, Senator Collins, right here on the floor. I will yield to her in
short time.
She is helping lead the fight to reduce drug prices. We have been
working together on many issues. I am a former chairman of the Special
Committee on Aging, and she is the current chair of the Special
Committee on Aging. We are committed to help older Americans lead
productive lives. We also share a top priority not to miss a vote.
While I might have a stronger voting streak, Susan hasn't missed a
single vote. I hope Maine appreciates a person who has been in the
Senate since 1997 and hasn't missed a single vote.
Senator Collins is one of those rare lawmakers who doesn't care who
gets the credit, as long as we are doing the right thing. The name of
this bill that I am talking about--and I imagine she will refer to--is
the Prescription Drug Pricing Reduction Act. That will be the right
thing to do, and it will do the right thing. So it is time for Congress
to do the right thing.
Just in case I said anything different about Senator Collins that is
not accurate, she can feel free to correct me, but I now yield to
Senator Collins, a strong voice for this piece of legislation.
The PRESIDING OFFICER. The Senator from Maine.
Ms. COLLINS. Mr. President, let me first thank and recognize Senator
Grassley for his farsighted, courageous leadership on this issue of
vital importance to the American people, the escalating costs of
prescription drugs.
Under Senator Grassley's chairmanship, the Finance Committee has held
numerous hearings on drug pricing. His diligence, his persistence on
this issue has produced the bipartisan Prescription Drug Price
Reduction Act, a bold and effective set of proposals that I strongly
endorse and look forward to seeing signed into law.
This past century could well be called the age of miracle drugs, from
insulin and penicillin to pharmaceuticals that treat cancer, HIV, heart
disease, and so many other serious conditions, modern drugs have been
proven to improve, extend, and even save lives. In our time, however,
we might define a miracle drug as one that has not doubled in price
since the last refill. With prescription drugs among the key factors
driving up the cost of healthcare, it is essential that we approve
policies that both encourage innovation and protect consumers,
particularly our seniors.
Demonstrating the importance of this challenge, three Senate
committees--the Senate Finance Committee, ably chaired by Senator
Grassley, which I mentioned earlier; the Senate HELP Committee, which
is led by our friend and colleague Senator Lamar Alexander; and the
Judiciary Committee, which is led by Senator Graham--have advanced
bills aimed at reforming our broken drug pricing system.
In addition, the Senate Aging Committee, which I chair, has held
eight hearings on drug pricing since 2015 and issued a major report in
2016 on Sudden Price Spikes in Off-Patent Prescription Drugs. Our
report highlighted the manipulative schemes employed by Martin Shkreli,
who increased the price of a drug that was more than 63 years old--a
lifesaving medication--by 5,000 percent in just 1 day.
To paraphrase his words, he could drive up the price of drugs like
this one on which he had not spent a dime in the research and
development because he could. His price gouging caused real hardships
for patients.
Some of the most alarming testimony we have heard on the Aging
Committee has come from patients. They describe the financial impact of
their prescription drug prices, the depths they have gone to to access
medications they need, and how this struggle has affected their health
and their overall quality of life. They are truly choosing between
paying their electric bill, buying the food they need, and filling
their prescription drugs.
An example is a young father from New Gloucester, ME, who discovered
that the cost of a 90-day supply of insulin for his 13-year-old son who
has type 1 diabetes had more than tripled to more than $900.
A woman from Falmouth, ME, saw her out-of-pocket costs for the
arthritis medication Enbrel that she needs soar from $10 to $3,800 per
month when she transitioned from her employer-sponsored insurance to
Medicare when she retired. She had no choice but to switch medications,
which did not work nearly as well for her, but she simply could not
afford that out-of-pocket cost.
I will never forget standing in line at the pharmacy counter in
Bangor, ME, where I live. The couple ahead of me received their
prescription drug and the unwelcome news that their prescription copay
was going to be $111. The husband turned to his wife and said ``Honey,
we simply cannot afford that,'' and they walked away, leaving that
needed prescription on the pharmacy counter.
I asked the pharmacist: How often does this happen?
His answer: Every day.
The results of exorbitant increases in the price of drugs are that
needed prescriptions aren't filled, doses are skipped, and pills are
cut in half--all harmful to the patient's health. And why? Because the
patient simply cannot afford the exorbitant costs, the skyrocketing
costs of these drugs.
This should not happen. We must join together to combat the
exorbitant prescription costs that confront more and more Americans
every day. More than half of all Americans and 90 percent of our
seniors take at least one prescription drug each month. For many,
access to these medicines is not only critical to their well-being, but
it can literally be a matter of life and death.
For children and adults with type 1 diabetes, insulin is not a luxury
or something that is nice to have; insulin is essential to their
ability to survive. Insulin was first isolated nearly a century ago in
Canada. Yet its cost has soared in recent years.
Another chairman in the Senate who has worked very hard on this
issue, along with Senator Grassley, is Senator Lamar Alexander. He has
made it a strong priority of the HELP Committee, on which I serve, to
increase transparency and competition in the prescription drug market.
I don't think there is any product that we buy in this country where
there is less transparency in the price than the price of prescription
drugs and where the supply chain is more rife with conflicts of
interest.
Last year, in response to my experience listening to this couple in
Bangor, ME, I authored a bill to block pharmacy gag clauses. Under
these contractual gag clauses, pharmacists were actually prohibited
from volunteering to a consumer that it might well be less expensive to
pay out-of-pocket rather than use their insurance. A recent study
published by the Journal of the American Medicine Association found
[[Page S6527]]
that this new law could help Americans save money in nearly one out of
four prescription transactions in a pharmacy.
Another bill I authored in 2017 to promote more competition from
lower price but equally effective generic drugs is also showing
results. To date, the FDA has granted nearly 200 application requests
under the new expedited pathway established by this law, with 12
approvals. That is a much faster pace than in the past.
In June, the HELP Committee reported out the Lower Healthcare Costs
Act, which incorporates more than 14 measures to increase drug price
competition. I am pleased to say that it includes major portions of the
Biologic Patent Transparency Act that I authored with Senator Kaine,
and that is cosponsored by Senators Braun, Hawley, Portman, Shaheen,
Stabenow, Paul, and Murkowski. It is intended to prevent drug
manufacturers from gaming the patent system. It requires earlier and
greater disclosure of the web of patents held by biologic
manufacturers, thus making it easier for biosimilar competitors to
develop more affordable alternatives without being stymied by the
filing of last-minute patents.
According to former FDA Commissioner Scott Gottlieb, if all of the
biosimilars that have been approved by the FDA were successfully
marketed in the United States in a timely fashion, Americans would have
saved more than $4.5 billion in 2017.
The fact that a biosimilar version of HUMIRA--the best selling drug
in the world--has been on the market in Europe for more than a year
while American patients must wait until 2023 is a clear example that
the biosimilar market is not working as it should.
The Lower Healthcare Costs Act also includes the CREATES Act--a bill
that I know Senator Grassley has been very involved in. It addresses
the anti-competitive practices of companies that delay or even block
access to a sufficient quantity of the brand-name drug needed to
conduct the bioequivalency test required by the FDA as part of the
generic drug approval process. This addresses one of the major problems
identified by the Aging Committee when we looked at this issue starting
in 2016, examining the explosion in prices of prescription drugs for
which there is no generic equivalent. I am pleased that we are on the
verge of taking action to combat and stop this unfair practice.
The HELP Committee bill also requires significantly more disclosure
on the costs, fees, and rebate information associated with PBM
contracts; that is, prescription benefit managers. I know the Finance
Committee bill does as well.
As I mentioned previously, the Finance Committee passed the
Prescription Drug Pricing Reduction Act--landmark legislation that
would save taxpayers more than $100 billion and save seniors more than
$30 billion in out-of-pocket costs for their prescriptions. I strongly
support this bill because it strikes the right balance between reducing
out-of-pocket costs for consumers without hindering innovation and
investment in the next lifesaving medications.
The Finance Committee bill also makes crucial improvements to
Medicare Part D, such as protecting seniors with an out-of-pocket
spending cap--another long overdue change that would ensure that
patients with high-cost conditions, such as cancer, multiple sclerosis,
and rheumatoid arthritis, can get the medications they need.
Furthermore, the bill would protect taxpayers from higher than
inflation increases in drug prices, while reducing government spending,
premiums, and overall out-of-pocket costs.
The Judiciary Committee has also advanced proposals that would
empower the Federal Trade Commission to take more aggressive action on
anti-competitive behaviors.
These are three worthwhile pieces of legislation that should be
brought to the Senate floor. The work of the Finance Committee, the
HELP Committee, and the Judiciary Committee is a tremendous
breakthrough that would make such a difference to the American people.
As we continue to find further consensus and a path forward on each
of these bipartisan bills, I hope we can also look for additional
improvements. For example, as cochairs of the Senate Diabetes Caucus,
Senator Shaheen and I, along with Senators Cramer and Carper, have
introduced legislation to address flaws in the system that have allowed
pharmacy benefit managers and manufacturers to implement what are truly
unscrupulous price increases on lifesaving insulin. I also support a
measure introduced by Senators Klobuchar and Grassley to prohibit
brand-name drug companies from compensating generic drug companies to
delay the entry of a less costly but equally effective generic into the
market. That is referred to as ``pay for delay.'' I am amazed that it
is not already illegal under our anti-trust laws. This bill would make
it clear that this tactic is no longer permitted.
Congress has a tremendous opportunity to deliver a decisive victory
in both lowering healthcare costs and improving healthcare for the
people in my State of Maine and throughout America. If we want new
medicines to reach consumers who need them, the companies that invest
in research and take the risks necessary must see a fair return on
their investment, but at the same time, we can no longer allow the
price manipulation and the market distortions to continue at the
expense of the most vulnerable Americans and their families and
ultimately at the expense of every American taxpayer.
We can act to make a real difference in the lives of Americans whose
health depends on affordable prescription drugs. The required policy
solutions will not come in the form of a miracle but through hard work
and continued bipartisan cooperation.
Let us come together. I urge all of my colleagues to join in
supporting the measures we have worked so hard on and that the HELP
Committee, the Finance Committee, and the Judiciary Committee have all
reported, on a bipartisan basis, recognizing the hardships imposed on
the American people. Let us bring these bills to the Senate floor
expeditiously.
I yield the floor.
The PRESIDING OFFICER. The Senator from North Dakota.