[Congressional Record Volume 166, Number 47 (Wednesday, March 11, 2020)]
[Senate]
[Pages S1687-S1690]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        PRESCRIPTION DRUG COSTS

  Mr. GRASSLEY. Mr. President, as most of my colleagues know, I hold a 
meeting in each of Iowa's 99 counties every year for Q&A with my 
constituents. Over the last couple of years, without fail, Iowans have 
brought up the skyrocketing prices of prescription drugs. People all 
over my State, including farmers, factory workers, and especially 
senior citizens, have raised the concern that pharmacy bills have been 
ballooning.
  I will say, Iowans are always interested in hearing about solutions, 
and they are looking for solutions on this issue from Congress, but not 
a single one of these people who bring this issue up cares about the 
partisan politics of the issue. Iowans just want Congress to act. This 
is my 40th year of taking questions in our 99 counties--although, as of 
now, only 14. Rarely have I heard so much unanimity when it comes to 
this issue, but on prescription drug prices, it is unanimous. 
Republicans, Democrats, and Independents alike all want us to take 
action, and the data, both polling and otherwise, bears out our 
constituents' concerns.
  As I highlighted last week, right here in this position on the Senate 
floor, a new study shows that pharmaceutical prices have increased 3\1/
2\ times the rate of inflation in recent years. People are paying more 
than double what they paid in the year 2007 for drugs treating 
conditions from MS to diabetes and everything in between. The lack of 
transparency and the enormous subsidy incentives are driving these 
price hikes--perverse incentives that we have in law. If they were not 
intended to be perverse, they are incentives people have found out how 
to benefit from.
  This is because the government's spigot is all the way open for the 
big pharmaceutical companies or--how we say it around here--Big Pharma. 
Of course, when this happens, taxpayers get ripped off. It happens 
because we pay a lot of money--I think about $138 billion--for Medicare 
and Medicaid. We pay at least that much. So, when you have 5- to 10-
percent increases on January 1, you can see willy-nilly, on the 
judgment of Big Pharma, that taxpayers are paying a heck of a lot more.
  I know all of my colleagues want to do something about this, and I 
know the administration wants to do something about it. In fact, let me 
say to the administration that I have been involved in this as the 
chairman of this committee since just a year ago January. The 
administration has given a major speech, and the Secretary of HHS has 
taken major action going way back to June of 2018. So we all know that 
our colleagues and our administration know that something needs to be 
done.
  We are fortunate that, just yesterday, the White House published five 
principles that the administration can get behind for reducing 
prescription drug costs. Our legislation in the Senate fits the bill, 
or the principles, that were laid out in that op-ed piece. The 
Prescription Drug Pricing Reduction Act is the name of our legislation, 
and it addresses those principles. More importantly, it is the only 
option that can get 60 votes in the U.S. Senate.
  Many Americans are reading about the coronavirus issue. It scares our 
constituents. We don't know what kind of drugs might come into the 
market to help treat the disease. Senator Cassidy, who will soon speak, 
is an expert on that. He can address those issues for anybody who wants 
them addressed. Yet, if our bill becomes law, we know that folks who 
are on Medicare will not face sticker shock at the drugstore counter. 
Not only is that important in its being a comforting thought in the 
short term, as we face the coronavirus, but it is important in the long 
term, when we inevitably encounter another novel outbreak.
  It took a long time to hammer out the Prescription Drug Pricing 
Reduction Act. I thank Senator Wyden for sticking it out with me and 
working in good faith for the benefit of all of our constituents so we 
could produce a bipartisan bill. His determination as well as the 
leadership of many of my colleagues, like Senators Cassidy, Collins, 
and Daines, have further improved the legislation. We have a bill. We 
have bipartisan support, and we have White House support. We also have 
the opportunity. The bottom line is, let's act.
  I thank my colleagues for joining me in this effort.
  I yield to my colleague Senator Collins.
  The PRESIDING OFFICER. The Senator from Maine.
  Ms. COLLINS. Mr. President, first, I express my appreciation to the 
chairman of the Committee on Finance, Senator Grassley, not only for 
his leadership but also for his persistence on an issue that affects so 
many Americans, and that is the soaring price of prescription drugs.
  Three committees--the Committee on Finance, the Committee on Health, 
Education, Labor, and Pensions, and the Committee on the Judiciary--
have all advanced bipartisan legislation to reform our broken drug 
pricing system.
  The Aging Committee, which I chair, has held eight drug pricing 
hearings which have highlighted the burden of soaring prices and the 
manipulation of the market by individuals like the infamous Martin 
Shkreli. It is now past time for us to move forward to the Senate floor 
to debate these bills that have

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bipartisan support and that have garnered the approval of three major 
committees.
  The Finance bill, which Senator Grassley has crafted with Senator 
Wyden and others and of which I am proud to be a cosponsor, makes 
crucial improvements to Medicare Part D, such as protecting seniors 
with an out-of-pocket spending cap as well as including cost control 
measures, such as an inflationary cap to limit pharmaceutical price 
hikes.
  In one of the hearings that the Aging Committee held, it heard 
testimony that was heartbreaking from a former teacher with multiple 
myeloma who had to refinance her home in order to cover the cost of her 
$250,000 cancer medication. We heard example after example.
  I will never forget my standing in the pharmacy line in Bangor, ME, 
where I live, and ahead of me was a couple who had just been told that 
the couple's copay was $111.
  The husband turned to his wife and said: Honey, we just can't afford 
that.
  They walked away--away from the medication that one of them needed.
  I asked the pharmacist: How often does this happen?
  He told me that it happens every day.
  We have to take action. That experience led me to author legislation 
that became law that prohibited gag clauses that were preventing 
pharmacists from advising their patients, their customers, on whether 
or not there was a less expensive way to purchase their prescription 
drugs. I am proud to say that this legislation is now law, but there is 
much more that we need to do.
  The Committee on Health, Education, Labor, and Pensions, on which I 
serve, has incorporated more than 14 measures to increase price 
competition in its legislation on lowering healthcare costs. I know the 
Presiding Officer is a member of that committee as well. I am pleased 
to say that the bill includes major portions of the Biologic Patent 
Transparency Act, which is a bill that I authored with Senator Tim 
Kaine. It is intended to prevent drug manufacturers from gaming the 
patent system.
  Now, patents are very important. They help to spur innovation, and 
that period of exclusivity encourages drug manufacturers to invest more 
into lifesaving drugs. Yet the fact is, when the patent has expired, 
generics should be allowed to come to the market and drive down the 
costs. According to former FDA Commissioner Scott Gottlieb, if all of 
the biosimilars--those are generics for biologic drugs--that had been 
approved by the FDA had been successfully marketed in our country in a 
timely fashion, Americans would have saved more than $4.5 billion in 
2017.
  A biosimilar version of HUMIRA, the world's best-selling drug, has 
been on the market in Europe for more than a year, while American 
patients must wait until 2023. We simply cannot allow this kind of 
abuse of the patent system to continue.
  The Judiciary Committee has also advanced proposals to empower the 
Federal Trade Commission to take more aggressive action against 
anticompetitive behaviors. Last month, the FTC charged the infamous 
Martin Shkreli with an anticompetitive scheme of setting an increase of 
more than 4,000 percent overnight for the lifesaving drug DARAPRIM. 
That was the focus of an investigation on the Aging Committee that I 
led with former Senator Claire McCaskill. I applaud the FTC for taking 
action, and we simply must give them more authority and the resources 
to pursue these kinds of anticompetitive cases that drive up the cost 
of prescription drugs.
  Finally, I hope that we have the opportunity to debate other worthy 
proposals, including one that Senator Shaheen and I have introduced to 
lower the skyrocketing price of insulin.
  I want to commend the administration for today releasing a new plan 
to drive down the cost of insulin for Medicare beneficiaries. The fact 
is, between 2012 and 2016, the average price of insulin nearly doubled. 
According to the Health Care Cost Institute, the price of an average 
40-day supply of insulin rose from $344 in 2012 to $666 in 2016. There 
is no justification for that. Insulin was isolated nearly 100 years 
ago, and while there are different varieties of insulin, it is still 
insulin.
  As cochairs of the Senate Diabetes Caucus, Senator Shaheen and I have 
introduced legislation which creates a new pricing model for insulin, 
and our bill would hold pharmacy benefit managers, pharmaceutical 
companies, and insurers accountable for surging insulin prices by 
incentivizing reductions in list prices.
  For the most popular insulins, this would result in as much as a 75-
percent decrease in prices on average. Whether you are insured or you 
are paying out of pocket, you would benefit from that significant 
decline in the price if you need insulin to control your diabetes.
  Congress has a tremendous opportunity to deliver a decisive victory 
in both lowering healthcare costs and in improving healthcare for the 
people in my State of Maine and throughout our country.
  Let's not delay any longer. We must act on prescription drug 
legislation without further delay. We have three committees that have 
produced bills, and I believe this should be a priority for this 
Chamber.
  The PRESIDING OFFICER (Mrs. Blackburn). The Senator from Louisiana.
  Mr. CASSIDY. Madam President, I am going to speak about the drug 
affordability act, what people in Washington call the Grassley-Wyden 
bill.
  I am renaming that bill. I am going to rename that bill to what I 
call the ``Making Coronavirus Medicines Affordable Act,'' and I want to 
address drug affordability from the perspective of coronavirus and 
address it from the perspective of a physician.
  First, people ask: How is this different than regular flu? Ten 
thousand people die a year from flu. Why is this so different from 
that?
  Well, again, as a physician, let me speak to that. Each of us, 
however old we are, have been exposed to flu, either by the flu vaccine 
or a flu infection, as many years as we have been alive. So when 
someone is exposed to the flu, they have a whole kind of armamentarium 
of antibodies. When the flu virus comes into your body, those 
antibodies mobilize, and it is not an exact fit to block the effects of 
the flu virus, but it is a pretty good fit. So for an infection which 
otherwise might cause problems, the effect is blunted and the symptoms 
are either absent or minimized.
  As it turns out, the flu virus kills the very young, who have never 
before been exposed to the flu virus before, or the very old, whose 
immune systems are no longer working as well. Even though they have 
been previously exposed, their body is more vulnerable.
  Now, as for coronavirus, nobody's body has ever seen that before. For 
everyone, this is a brand-new infection, and there is not a library 
book of immunologic responses that enable us to fight back against this 
virus. For all of us, if you will, it is a sucker punch to our health. 
We turn around, and, boom, it hits us.
  Now, in terms of who it can kill, again, it seems to cause problems 
in newborns--the very young--but it also causes problems not just in 
the very old but in the older but not so very old.
  In China we have learned that if someone is over 50 and they have an 
underlying medical condition, they are at increased risk. If you are 
over 60, you are at even more risk. So unlike influenza, where 
typically the person who dies would be 75 or 85 and in a nursing home, 
in terms of coronavirus, it might be somebody with high blood pressure 
or diabetes, heart disease, cancer, or a lung disease, who is otherwise 
living life, walking around the streets. They get hit with this virus, 
and, all of a sudden, they have a problem.
  Now, we are going to find a cure. Sooner or later, we will come up 
with medicines that help somebody who is infected get well. The 
question is, Will those medicines be available to you? That is what we 
need to be concerned about.
  So what does it mean? Well, first there have been reports that both 
because of the infection raging through China and a decision by India, 
it is possible that some of these drugs will not be available.
  In China, they make the raw ingredients that are shipped to India, 
and they make the medicines. Well, China is not producing as many of 
the raw ingredients, and India has put an embargo on the export of some 
of those drugs to the United States.

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  At least of the drugs they have embargoed that I saw a list of 
recently, none of those medicines are medicines that we think might 
ultimately help fight coronavirus. So even though we have a problem 
with supply chain, so far there is no evidence it will impact the 
ability of a medication, whenever it is discovered, to be available 
here in the United States.
  But there is another issue. Can the senior citizen who is most 
vulnerable afford the medicine?
  Let me put this up.
  Under the current structure of Medicare Part D, the senior citizen--
the personal Medicare Part D--pays a certain amount of money until they 
go into the so-called catastrophic coverage phase. Now, pharmaceutical 
manufacturers and pharmacy benefit managers manipulate that list price 
to more quickly move the senior citizen into her catastrophic phase, 
and when she is in her catastrophic phase of our Medicare Part D 
benefit, she must pay 5 percent of whatever is the price of that drug. 
Even--imagine this--if that drug costs $1 million a year, she would 
have to pay 5 percent of it under the current structure of the Medicare 
Part D benefit.
  I just posted a video on my Facebook page, and an oncology nurse, 
Kathy at East Jefferson General Hospital in New Orleans, was speaking 
about how this benefit design, where the senior has to pay 5 percent, 
no matter the cost, is so harmful in terms of her ability to get 
certain cancer drugs to cancer patients.
  Now, imagine it is a coronavirus drug--a cure for coronavirus that we 
know is going to eventually be here, and it can be priced. You name the 
price; we are going to pay it. Or can we? Can someone afford 5 percent 
of $100,000 or 5 percent of $50,000? Is it imaginable that such a 
medication would be priced as such?
  It is totally imaginable.
  We need to enact what the chairman of the committee calls the 
Grassley-Wyden bill but which I call the ``Making Coronavirus Drugs 
Affordable Act.''
  What we would do with this bill is change the Part D benefit so that 
when a senior pays up to a certain amount, period, it is stopped. She 
or he pays no more. And no matter how much that coronavirus drug is 
priced, she or he will not pay above a certain amount.
  If they price it at $100,000, under current law you are paying 5 
percent of that. Under this law, you would not. The out-of-pocket 
exposure, if you will, is capped. By the way, it also caps it for the 
taxpayer, which saves you and me as taxpayers--all of us as taxpayers--
a heck of a lot of money as we attempt to balance the Federal budget 
and as we attempt to preserve the life of the Medicare Program.
  So I will point out that we are going to have a cure for coronavirus 
sooner or later, but if a senior citizen or anyone cannot afford that 
cure, it is as if the cure had never been invented. We need both for 
the cure to be invented and we also need for it to be affordable. 
Otherwise, it would not be available.
  By the way, somebody may tell you they are supporting another bill 
either in the House of Representatives or here in the Senate. This is 
the only bill out there which is bipartisan. This is the only bill out 
there which has a chance to pass. This is the only bill that can 
protect senior citizens, not only by being good policy but by being 
signed into law by the President of the United States. The President of 
the United States has signaled that he, indeed, would sign this law.
  Now, the ``Making Coronavirus Drug Affordable Act'' does other things 
as well. It caps out-of-pocket expenses. It lets patients pay over 
time. If they know they are going to have a big amount in January, they 
don't have to pay it all in January. They can pay it a little bit in 
January, February, March, and all the way through the end of the year. 
It protects patients from price gouging, but it still preserves 
incentives for these cures to be invented.
  As we look for a holistic response to the coronavirus infection, we 
must keep in mind that drugs have to be affordable. So I am asking all 
my fellow Senators to support the ``Making Coronavirus Drugs Affordable 
Act,'' also known as the Grassley-Wyden bill, and for Senator McConnell 
to bring it to the floor.
  With that, I introduce my colleague from Montana, Steve Daines, to 
continue this discussion.
  Mr. DAINES. Senator Cassidy, thank you--Dr. Cassidy. It is a really 
good thing to have a physician serving on the floor of the U.S. Senate 
and your additional insight you have as a physician. Thank you.
  Madam President, I am grateful for not only Senator Cassidy's 
leadership but also Senator Grassley's on this very important issue 
impacting millions of Montanans and Americans across our country.
  I also want to thank my colleagues who spoke on this issue earlier 
today.
  When I am back home in Montana, I hear the same concerns in virtually 
every corner of our State. Whether I am down in southeast Montana, in 
places like Ekalaka or Baker; or up in northeast Montana, in places 
like Westby and in places like Sidney and Plentywood; and if we go out 
to the northwest part of our State, to places like Eureka, Libby; or in 
southwest Montana, where I am from, in Bozeman, Belgrade, or anywhere 
you go, I am hearing that Montanans are concerned with the high cost of 
prescription drugs. That is why I have made it one of my top priorities 
in Congress and on the Senate Finance Committee to lower prescription 
drug costs for Montanans and for folks across the country.
  Year after year, prescription drug out-of-pocket costs are reaching 
sky-high levels. They are impacting our seniors, our veterans, our 
families, and our working men and women. It is truly heart-wrenching to 
hear the stories of folks who are rationing or even skipping doses of 
daily medications because they can't afford the out-of-pocket costs. 
The American people are struggling under the burden of these out-of-
control, high costs of prescription drugs, and they need relief.
  That is why I am grateful to be working with Chairman Grassley on the 
Finance Committee and my colleagues here today in a bipartisan fashion 
to lower costs, improve competition, and get our patients more bang for 
the buck. The complex drug pricing system has allowed Big Pharma and 
these pharmacy benefit managers--you may have seen the chart that 
Senator Cassidy just laid out showing some of these complexities. These 
pharmacy benefit managers are the middle men responsible for 
negotiating drug prices, but in doing so, they take advantage of the 
secrecy of the pricing supply chain.
  The bipartisan reforms we are fighting for and advocating for today 
would help fix the secrecy and save taxpayers more than $80 billion. 
These reforms will cap out-of-pocket costs in Medicare, providing our 
seniors with enhanced financial security. One of the great sources of 
anxiety for our seniors is financial security. When you think about it, 
their financial situation could be devastated with the out-of-pocket 
costs for a single prescription drug.
  Our efforts would reform the payment incentives and ensure that Big 
Pharma and the pharmacy benefit managers have more skin in this game. 
These reforms are the product of over 1 year of bipartisan 
negotiations. Although this may not be what you hear on the news, 
bipartisan compromise is not dead. I am pleased to see my colleagues 
putting politics aside and doing what is right for this country. 
Lowering costs is more than just figures and numbers and spreadsheets. 
This is about keeping our families healthy without having to worry 
about how much it is going to cost or if they can even afford it. This 
is about getting relief for the retiree who has worked and saved their 
entire life only to see the dollars they earned go down the drain 
because of the high cost of prescription drugs.
  President Trump is ready to sign prescription drug reform. He is 
committed to getting this done on behalf of the American people. He 
hears it when he travels around the country. With strong support from 
this administration, I am confident we can achieve some major reforms 
for the American people. Montanans and Americans across the country 
want to see reform, and that is why I am standing here today, fighting 
for it.
  Let's move past the congressional gridlock and get this done. We had 
a good, strong, bipartisan vote out of the Senate Finance Committee, 
which will allow us to take a vote here on the floor of the U.S. 
Senate. Truly, Republicans, Democrats, and Independents

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can deliver a historic victory for the American people, and I will 
continue working to get this bill on President Trump's desk.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Perdue). The Senator from Iowa.

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