[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.