[Congressional Record Volume 168, Number 57 (Thursday, March 31, 2022)]
[House]
[Pages H4033-H4046]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       AFFORDABLE INSULIN NOW ACT

  Mr. PALLONE. Madam Speaker, pursuant to House Resolution 1017, I call 
up the bill (H.R. 6833) to amend title XXVII of the Public Health 
Service Act, the Internal Revenue Code of 1986, and the Employee 
Retirement Income Security Act of 1974 to establish requirements with 
respect to cost-sharing for certain insulin products, and for other 
purposes, and ask for its immediate consideration in the House.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore (Ms. Porter). Pursuant to House Resolution 
1017, an amendment in the nature of a substitute consisting of the text 
of Rules Committee Print 117-38, modified by the amendment printed in 
part C of House Report 117-285, is adopted and the bill, as amended, is 
considered read.
  The text of the bill, as amended, is as follows:

                               H.R. 6833

       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 ``Affordable Insulin Now 
     Act''.

     SEC. 2. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR INSULIN 
                   PRODUCTS.

       (a) PHSA.--Part D of title XXVII of the Public Health 
     Service Act (42 U.S.C. 300gg-111 et seq.) is amended by 
     adding at the end the following new section:

     ``SEC. 2799A-11. REQUIREMENTS WITH RESPECT TO COST-SHARING 
                   FOR CERTAIN INSULIN PRODUCTS.

       ``(a) In General.--For plan years beginning on or after 
     January 1, 2023, a group health plan or health insurance 
     issuer offering group or individual health insurance coverage 
     shall provide coverage of selected insulin products and, with 
     respect to such products, shall not--
       ``(1) apply any deductible; or
       ``(2) impose any cost-sharing in excess of the lesser of, 
     per 30-day supply--
       ``(A) $35; or
       ``(B) the amount equal to 25 percent of the negotiated 
     price of the selected insulin product net of all price 
     concessions received by or on behalf of the plan or coverage, 
     including price concessions received by or on behalf of 
     third-party entities providing services to the plan or 
     coverage, such as pharmacy benefit management services.
       ``(b) Definitions.--In this section:
       ``(1) Selected insulin products.--The term `selected 
     insulin products' means at least one of each dosage form 
     (such as vial, pump, or inhaler dosage forms) of each 
     different type (such as rapid-acting, short-acting, 
     intermediate-acting, long-acting, ultra long-acting, and 
     premixed) of insulin (as defined below), when available, as 
     selected by the group health plan or health insurance issuer.
       ``(2) Insulin defined.--The term `insulin' means insulin 
     that is licensed under subsection (a) or (k) of section 351 
     and continues to be marketed under such section, including 
     any insulin product that has been deemed to be licensed under 
     section 351(a) pursuant to section 7002(e)(4) of the 
     Biologics Price Competition and Innovation Act of 2009 and 
     continues to be marketed pursuant to such licensure.
       ``(c) Out-of-Network Providers.--Nothing in this section 
     requires a plan or issuer that has a network of providers to 
     provide benefits for selected insulin products described in 
     this section that are delivered by an out-of-network 
     provider, or precludes a plan or issuer that has a network of 
     providers from imposing higher cost-sharing than the levels 
     specified in subsection (a) for selected insulin products 
     described in this section that are delivered by an out-of-
     network provider.
       ``(d) Rule of Construction.--Subsection (a) shall not be 
     construed to require coverage of, or prevent a group health 
     plan or health insurance coverage from imposing cost-sharing 
     other than the levels specified in subsection (a) on, insulin 
     products that are not selected insulin products, to the 
     extent that such coverage is not otherwise required and such 
     cost-sharing is otherwise permitted under Federal and 
     applicable State law.
       ``(e) Application of Cost-Sharing Towards Deductibles and 
     Out-of-Pocket Maximums.--Any cost-sharing payments made 
     pursuant to subsection (a)(2) shall be counted toward any 
     deductible or out-of-pocket maximum that applies under the 
     plan or coverage.''.
       (b) IRC.--
       (1) In general.--Subchapter B of chapter 100 of the 
     Internal Revenue Code of 1986 is amended by adding at the end 
     the following new section:

     ``SEC. 9826. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR 
                   CERTAIN INSULIN PRODUCTS.

       ``(a) In General.--For plan years beginning on or after 
     January 1, 2023, a group health plan shall provide coverage 
     of selected insulin products and, with respect to such 
     products, shall not--
       ``(1) apply any deductible; or
       ``(2) impose any cost-sharing in excess of the lesser of, 
     per 30-day supply--
       ``(A) $35; or
       ``(B) the amount equal to 25 percent of the negotiated 
     price of the selected insulin product net of all price 
     concessions received by or on behalf of the plan, including 
     price concessions received by or on behalf of third-party 
     entities providing services to the plan, such as pharmacy 
     benefit management services.
       ``(b) Definitions.--In this section:
       ``(1) Selected insulin products.--The term `selected 
     insulin products' means at least one of each dosage form 
     (such as vial, pump, or inhaler dosage forms) of each 
     different type (such as rapid-acting, short-acting, 
     intermediate-acting, long-acting, ultra long-acting, and 
     premixed) of insulin (as defined below), when available, as 
     selected by the group health plan.
       ``(2) Insulin defined.--The term `insulin' means insulin 
     that is licensed under subsection (a) or (k) of section 351 
     of the Public Health Service Act and continues to be marketed 
     under such section, including any insulin product that has 
     been deemed to be licensed under section 351(a) of such Act 
     pursuant to section 7002(e)(4) of the Biologics Price 
     Competition and Innovation Act of 2009 and continues to be 
     marketed pursuant to such licensure.
       ``(c) Out-of-Network Providers.--Nothing in this section 
     requires a plan that has a network of providers to provide 
     benefits for selected insulin products described in this 
     section that are delivered by an out-of-network provider, or 
     precludes a plan that has a network of providers from 
     imposing higher cost-sharing than the levels specified in 
     subsection (a) for selected insulin products described in 
     this section that are delivered by an out-of-network 
     provider.
       ``(d) Rule of Construction.--Subsection (a) shall not be 
     construed to require coverage of, or prevent a group health 
     plan from imposing cost-sharing other than the levels 
     specified in subsection (a) on, insulin products that are not 
     selected insulin products, to the extent that such coverage 
     is not otherwise required and such cost-sharing is otherwise 
     permitted under Federal and applicable State law.
       ``(e) Application of Cost-Sharing Towards Deductibles and 
     Out-of-Pocket Maximums.--Any cost-sharing payments made 
     pursuant to subsection (a)(2) shall be counted toward any 
     deductible or out-of-pocket maximum that applies under the 
     plan.''.
       (2) Clerical amendment.--The table of sections for 
     subchapter B of chapter 100 of the Internal Revenue Code of 
     1986 is amended by adding at the end the following new item:

``Sec. 9826. Requirements with respect to cost-sharing for certain 
              insulin products.''.
       (c) ERISA.--
       (1) In general.--Subpart B of part 7 of subtitle B of title 
     I of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1185 et seq.) is amended by adding at the end the 
     following:

     ``SEC. 726. REQUIREMENTS WITH RESPECT TO COST-SHARING FOR 
                   CERTAIN INSULIN PRODUCTS.

       ``(a) In General.--For plan years beginning on or after 
     January 1, 2023, a group health plan or health insurance 
     issuer offering group health insurance coverage shall provide 
     coverage of selected insulin products and, with respect to 
     such products, shall not--
       ``(1) apply any deductible; or
       ``(2) impose any cost-sharing in excess of the lesser of, 
     per 30-day supply--
       ``(A) $35; or
       ``(B) the amount equal to 25 percent of the negotiated 
     price of the selected insulin product net of all price 
     concessions received by or on behalf

[[Page H4034]]

     of the plan or coverage, including price concessions received 
     by or on behalf of third-party entities providing services to 
     the plan or coverage, such as pharmacy benefit management 
     services.
       ``(b) Definitions.--In this section:
       ``(1) Selected insulin products.--The term `selected 
     insulin products' means at least one of each dosage form 
     (such as vial, pump, or inhaler dosage forms) of each 
     different type (such as rapid-acting, short-acting, 
     intermediate-acting, long-acting, ultra long-acting, and 
     premixed) of insulin (as defined below), when available, as 
     selected by the group health plan or health insurance issuer.
       ``(2) Insulin defined.--The term `insulin' means insulin 
     that is licensed under subsection (a) or (k) of section 351 
     of the Public Health Service Act and continues to be marketed 
     under such section, including any insulin product that has 
     been deemed to be licensed under section 351(a) of such Act 
     pursuant to section 7002(e)(4) of the Biologics Price 
     Competition and Innovation Act of 2009 and continues to be 
     marketed pursuant to such licensure.
       ``(c) Out-of-Network Providers.--Nothing in this section 
     requires a plan or issuer that has a network of providers to 
     provide benefits for selected insulin products described in 
     this section that are delivered by an out-of-network 
     provider, or precludes a plan or issuer that has a network of 
     providers from imposing higher cost-sharing than the levels 
     specified in subsection (a) for selected insulin products 
     described in this section that are delivered by an out-of-
     network provider.
       ``(d) Rule of Construction.--Subsection (a) shall not be 
     construed to require coverage of, or prevent a group health 
     plan or health insurance coverage from imposing cost-sharing 
     other than the levels specified in subsection (a) on, insulin 
     products that are not selected insulin products, to the 
     extent that such coverage is not otherwise required and such 
     cost-sharing is otherwise permitted under Federal and 
     applicable State law.
       ``(e) Application of Cost-Sharing Towards Deductibles and 
     Out-of-Pocket Maximums.--Any cost-sharing payments made 
     pursuant to subsection (a)(2) shall be counted toward any 
     deductible or out-of-pocket maximum that applies under the 
     plan or coverage.''.
       (2) Clerical amendment.--The table of contents in section 1 
     of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1001 et seq.) is amended by inserting after the item 
     relating to section 725 the following:

``Sec. 726. Requirements with respect to cost-sharing for certain 
              insulin products.''.
       (d) No Effect on Other Cost-Sharing.--Section 1302(d)(2) of 
     the Patient Protection and Affordable Care Act (42 U.S.C. 
     18022(d)(2)) is amended by adding at the end the following 
     new subparagraph:
       ``(D) Special rule relating to insulin coverage.--The 
     exemption of coverage of selected insulin products (as 
     defined in section 2799A-11(b) of the Public Health Service 
     Act) from the application of any deductible pursuant to 
     section 2799A-11(a)(1) of such Act, section 726(a)(1) of the 
     Employee Retirement Income Security Act of 1974, or section 
     9826(a)(1) of the Internal Revenue Code of 1986 shall not be 
     considered when determining the actuarial value of a 
     qualified health plan under this subsection.''.
       (e) Coverage of Certain Insulin Products Under Catastrophic 
     Plans.--Section 1302(e) of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18022(e)) is amended by adding 
     at the end the following:
       ``(4) Coverage of certain insulin products.--
       ``(A) In general.--Notwithstanding paragraph (1)(B)(i), a 
     health plan described in paragraph (1) shall provide coverage 
     of selected insulin products, in accordance with section 
     2799A-11 of the Public Health Service Act, before an enrolled 
     individual has incurred, during a plan year, cost-sharing 
     expenses in an amount equal to the annual limitation in 
     effect under subsection (c)(1) for the plan year.
       ``(B) Terminology.--For purposes of subparagraph (A)--
       ``(i) the term `selected insulin products' has the meaning 
     given such term in section 2799A-11(b) of the Public Health 
     Service Act; and
       ``(ii) the requirements of section 2799A-11 of such Act 
     shall be applied by deeming each reference in such section to 
     `individual health insurance coverage' to be a reference to a 
     plan described in paragraph (1).''.
       (f) Implementation.--The Secretary of Health and Human 
     Services, the Secretary of Labor, and the Secretary of the 
     Treasury may implement the provisions of, including the 
     amendments made by, this section through sub-regulatory 
     guidance, program instruction, or otherwise.

     SEC. 3. APPROPRIATE COST-SHARING FOR CERTAIN INSULIN PRODUCTS 
                   UNDER MEDICARE PART D.

       (a) In General.--Section 1860D-2 of the Social Security Act 
     (42 U.S.C. 1395w-102) is amended--
       (1) in subsection (b)--
       (A) in paragraph (1)(A), by striking ``The coverage'' and 
     inserting ``Subject to paragraph (8), the coverage'';
       (B) in paragraph (2)--
       (i) in subparagraph (A), by striking ``and (D)'' and 
     inserting ``and (D) and paragraph (8)'';
       (ii) in subparagraph (B), by striking ``and (D)'' and 
     inserting ``and (D) and paragraph (8)'';
       (iii) in subparagraph (C)(i), by striking ``paragraph (4)'' 
     and inserting ``paragraphs (4) and (8)''; and
       (iv) in subparagraph (D)(i), by striking ``paragraph (4)'' 
     and inserting ``paragraphs (4) and (8)'';
       (C) in paragraph (3)(A), by striking ``and (4)'' and 
     inserting ``(4), and (8)'';
       (D) in paragraph (4)(A)(i), by striking ``The coverage'' 
     and inserting ``Subject to paragraph (8), the coverage''; and
       (E) by adding at the end the following new paragraph:
       ``(8) Treatment of cost-sharing for certain insulin 
     products.--
       ``(A) In general.--For plan years beginning on or after 
     January 1, 2023, with respect to an individual, the following 
     shall apply with respect to any insulin product (as defined 
     in subparagraph (B)) that is covered under the prescription 
     drug plan or MA-PD plan in which the individual is enrolled:
       ``(i) No application of deductible.--The deductible under 
     paragraph (1) shall not apply with respect to such insulin 
     product.
       ``(ii) Application of cost-sharing.--

       ``(I) In general.--The coverage provides benefits for such 
     insulin product, regardless of whether an individual has 
     reached the initial coverage limit under paragraph (3) or the 
     out-of-pocket threshold under paragraph (4), with cost-
     sharing for a one-month supply that is equal to the 
     applicable copayment amount.
       ``(II) Applicable copayment amount.--For purposes of this 
     clause, the term `applicable copayment amount' means, with 
     respect to an insulin product under a prescription drug plan 
     or an MA-PD plan, an amount that is not more than $35.

       ``(B) Insulin product.--For purposes of this paragraph, the 
     term `insulin product' means a covered part D drug that is an 
     insulin product that is approved under section 505 of the 
     Federal Food, Drug, and Cosmetic Act or licensed under 
     section 351 of the Public Health Service Act and marketed 
     pursuant to such approval or licensure, including any insulin 
     product that has been deemed to be licensed under section 351 
     of the Public Health Service Act pursuant to section 
     7002(e)(4) of the Biologics Price Competition and Innovation 
     Act of 2009 and marketed pursuant to such section.''; and
       (2) in subsection (c), by adding at the end the following 
     new paragraph:
       ``(4) Treatment of cost-sharing for insulin products.--The 
     coverage is provided in accordance with subsection (b)(8).''.
       (b) Conforming Amendments to Cost-Sharing for Low-Income 
     Individuals.--Section 1860D-14(a) of the Social Security Act 
     (42 U.S.C. 1395w-114(a)) is amended--
       (1) in paragraph (1)--
       (A) in subparagraph (D)(iii), by adding at the end the 
     following new sentence: ``For plan year 2023 and subsequent 
     plan years, the copayment amount applicable under the 
     preceding sentence for a one-month supply of an insulin 
     product (as defined in subparagraph (B) of section 1860D-
     2(b)(8)) dispensed to the individual may not exceed the 
     applicable copayment amount (as defined in subparagraph 
     (A)(ii)(II) of such section) for the product under the 
     prescription drug plan or MA-PD plan in which the individual 
     is enrolled.''; and
       (B) in subparagraph (E), by inserting the following before 
     the period at the end ``or under section 1860D-2(b)(8) in the 
     case of an insulin product (as defined in subparagraph (B) of 
     such section)''; and
       (2) in paragraph (2)--
       (A) in subparagraph (B), by adding at the end the following 
     new sentence: ``For plan year 2023 and subsequent plan years, 
     the annual deductible applicable under such section, 
     including as reduced under the preceding sentence, shall not 
     apply with respect to an insulin product (as defined in 
     subparagraph (B) of section 1860D-2(b)(8)) dispensed to the 
     individual.'';
       (B) in subparagraph (D), by adding at the end the following 
     new sentence: ``For plan year 2023 and subsequent plan years, 
     the amount of the coinsurance applicable under the preceding 
     sentence for a one-month supply of an insulin product (as 
     defined in subparagraph (B) of section 1860D-2(b)(8)) 
     dispensed to the individual may not exceed the applicable 
     copayment amount (as defined in subparagraph (A)(ii)(II) of 
     such section) for the product under the prescription drug 
     plan or MA-PD plan in which the individual is enrolled.''; 
     and
       (C) in subparagraph (E), by adding at the end the following 
     new sentence: ``For plan year 2023 and subsequent plan years, 
     the amount of the copayment or coinsurance applicable under 
     the preceding sentence for a one-month supply of an insulin 
     product (as defined in subparagraph (B) of section 1860D-
     2(b)(8)) dispensed to the individual may not exceed the 
     applicable copayment amount (as defined in subparagraph 
     (A)(ii)(II) of such section) for the product under the 
     prescription drug plan or MA-PD plan in which the individual 
     is enrolled.''
       (c) Implementation.--Notwithstanding any other provision of 
     law, the Secretary of Health and Human Services shall 
     implement this section for plan years 2023 and 2024 by 
     program instruction or otherwise.

     SEC. 4. ONE YEAR-EXTENSION ON MORATORIUM ON IMPLEMENTATION OF 
                   RULE RELATING TO ELIMINATING THE ANTI-KICKBACK 
                   STATUTE SAFE HARBOR PROTECTION FOR PRESCRIPTION 
                   DRUG REBATES.

       Section 90006 of the Infrastructure Investment and Jobs Act 
     (P.L. 117-58) is amended by striking ``January 1, 2026'' and 
     inserting ``January 1, 2027''.

     SEC. 5. MEDICARE IMPROVEMENT FUND.

       Section 1898(b)(1) of the Social Security Act (42 U.S.C. 
     1395iii(b)(1)), as amended by section 313 of division P of 
     the Consolidated Appropriations Act, 2022, is amended by 
     striking ``$5,000,000'' and inserting ``$9,046,500,000''.

  The SPEAKER pro tempore. The bill, as amended, shall be debatable for 
1 hour equally divided among and controlled by the respective chairs 
and

[[Page H4035]]

ranking minority members of the Committees on Education and Labor, 
Energy and Commerce, and Ways and Means, or their respective designees.
  The gentleman from California (Mr. DeSaulnier), the gentlewoman from 
North Carolina (Ms. Foxx), the gentleman from New Jersey (Mr. Pallone), 
the gentlewoman from Washington (Mrs. Rodgers), the gentleman from 
Michigan (Mr. Kildee), and the gentleman from Nebraska (Mr. Smith) each 
will control 10 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and insert extraneous material on H.R. 6833.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, I rise today in strong support of the Affordable 
Insulin Now Act, which is critical to protecting more than 7 million 
American patients who rely on insulin.
  Today, one in four Americans who need insulin report either having 
cut back or skipped doses because the cost is simply too high. That is 
heartbreaking and unacceptable. No one should have to ration their 
insulin to help reduce costs, risking their health and, in some tragic 
cases, actually costing them their lives.
  This bill will make insulin more affordable by capping the out-of-
pocket cost for consumers in both Medicare and the private insurance 
market at $35 a month. This will address the vast disparities between 
what people pay for insulin in other countries as compared to the 
United States.
  Right now, Americans are paying more than 10 times the price for 
insulin as people in other high-income countries. That is simply not 
fair.
  Right now, one out of every five Americans who depend on insulin have 
out-of-pocket costs of significantly more than $35 per month. That is 
unconscionable considering that insulin has been in use for over a 
century.
  I have heard my Republican colleagues contend that prices for insulin 
are coming down but, in reality, prices are going up for the consumer. 
The list prices set by the manufacturer, which patient cost-sharing is 
based off of, keep going up. In fact, reports note that the average 
retail price for insulin rose 54 percent--more than double--from 2014 
to 2019.
  Now, Madam Speaker, I continue to strongly support comprehensive 
efforts to rein in the soaring costs of prescription drugs and 
empowering Medicare to negotiate fair prices, but we cannot afford to 
wait any longer to address the price of insulin.
  I commend Representatives Craig, Kildee, and McBath for their 
leadership and hard work in bringing this important legislation to the 
House floor.
  I urge my colleagues, on a bipartisan basis, to support this 
lifesaving legislation.
  Madam Speaker, I reserve the balance of my time.
  Mrs. RODGERS of Washington. Madam Speaker, I yield myself such time 
as I may consume.
  We all share the goal of reducing the cost of insulin. This bill, 
however, is not the right answer. This is an attempt to revive Speaker 
Pelosi's proposed government drug-pricing scheme, part of a socialized 
medicine approach that would lead to fewer cures.
  It is the largest expansion of the Federal Government's role in 
private health insurance design since ObamaCare. It will cost more than 
$11 billion over the next 10 years through higher subsidies for higher 
premiums.
  Just this morning, Axios reported: ``But legislation like a House 
bill from Representative Angie Craig . . . that will be debated on the 
floor today wouldn't address the core problem of rising prices for 
insulin. It would instead shift more of the cost onto health insurers 
and employers and result in higher premiums, according to experts.''
  That means people who can't afford day-to-day life because of 
inflation and spending will face higher costs somewhere else.
  Today, it is the government fixing the price on insulin. What is 
next? Gas? Food?
  History tells us that price-fixing doesn't work. It shifts the 
problem somewhere else so the powerful have the excuse for more 
subsidies, more spending, and more control.
  This bill does nothing to address the real reasons insulin prices are 
going up. One of those is the pharmacy benefit managers and other 
middlemen who negotiate for high list prices and then hide the lower 
costs from the patients. This bill gives the middlemen who are making 
the money a pass because again, in this bill, the Democrats delay the 
rebate rule that would ensure that the real savings go into the pockets 
of the patients.

  Madam Speaker, we have a solution. We have a bill that we have been 
working on for several Congresses. It enjoys bipartisan support. It is 
H.R. 19, the Lower Costs, More Cures Act.
  It would lower the costs of all prescription drugs, including 
insulin. It caps seniors' out-of-pocket insulin costs at $50 per month 
through Medicare. It also allows high-deductible plans to cover insulin 
before the deductible kicks in. It increases low-cost options with more 
generic and biosimilar competition. There is exciting innovation on the 
way being built right now. And it creates more price transparency.
  We should be lowering the costs without going down the road of price 
controls that destroy the hope of so many people in this country for 
lifesaving cures.
  I urge us to reject H.R. 6833. Let's work on a solution for all 
diseases. Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from 
Maryland (Mr. Hoyer), the majority leader, who, along with the rest of 
the leadership, continues this effort to address affordability.
  Mr. HOYER. Madam Speaker, I thank the gentleman for yielding.
  First of all, this is not price control. It is limiting the purchaser 
on a price, but the companies are still going to charge what they are 
going to charge, and somebody is going to have to pay, and Medicare is 
going to have to pay. So, it does increase the cost. But it is not 
price control on the pharmaceuticals. And I want to say that we have a 
bill, of course, that will allow negotiation in Medicare, just as the 
VA does.

                              {time}  1430

  Negotiation is not price control. Negotiation is saying, I am going 
to buy a lot of your product, and I want a better price.
  A lot of us do that. We call it Sam's Club, or some other club that 
we go to. And we buy large volumes and get a cheaper price than our 
poorer friends who just buy it one at a time. So I am for this bill. It 
is a good bill.
  Madam Speaker, I thank Representatives Craig, Kildee, and McBath for 
their leadership on this bill. They have long been champions of making 
healthcare and prescription medications accessible and affordable for 
all Americans.
  More than one in three Americans are at high risk of developing 
diabetes, and over 37 million Americans already have it. A lot of those 
folks can't do without insulin. They don't have an option. And insulin 
has been on the market for decades and is not protected under patent, 
and the development prices have ages ago been amortized.
  Madam Speaker, to treat their condition, the people who have diabetes 
must rely on insulin injections to regulate their blood sugar levels. 
Now, if you have no option of not buying a product, those who sell that 
product can put the price wherever, if it means your life. A lack of 
insulin can lead to insulin shock, diabetic coma, kidney failure, and 
death.
  It is unacceptable that this lifesaving medication is priced out of 
reach for many who need it because it costs so little to produce.
  This is not a mechanism that has to charge these prices because it 
took so much to produce it. It costs only $10 to manufacture a month's 
supply. Yet, a month's supply can cost hundreds of dollars. However, 
with out-of-pocket costs as high as over $600 for a 40-day supply--now, 
if you extrapolate 40 days, that is 10 days more than a

[[Page H4036]]

month, so that is a third more. So let's say it costs $13 to produce. 
$600. Why?
  Because if they don't have it, they die.
  So all we are saying is, let's make sure this is affordable so people 
can sustain their lives and their health.
  Many Americans have resorted to rationing by skipping doses of their 
insulin because they can't afford it. The legislation before us would 
cap the out-of-pocket price of insulin at $35 a month.
  Let me again remind you, that is 350 percent of the cost of producing 
it. This would ease the burden of skyrocketing prices and impossible 
choices.
  Americans should not have to choose between paying the rent or for 
food, whatever, or paying for their insulin. As a matter of fact, they 
can't make that choice. They need both. They need to eat, and they need 
to live. And insulin is so often the way they assure that outcome. The 
prices will continue to rise unless we choose to act today.
  Madam Speaker, House Democrats already voted for this measure once, 
and Republicans already voted against it. So I guess we don't have any 
surprise of what's going to happen here.
  The Republicans are going to say to those who are using insulin: You 
are on your own. You are on your own. We are not going to worry about 
it.
  And we are going to say: We are here to help. We are here to make 
sure you don't get ripped off. We are here to make sure that you have 
the medicine that you absolutely need to survive.
  We voted for this measure as part of the Build Back Better Act in 
November. We made a promise to the American people that we would 
address the cost of prescription drugs, and we honored that promise.
  Republicans said no. They said once again: Consumer, you need 
insulin, you are on your own. They voted for higher drug prices. They 
voted for the status quo where many Americans have to choose between 
lifesaving insulin and putting food on the table.
  Today, my fellow colleagues, is an opportunity to vote to save lives 
and to provide a lifeline for millions of Americans with diabetes.
  Madam Speaker, I urge my colleagues on both sides of the aisle, do 
not say to the American people: You are on your own.
  Tell them: We are here to help. Vote to help them. Vote to ensure 
that they will be able to afford a drug they need to protect themselves 
from death.
  Madam Speaker, I ask my colleagues to join me in voting to bring 
prices down across our economy and our healthcare system. Join me in 
protecting Americans' ability to access lifesaving medication that 
prevents needless suffering, extends life, and provides a higher 
quality of living.
  Join me in voting for the Affordable Insulin for All Act. Again, I 
thank Ms. Craig, Mr. Kildee, Mrs. McBath, the chairman of this 
committee, and all those who brought this bill to the floor.
  Madam Speaker, I urge my colleagues, don't say, You are on your own.
  Say, We are by your side, and we are here to help.
  Mrs. RODGERS of Washington. Madam Speaker, I would just remind the 
body that the measure that the majority leader referred to failed in 
the Committee on Energy and Commerce with opposition from Democrats and 
Republicans because the proposed capping, price-fixing of drugs that 
the Democrats are promoting, would jeopardize cures; cures for people 
with Alzheimer's, cancers, diabetes.
  This bill does not bring down the cost. It only shifts the cost. And 
in fact, their definition of negotiation would allow the government to 
impose a 95 percent tax on the innovators.
  Madam Speaker, I yield such time as he may consume to the gentleman 
from Kentucky (Mr. Guthrie), leader on the Committee on Energy and 
Commerce, Health Subcommittee.
  Mr. GUTHRIE. Madam Speaker, I am proud to be here today. I worked 
with my colleague, Diana DeGette. We had hearings on the cost of 
diabetes and on the supply chain, and we said this is something we can 
work on together. And we did work on it together. And most of those 
provisions are in a bipartisan H.R. 19, the Lower Costs, More Cures 
Act.

  Madam Speaker, I am fighting for my constituents to have lower 
insulin costs. But I think, more importantly, I am fighting for my 
constituents to deliver a cure for diabetes. Our experts say it is not 
impossible to have a cure for diabetes in the next decade. And we need 
to continue to push policies that promote innovation, not slow it down. 
So the Lower Costs, More Cures Act will help patients, including 
seniors, afford monthly insulin prescriptions without discouraging 
future investments in breakthrough medications.
  I encourage the majority to come back with H.R. 19, Lower Costs, More 
Cures Act, and let's work together, instead of the rhetoric that we 
just heard from our respected leader. Let's work together and do it in 
a bipartisan way, the way we tried to do it in the Committee on Energy 
and Commerce.
  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentlewoman from 
Minnesota (Ms. Craig), the prime sponsor of the bill, who is constantly 
working to address affordability issues for Americans.
  Ms. CRAIG. Madam Speaker, I thank Chairman Pallone for yielding.
  Madam Speaker, diabetes does not care if you are a Republican or a 
Democrat. This disease is an absolute torrential disease inside working 
families across our country. This bill has been mischaracterized by the 
other side. This would lead to a $35 cost for Americans, for 
Minnesotans, for part D Medicare beneficiaries and commercial plan 
beneficiaries.
  For the vast majority of working families, the price of insulin is 
simply unsustainable. Many Americans are forced to risk their own lives 
by rationing doses or skipping treatments entirely. Today, we have an 
opportunity to save American families thousands of their hard-earned 
dollars.
  Madam Speaker, my bill, the Affordable Insulin Now Act, would cap it 
at $35 a month. Certainly, our work to lower drug costs and expand 
access to healthcare across this Nation is not done. But this is a 
major step forward in the right direction and a chance to make good on 
our promises to the American people.
  Madam Speaker, I encourage all of my colleagues to vote ``yes.''
  Mrs. RODGERS of Washington. Madam Speaker, I yield 2 minutes to the 
gentleman from Indiana (Mr. Bucshon), a great member of the Committee 
on Energy and Commerce.
  Mr. BUCSHON. Madam Speaker, we all share the same goal of lowering 
the cost of prescription drugs, especially insulin. But H.R. 6833 
doesn't get to the actual factors that drive the pricing.
  The bill before us today is just another attempt by Democrats in 
Washington to pass a political solution and set Federal price controls. 
And once they open that door, what happens when they don't stop with 
insulin? What happens when they decide to move on past healthcare, set 
price controls on other sectors of our economy?
  Why not cap what you can sell your house for in order to get the cost 
of housing down? Congress can't be for government price controls, as 
that is a slippery slope.
  Now, some of my colleagues may bring up the fact that Republicans' 
bipartisan alternative, H.R. 19, also caps seniors' out-of-pocket 
costs. But let me point out the distinction, it is Medicare part D.
  H.R. 6833 caps Medicare part D and private health plans. That is a 
direct, government price control on private companies.
  Madam Speaker, I am a doctor. I am also the co-chair of the House 
Kidney Caucus. I have an acute understanding of how expensive 
prescription drugs are and the need for Congress to act. However, I 
also understand that it is a structural issue and simply slapping price 
controls on it would not actually solve the problem. This will only 
raise premiums and shift the costs to patients with other diseases.
  Thankfully, there is a better way. H.R. 19, the Lower Costs, More 
Cures Act is a truly bipartisan solution to lower costs of all 
prescription drugs, including insulin. The bill caps out-of-pocket 
costs on prescription drugs in Medicare part D for seniors, allows high 
deductible health plans to cover insulin before the deductible kicks 
in, increases low-cost options by bringing more generic and biosimilar 
competition to the marketplace, and increases drug price transparency 
for patients. And the best part: Every provision is bipartisan.

[[Page H4037]]

  So let's get back to working together on bipartisan solutions that 
actually lower drug prices rather than resort to government price 
controls and a march towards government-run healthcare.
  Madam Speaker, if we adopt the motion to recommit, we will instruct 
the Committee on Energy and Commerce to consider my amendment to H.R. 
6833, which is H.R. 19, the Lower Costs, More Cures Act of 2022.
  Madam Speaker, I ask unanimous consent to insert the table of 
contents of this amendment in the Record immediately prior to the vote 
on the motion to recommit.

  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Indiana?
  There was no objection.
  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentlewoman from 
California (Ms. Eshoo), chair of the Committee on Energy and Commerce, 
Subcommittee on Health.
  Ms. ESHOO. Madam Speaker, I rise in full support of this legislation. 
Seated here on the floor, listening to our Republican friends--price 
controls, socialists, killing innovation. I am not going to use all of 
my time using their language.
  How about this? Diabetes kills. Diabetics need insulin. They have to 
be able to afford it. They have paid their taxes all of their lives, 
hardworking people.
  So the cost for this? Sign me up for it. Sign me up for it to help 
people, to invest in our own people.
  This is absurd, the prices in our country, when it costs $15 to 
manufacture.
  So today, we stand with your constituents as well as ours to lower 
the price of insulin for those that need it so that they can go on with 
their lives.
  Mrs. RODGERS of Washington. Madam Speaker, I reserve the balance of 
my time.
  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentlewoman from 
Illinois (Ms. Schakowsky), the chair of the Committee on Energy and 
Commerce, Subcommittee on Consumer Protection and Commerce.
  Ms. SCHAKOWSKY. Madam Speaker, I thank the gentleman for yielding.
  Madam Speaker, Americans pay 10 times as much for insulin as do any 
other consumers in countries around the world. The exact same drug. You 
know, we actually have the names of people who have died because they 
could not afford their insulin and started to cut back on their 
prescribed amount. And that is just unacceptable.
  Big Pharma has been gouging consumers for a long time, even for 
lifesaving drugs, and it is time to stop it. The Affordable Insulin Now 
Act will make insulin $35 a month for millions of Americans, and it 
will save life after life after life. This is only the start. We have 
to make sure that all Americans have access, including those who have 
no insurance.

                              {time}  1445

  Mrs. RODGERS of Washington. Madam Speaker, I reserve the balance of 
my time.
  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentleman from 
Oregon (Mr. Schrader), a member of the Energy and Commerce Committee.
  Mr. SCHRADER. Madam Speaker, I rise today in support of the 
Affordable Insulin Now Act. The bill before us today will finally 
deliver the financial relief Oregonians whose lives depend on insulin 
so desperately need.
  By capping the costs to no more than $35 month in Medicare part D and 
commercial insurance, Congress is making it clear that no one should 
have to cut back, ration, or skip doses of lifesaving medication.
  I am proud that this policy is a central tenet of my own drug pricing 
bill that I have worked on with leadership, secured in the House, and 
passed in the Build Back Better bill. We need to rein in all drug price 
prescriptions. That is why it is important to negotiate drug prices 
without stifling innovation, like we do in our bill. Limit the price 
increases of everyday drugs to the price of inflation, and perhaps more 
importantly, limit out-of-pocket costs to seniors to $2,000 or less.
  Mrs. RODGERS of Washington. Madam Speaker, I reserve the balance of 
my time.
  Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentlewoman from 
New Hampshire (Ms. Kuster), a member of Energy and Commerce Committee.
  Ms. KUSTER. Madam Speaker, I rise today in support of the Affordable 
Insulin Now Act, critical legislation to cap out-of-pocket costs for 
insulin at $35 per month.
  I consistently hear from Granite State families about how the rising 
cost of insulin is forcing them to put their health at risk by cutting 
back on doses or skipping them all together because it is just too 
expensive.
  We cannot continue to force American families to make impossible 
decisions between their medication and their well-being. At the end of 
the day, the work that we do is about our constituents, and I can say 
right here, right now that I care more about the well-being of my 
constituents and their health than I do about the profits of certain 
companies that seem to be protected on the other side of the aisle.
  No one should pay more than $35 a month for their insulin, and I urge 
my colleagues to support this bill.
  Mrs. RODGERS of Washington. Madam Speaker, I reserve the balance of 
my time.
  Mr. PALLONE. Madam Speaker, I would inquire how much time is 
remaining on each side.
  The SPEAKER pro tempore. The gentleman from New Jersey has 2 minutes 
remaining, and the gentlewoman from Washington has 3\1/2\ minutes 
remaining.
  Mr. PALLONE. Madam Speaker, I yield 1 minute to the gentlewoman from 
Washington (Ms. Schrier), a member of the Energy and Commerce 
Committee.
  Ms. SCHRIER. Madam Speaker, I am delighted that today we will be 
voting to pass the Affordable Insulin Now Act. This is personal for me. 
I have type 1 diabetes and insulin keeps me alive. This tiny 2 teaspoon 
bottle that used to cost $40 now retails for over $300. Most of us need 
more than one bottle a month to survive.
  No one should have to ration their insulin--taking just enough to 
stay alive but not enough to stay healthy. That is a dangerous and 
sometimes deadly tightrope to walk, which is why this bill to cap 
insulin at $35 a month is so critical for my patients, as a 
pediatrician, and for people like me.
  Mrs. RODGERS of Washington. Madam Speaker, I yield 2 minutes to the 
gentleman from Georgia (Mr. Carter), an outstanding member of the 
Energy and Commerce Committee.
  Mr. CARTER of Georgia. Madam Speaker, for over 30 years I was the one 
who was on the other side of the counter who had to tell the patient 
how much their insulin costs. I was the one who watched the senior 
citizens trying to decide whether they were going to buy insulin or buy 
groceries. I was the one who watched a mother cry because she couldn't 
afford the medication for her child.
  I was the one who watched all this happen, and now I am finally 
getting the opportunity to address this issue on the House floor. I am 
saddened that it will do nothing to protect those mothers from the pain 
of not being able to afford lifesaving medications.
  Make no mistake about this. We all agree on the same thing, Madam 
Speaker. We want lower prices for drugs, particularly for insulin. But 
instead of fixing a broken system, this bill aims to control it. This 
Socialist plan of requiring every private insurance company across the 
country to offer certain insulins, not all but certain, at a mandated 
price will have disastrous consequences on seniors and the 217 million 
Americans who rely on private insurance.
  We all know that insurance agencies will shift these costs to 
patients with other diseases. Don't kid yourself. This is like 
squeezing a balloon, it is going to go somewhere else. We aren't 
talking about the bipartisan solutions that currently exist, like the 
Lower Costs, More Cures Act of 2021, H.R. 19. That is what we ought to 
be talking about.
  Why aren't we talking about the PBMs, the middlemen? The Berkeley 
Institute came out with a study last week, Madam Speaker, that said 
that 37 percent of the price of a drug goes to the pharmaceutical 
manufacturer and the rest goes to the middleman, the PBM. The solution 
is right there before us. This is not going to fix it. This is going to 
control it, but it is not going to fix it.
  Madam Speaker, I oppose this. We all have the same common goal, but 
this is not the solution.

[[Page H4038]]

  

  Mr. PALLONE. Madam Speaker, I yield 30 seconds to gentlewoman from 
Georgia (Ms. Bourdeaux).

  Ms. BORDEAUX. Madam Speaker, I rise in support of the Affordable 
Insulin Now Act.
  Before his death, my father paid $300 for a 10 milliliter vial of 
insulin that cost about $25 in Canada. Far too many Americans, like my 
father, are forced to choose between paying for their medication or 
buying food for their families. No one should have to make that choice.
  Georgia has one of the highest diabetes rates in the country, and 
this measure would provide my constituents with meaningful relief. I 
urge all of my colleagues to vote ``yes'' on H.R. 6833 and lower the 
cost of insulin.
  Mrs. RODGERS of Washington. Madam Speaker, I reserve the balance of 
my time.
  Mr. PALLONE. Madam Speaker, I yield the balance of my time to the 
gentleman of New Jersey (Mr. Payne).
  Mr. PAYNE. Madam Speaker, I would like to thank the chairman for 
giving me this opportunity because I wanted my colleagues on the other 
side to see what an insulin patient looks like. You are looking at him.
  I need insulin in order to stay alive. The boot that I am wearing is 
not a fashion decision, it is because I have a diabetic ulcer on my 
foot, the fourth one I have had in 7 years.
  I have left my insulin in New Jersey, gone to the drugstore when I 
arrived down here in Washington, and said: I need insulin. They said: 
Well, Mr. Payne, your insurance isn't ready to cover it. I said: Well, 
that is all right. I am doing okay in life, I will pay for it. She goes 
back, she gets the bag and hands it to me and says: $348. What happens 
to the people that are not at the level of a Member of Congress? Think 
about that. It is $12 in Canada.
  We are asking for it to be three times higher than it is in Canada. 
Think about that. I live it every single day.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mrs. RODGERS of Washington. Madam Speaker, I yield myself such time 
as I may consume.
  Madam Speaker, I hear the Democrats talking about this helping all 
Americans. This does nothing to help those without insurance. Let me 
repeat this. If you do not have insurance, this does not lower your 
cost, it may actually increase the price of your insulin.
  Increasing competition to lower prices, as we do in H.R. 19 is the 
way, not dictating a price cap. We have break-through biosimilars right 
now. We had two approved last year; biosimilars that would help bring 
down the costs; costs savings within all markets so that patients would 
have access to lower-cost insulin.
  The problem is getting those savings to the patients. The PBMs are 
the ones pocketing the money. Net prices have come down because of 
innovation. We can lower costs without shifting them. Let's go to work. 
Republicans and Democrats, we all want to lower the price of insulin 
and we can do it without government price controls and we can do it by 
working together and actually solving the problem.
  Madam Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The gentleman from Michigan (Mr. Kildee) and 
the gentleman from Nebraska (Mr. Smith) each will control 10 minutes.
  The Chair recognizes the gentleman from Michigan.
  Mr. KILDEE. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I want to thank Chairman Neal for his leadership on 
the Ways and Means Committee in helping to bring this important 
legislation to the floor.
  Right now, families and seniors that I represent in Michigan, and all 
across the country, are paying too much for prescription drugs, in 
particular, for insulin. That is why Congresswoman Craig and 
Congresswoman McBath and I have introduced the Affordable Insulin Now 
Act to make insulin more accessible and more affordable.
  This legislation would lower out-of-pocket costs for Americans with 
diabetes by ensuring that insurers and Medicare can't charge more than 
$35 a month out-of-pocket for this medication.
  Insulin was discovered over 100 years ago. Since then, little about 
this lifesaving medication has changed, but the price of insulin in the 
United States has absolutely skyrocketed. As a result, Americans pay 10 
times more for insulin than patients in other developed countries, and 
one in four Americans who rely on insulin have cut back or skipped 
their doses due to costs.
  No one should have to choose between taking their medication as 
prescribed and putting food on the table or a roof over their head. 
People must make that choice because of Big Pharma's unfair pricing 
practices. This is something I know a little bit about.
  As a father of a type 1 diabetic, I have seen firsthand how the high 
price of prescription drugs like insulin can harm patients and harm 
families. When my daughter turned 26 and got her own health insurance, 
there are months where she spends a third of her take-home pay, because 
she is diabetic, on staying alive. She has her mom and I to back her, 
but not everybody has that advantage. Either way, it doesn't make it 
okay.
  In Michigan, it is estimated that 1 in 10 people have some form of 
diabetes. The average sticker price for a month's supply of insulin is 
$375, but for some it can be as high as $1,000 a month, just because 
they need to take more insulin. That is just not right.
  Jill Verdier, a type 1 diabetic from my district, was my virtual 
guest at the State of the Union this year. She told me that insulin is 
like air to people with diabetes, they need it to survive.

                              {time}  1500

  At a time when Big Pharma is making record profits, Congress has to 
do more to lower costs, out-of-pocket costs. And that is why I fought 
to bring this bill to the floor with my colleagues, Representative 
Craig and Representative McBath. I urge my colleagues to vote to pass 
our legislation to lower costs. This is important legislation. I know 
we need to invest in cures. Obviously we would like to see the total 
price of insulin come down. But it is difficult to hear my colleagues 
on the other side who oppose the legislation to bring down the cost 
will also oppose this legislation to keep Americans from having to 
spend more out of their pocket. I think this is legislation that makes 
sense. It would help people. It would save lives.
  Madam Speaker, I reserve the balance of my time.
  Mr. SMITH of Nebraska. Madam Speaker, I yield myself such time as I 
may consume.
  Madam Speaker, this issue is so important I don't think we should 
automatically accept a partisan proposal that doesn't even get to the 
heart of the problem.
  Today we actually could be voting on H.R. 19, the Lower Costs, More 
Cures Act, a bipartisan bill that would not only address the root 
causes of the high insulin prices, but lower costs for all patients.
  Instead, and I might say, very sadly, we are voting on a partisan 
messaging bill to give Washington a greater say in Americans' medical 
decisions while raising premiums on seniors and the millions of 
Americans with private health insurance.
  This is nothing more than an attempt by my colleagues on the other 
side to pass just piece by piece their cures-killing Socialist takeover 
of the entire innovation sector. And worse, despite the misleading 
title of this current bill, it does nothing to lower the actual price 
of insulin. Instead, it uses budget games and regulations to disguise 
the actual cost of insulin for all consumers.
  This is just another instance of misguided health and economic 
policies coming at a time when more than half of Americans are worried 
about rising prices and the economy. And, of course, like the 
President's budget released this week, this bill, too, is only ``paid 
for'' with gimmicks, adding to our deficit and the core causes of 
inflation.
  We can and should do more for the American people who are struggling. 
The American people expect us to work together. We could be doing that.
  Madam Speaker, I reserve the balance of my time.
  Mr. KILDEE. Madam Speaker, I yield 1 minute to the gentleman from 
Illinois (Mr. Danny K. Davis), who is my colleague on the Ways and 
Means Committee.
  Mr. DANNY K. DAVIS of Illinois. Madam Speaker, I rise in strong 
support of this legislation. As a type 2 diabetic myself for the last 
30 years, I

[[Page H4039]]

know firsthand the high cost of this prescription. There is nothing in 
my district more prevalent as a disease entity than diabetes. I 
strongly support it. It is an idea whose time not only has come but has 
passed.
  Mr. SMITH of Nebraska. Madam Speaker, I reserve the balance of my 
time.
  Mr. KILDEE. Madam Speaker, I yield 1 minute to the gentleman from 
Texas (Mr. Doggett), who is also a member of the Ways and Means 
Committee.
  Mr. DOGGETT. Madam Speaker, to assure a stable supply of insulin and 
better health at $35 instead of $300 monthly, I fully support this bill 
for Yolanda, a retired Texas teacher, and one-quarter of insulin-
dependent patients forced to ration their insulin because of predatory 
pricing.
  Yet, instead of addressing pharmaceutical price gouging, this bill 
really only shifts how Big Pharma is rewarded. Since this bill does not 
reduce any insulin prices by one penny, all of us who are insured will 
ultimately pay through our premiums while taxpayers are on the hook for 
$11 billion. For Americans who rely on other types of lifesaving drugs, 
there is also no relief. Big Pharma remains immune from any restraint 
on its monopoly prices from a Congress that is simply unable to hold it 
accountable.
  My further concern is that this bill widens the coverage gap for 
nearly 5.5 million Texans and 28 million Americans who are uninsured, 
wrongly excluded from any benefit, and who do not receive any benefit 
today. While the uninsured population represents 17 percent of the 
insulin-dependent population, they constitute 80 percent of the people 
who pay full, monopoly prices. So, help for some--which is important--
but there is a need to do more for the many who are not covered today.
  Mr. SMITH of Nebraska. Madam Speaker, I include in the Record letters 
from numerous groups representing and reflecting the views of millions 
of Americans.


                                                  AMAC Action,

                                     Leesburg, FL, March 30, 2022.
     Hon. Steve Scalise,
     House Republican Whip,
     Washington, DC.
       Dear Whip Scalise: On behalf of the 2.3 million members of 
     AMAC--Association of Mature American Citizens, I write to 
     express our concern with H.R. 6833, the Affordable Insulin 
     Now Act.
       Not too long ago, former President Trump made significant 
     gains in lowering insulin costs for Americans. He initiated 
     the Part D Senior Savings Model a voluntary program which 
     allows beneficiaries to choose enhanced Part D plan options 
     that offer lower out-of-pocket costs for insulin. He also 
     signed an Executive Order that delivered inexpensive insulin 
     and epinephrine to lower income patients. Unfortunately, 
     President Biden delayed this Executive Order the day after he 
     took office in 2021 before rescinding it later that year.
       Now, the Democrats are considering H.R. 6833 which is an 
     unserious attempt to lower the price of insulin. This bill 
     would exert price controls on private market insulin to cap 
     the costs paid by patients. H.R. 6833 takes us closer to 
     further pharmaceutical price-fixing, a policy contained the 
     Build Back Better plan. Price-fixing drugs leads to rationing 
     and shortages as evidenced in other countries who have 
     employed this policy. The Democrats' bill is estimated to 
     increase spending by about $11 billion, and the bill is paid 
     for by delaying the rebate rule for one year. This Trump-era 
     rule compels pharmacy benefit managers to share the rebates 
     they receive from drug manufacturers with Part D 
     beneficiaries to lower their out-of-pocket expenses.
       The Affordable Insulin Now Act is an election year 
     messaging act on the part of Democrats. If they were serious 
     about lowering the cost of insulin, they would work with 
     Republicans on innovative programs like the Part D Senior 
     Savings Model, a program that is expanding with robust 
     participation by plan sponsors and offers predictable insulin 
     costs that do not exceed $35/month.
       As an organization comprised of Americans who are age 55-
     plus, controlling drug costs, especially insulin costs, is 
     paramount to maintaining a good quality of life for AMAC 
     members. H.R. 6833 is a step in the wrong direction for 
     lowering insulin prices and opens the door for further 
     government price-fixing and regulation.
           Sincerely,
                                                    Bob Carlstrom,
     President, AMAC Action,
                                  ____

                                              Council for Citizens


                                     Against Government Waste,

                                                   March 30, 2022,
     House of Representatives,
     Washington, DC.
       Dear Representative: You will soon be considering H.R. 
     6833, the Affordable Insulin Now Act. On behalf of the more 
     than one million members and supporters of the Council for 
     Citizens Against Government Waste (CCAGW), I urge you to 
     oppose H.R. 6833 and any other measure to institute price 
     controls in the medical marketplace.
       In addition to imposing price controls, H.R. 6833 also 
     increases funding for the Medicare Improvement Fund by $9 
     billion and adds $1.5 million to the budget for the Centers 
     for Medicare and Medicaid Services to carry out the 
     provisions of the bill.
       Historically, price controls like those contained in the 
     Affordable Insulin Now Act increase costs and lead to 
     shortages and rationing. H.R. 6833 will lead to increased 
     premiums for seniors and the 217 million Americans who rely 
     on private health insurance. The government has no business 
     setting prices on any good or service, especially not 
     healthcare. Price controls inherently distort the medical 
     marketplace and leave Americans worse off by significantly 
     decreasing future research and development.
       Americans are already suffering under the highest inflation 
     in 40 years, and H.R. 6833 will increase this financial 
     hardship. The cost of medicines should be address without 
     instituting price controls or threatening future innovation. 
     I again urge you to oppose this legislation. All votes on 
     H.R. 6833 may be among those considered in CCAGW's 2022 
     Congressional Ratings.
           Sincerely,
     Tom Schatz.
                                  ____



                                                         NFIB,

                                   Washington, DC, March 30, 2022.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     Republican Leader, House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi and Leader McCarthy: On behalf of NFIB, 
     the nation's leading small business advocacy organization, I 
     write to express concern regarding H.R. 6833, the Affordable 
     Insulin Now Act.
       This legislation has a laudable goal of attempting to make 
     insulin more affordable and accessible to Americans on 
     private and public health plans. Unfortunately, it will have 
     unintended consequences for small businesses and employees by 
     necessitating increased premiums while failing to address the 
     underlying issues that make insulin unaffordable in the first 
     place.
       As studies have shown, a limited number of manufacturers, 
     patent evergreening, practices of pharmacy benefit managers 
     (PBMs), and other issues contribute to the high price of 
     insulin. H.R. 6833 does not address any of these problems and 
     instead seeks to solve consumer affordability by pushing 
     significant, additional costs onto employers and health plans 
     by limiting participant cost sharing.
       For over 30 years, NFIB members have identified the cost of 
     health insurance as the number one small business problem 
     with 50 percent ranking it as a critical problem. Rising 
     health insurance premiums result in fewer small businesses 
     offering health insurance benefits. Since 2000, the average 
     costs of an employer-sponsored single coverage plan and an 
     employer-sponsored family plan have increased 149 percent and 
     18 percent, respectively. Unsurprisingly, facing these cost 
     pressures, the number of small businesses with fewer than 50 
     employees offering coverage has declined from 47.2 percent in 
     2000 to 31 percent in 2020. Many small employers that are 
     providing insurance have been forced to increase participant 
     cost-sharing and deductibles as the only means to counter 
     unsustainable premium increases and continue to offer 
     coverage. To that end, solutions to affordability that limit 
     cost-sharing without corresponding reforms will only serve to 
     increase premiums and further exacerbate the small business 
     affordability problem.
       NFIB continues to advocate for affordable health insurance 
     for small businesses and all Americans. However, if the 
     system of employer sponsored health insurance is to endure in 
     the long-term, Congress must work together to address the 
     underlying cost drivers of the American healthcare system, 
     rather than shift additional cost burdens onto employers 
     seeking to offer health insurance to their employees.
           Sincerely,

                                                Kevin Kuhlman,

                                                   Vice President,
     Federal Government Relations.
                                  ____

                                                   Partnership for


                                  Employer-Sponsored Coverage,

                                                   March 30, 2022.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     Minority Leader, House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi and Leader McCarthy: The Partnership 
     for Employer-Sponsored coverage (P4ESC) writes to share our 
     strong concerns regarding H.R. 6833 the ``Affordable Insulin 
     Now Act.'' Although P4ESC shares the goal of lowering the 
     cost of insulin, we believe this bill will simply shift costs 
     back to employers and employees, including those who are 
     insulin dependent. A better and more direct solution that 
     addresses excessive profit taking by pharmaceutical 
     manufacturers and others, including pharmacy benefit 
     managers, in the pharmaceutical supply chain would be 
     preferable.
       The Congressional Budget Office (CBO) recently found that 
     H.R. 6833 would increase the federal deficit by as much as 
     $11 billion over ten years and increase health insurance

[[Page H4040]]

     premiums for all Americans. Indeed, there will not be any 
     curb on future insulin price increases paid by employers and 
     insurers. Every dollar of cost increase will be reflected in 
     ever higher health insurance premiums paid by all Americans, 
     whether privately insured or covered through Medicare. Better 
     approaches that increase competition among insulin 
     manufacturers, address regulatory problems and streamline the 
     supply chain will help reduce the cost of all prescription 
     drugs, including insulin.
       The Partnership for Employer-Sponsored Coverage is an 
     advocacy alliance of employment-based organizations and trade 
     associations representing businesses of all sizes and the 
     more than 181 million American employees and their families 
     who rely on employer-sponsored coverage every day. We are 
     committed to working to ensure that employer-sponsored 
     coverage is strengthened and remains a viable, affordable 
     option for decades to come. We look forward to working with 
     you to ensure employer-sponsored coverage continues to 
     thrive.
       We would welcome the opportunity to discuss these issues 
     with you or your staffs.
           Sincerely,
                                Partnership for Employer-Sponsored
     Coverage (P4ESC).
                                  ____



                                 The ERISA Industry Committee,

                                   Washington, DC, March 29, 2022.
       Dear Member of Congress: As the House prepares to vote on 
     the ``Affordable Insulin Now Act'' (H.R. 6833), The ERISA 
     Industry Committee (ERIC) writes to share opposition to this 
     legislation and urges members to vote ``NO'' when the bill is 
     called for a vote.
       ERIC is a national nonprofit organization exclusively 
     representing the largest employers in the United States in 
     their capacity as sponsors of employee benefit plans for 
     their nationwide workforces. With member companies that are 
     leaders in every economic sector, ERIC is the voice of large 
     employer plan sponsors on federal, state, and local public 
     policies impacting their ability to sponsor benefit plans and 
     to lawfully operate under ERISA's protection from a patchwork 
     of different and conflicting state and local laws, in 
     addition to federal law.
       ERIC member companies voluntarily offer comprehensive 
     health benefits to millions of active and retired workers and 
     their families across the country. Our members offer great 
     health benefits to attract and retain employees, be 
     competitive for human capital, and improve health and provide 
     peace of mind. On average, large employers pay around 75 
     percent of health care costs on behalf of 181 million 
     beneficiaries. As such, ERIC member companies have a 
     significant stake in, and deep commitment to, efforts to curb 
     unsustainable rising costs in the health care system.
       Employers oppose H.R. 6833 because the bill imposes 
     government-mandated prices, shifts costs to patients, and 
     will not lower drug costs. The bill may in fact increase the 
     costs of insulin by creating a perverse incentive wherein 
     insulin manufacturers know that no matter how much they 
     increase prices, their customers will pay government-set 
     prices. This action will cause employers, insurers, and other 
     health insurance enrollees to pay more to offset these high 
     costs. This view is supported by the Congressional Budget 
     Office (CBO), which recently found that this policy would 
     increase the federal deficit by around $11 billion and 
     increase health insurance premiums for all Americans.
       ERIC and our member companies support legislation that 
     would actually lower prescription drug costs, including for 
     insulin, rather than shift costs to employers and other 
     patients. Congress could achieve this by enacting policies 
     to:
       Increase competition among insulin manufacturers;
       Fix the regulatory problems that misclassify insulin and 
     fail to properly align market exclusivity and patent 
     protections to the drug; and
       Address supply chain issues like rebates and bona fide 
     service fees that lead to formularies that do not reflect 
     value for patients.
       Many of these proposals are already included in bipartisan 
     legislation that could be quickly passed and sent to the 
     President for his signature. They have been scored by CBO to 
     lower drug costs and health insurance premiums for all 
     Americans.
       Because the ``Affordable Insulin Now Act'' fails to reduce 
     drug prices and raises health insurance costs for all, ERIC 
     urges members to vote NO, and oppose the passage of H.R. 
     6833. We look forward to working with Congress on productive, 
     effective, value-driven solutions to make prescription 
     drugs--including insulin--affordable for all Americans.
           Sincerely,
     James P. Gelfand.
                                  ____



                                                 FreedomWorks,

                                                   March 30, 2022.

        Key Vote NO on the Affordable Insulin Now Act, H.R. 6833

       On behalf of FreedomWorks' activist community, I urge you 
     to contact your representative and ask him or her to vote NO 
     on the Affordable Insulin Now Act, H.R. 6833, introduced by 
     Rep. Angie Craig (D-Minn.). This legislation would impose 
     socialist price controls to cap the price of insulin at $35.
       Currently, Americans are grappling with the harsh reality 
     of increased prices on everything from gas to groceries. We 
     see firsthand the consequences of modem monetary theory and 
     the devastation it brings. Unfortunately, the many Americans 
     that struggle with diabetes are no stranger to increased 
     prices. The cost of insulin has been steadily rising for 
     decades.
       While progressives are all too eager to blame high prices 
     on ``corporate greed,'' the reality is that this is an issue 
     created by the federal government. Heavy-handed price 
     controls are a deeply flawed solution that misses the mark 
     when identifying the problem.
       Pharmacy benefit managers (PBMs) play a significant role in 
     the dramatic rise in the cost of prescription drugs. PBMs are 
     third-party administrators determining which drugs go on 
     formularies (a list of approved prescription drugs that 
     hospitals can prescribe and are covered under an insurance 
     policy). Ostensibly, PBMs negotiate to obtain the best price. 
     However, these ``savings'' are often pocketed by PBMs 
     themselves and aren't passed onto patients. Since they are 
     reimbursed based on the markdown from the original list 
     price, PBMs are incentivized to prioritize drugs with higher 
     list prices, so they can receive a larger markdown.
       There are free-market alternatives to lower the cost of 
     insulin and healthcare in general. For example, it was 
     reported in an article in The Federalist, ``A consortium of 
     hospitals recently announced plans to build a factory that 
     can manufacture insulin within two years. Once their plant 
     gets up and running, the non-profit consortium said it would 
     sell the insulin at a cost of $30 a vial--a fraction of what 
     pharmaceutical companies currently charge.''
       This legislation is a simplistic proposal to address a 
     highly complex problem. We cannot afford half-hearted 
     proposals based on unsound economics like this one for an 
     issue that impacts so many.
       FreedomWorks will count the vote for H.R. 6833 on our 2022 
     Congressional Scorecard and reserves the right to score any 
     amendments, motions, or other related votes. The scorecard is 
     used to determine eligibility for the FreedomFighter Award, 
     which recognizes Members of the House and Senate who 
     consistently vote to support economic freedom and individual 
     liberty.
           Sincerely,
                                                     Adam Brandon,
     President, FreedomWorks.
                                  ____


                        National Taxpayers Union

       As the calendar turns to April, the U.S. House of 
     Representatives is planning to vote on legislation that would 
     cap insulin costs for all Americans who are privately insured 
     or on Medicare Part D at no more than $35 per month in out-
     of-pocket payments. While the bill's sponsors may have good 
     intentions, and while Congress can certainly act to provide 
     support for Americans facing high prescription drug costs, 
     NTU has several concerns about the impact the ``Affordable 
     Insulin Now Act'' will have on America's taxpayers and 
     broader health care system.
       The legislation would impose new cost-sharing limits on 
     insulin for almost all privately insured Americans, and would 
     extend these limitations to the tens of millions of Americans 
     on Medicare Part D. According to a Congressional Budget 
     Office (CBO) cost estimate, the bill's requirements would 
     cost federal taxpayers around $11 billion ($6.6 billion in 
     higher spending and $4.8 billion in reduced revenues). It is 
     likely this cost estimate is due to anticipated higher 
     premiums in both Medicare Part D and the Affordable Care Act 
     individual marketplace. In these programs, higher premiums 
     usually mean higher federal subsidies for health coverage 
     that are paid for by taxpayers.
       Indeed, proponents of the legislation have not properly 
     addressed the impact this legislation would have on premiums 
     in both Part D and the private marketplace. The Affordable 
     Insulin Now Act puts a cap on the out-of-pocket costs owed by 
     insured enrollees for insulin products, but it does not 
     ultimately change the price of insulin paid for by health 
     insurers. If insurers face higher costs for covering these 
     drugs, they will likely be forced to pass those costs on to 
     customers in the form of higher premiums or higher cost-
     sharing on other health products and services. And, as noted 
     above, some higher premiums will result in higher costs for 
     taxpayers, who bear some of the burden for covering seniors 
     under Part D and low- and middle-income Americans on the ACA 
     marketplace.
       Perhaps the most troubling part of the legislation, though, 
     is the proposed offset for the cost of the legislation. House 
     Democratic leadership is proposing to `pay for' the 
     legislation's $11 billion cost with a shameless budget 
     gimmick that NTU and NTU Foundation have called out before: 
     delaying a Trump administration ``rebate'' regulation that 
     was projected to raise federal government costs but was never 
     likely to be implemented in the first place.
       As NTU wrote in July of last year, when a bipartisan group 
     of lawmakers proposed using rebate rule delay as a pay-for in 
     the major infrastructure bill:
       ``This phantom $49 billion ``pay for'' was called 
     ``Washington at its worst'' by one health industry lobbyist 
     speaking to The Washington Post. In short, the Biden 
     administration has delayed until 2023 a Trump administration 
     regulation that would change how prescription drug discounts 
     are handled by insurers and pharmacy benefit managers (PBMs). 
     Because the Congressional Budget Office projected that the 
     so-called rebate rule would increase federal spending in 
     Medicare and Medicaid by about $177 billion over

[[Page H4041]]

     a decade, due to a rise in Medicare premiums (and therefore, 
     taxpayer-funded subsidies for Medicare premiums), lawmakers 
     get to count a further delay in the rule (beyond the Biden 
     administration's one-year delay) as ``savings'' for the 
     federal government. Reports indicate Congressional Democrats 
     may use additional phantom ``savings'' from the rebate rule 
     in their larger reconciliation bill by repealing the rebate 
     rule entirely.
       . . . This rule has never been implemented, and there's no 
     clear indication that the Biden administration would have 
     followed through on implementing the regulation even after 
     their one-year delay. And even if the Biden administration 
     had implemented the rule, there's little clarity as to 
     whether the rebate rule would have actually cost federal 
     taxpayers over $177 billion over the decade. In short, 
     delaying the rebate rule does not present real, tangible 
     savings to taxpayers, like a reduction in federal spending 
     would.''
       Unfortunately, it seems like the rebate rule is becoming 
     yet another tried-and-true budget gimmick that Congress dips 
     into again and again, in order to appear as if they are 
     paying for new spending. And according to the CBO estimate 
     cited above, because the rebate rule is projected to offer 
     $20 billion in phantom savings--not just the $11 billion 
     needed to cover the insulin bill's costs--the revised insulin 
     legislation proposes spending another $9 billion on a broad-
     based Medicare Improvement Fund. That means $9 billion more 
     will ultimately be spent without real offsets and, in our 
     view, be paid for by taxpayers in the long run with higher 
     debt and deficits.
       To be clear, high out-of-pocket costs for insulin are a 
     real issue for many Americans. NTU continues to support 
     several bipartisan and meaningful proposals that would 
     provide relief for many Americans, including:
       An out-of-pocket cap in Medicare Part D, along with Part D 
     benefit redesign that would actually save taxpayers money in 
     the long run;
       An ongoing Medicare insulin model that represents a public-
     private partnership between the federal government, insurers, 
     and drug manufacturers that has the potential to meaningfully 
     reduce out-of-pocket insulin costs for up to millions of 
     seniors on Part D; and
       Allowing Part D enrollees to spread their out-of-pocket 
     burdens over the 12 months of a plan year, rather than having 
     to owe major bills in the first or second months of a new 
     plan year.
       This legislation could undermine the ongoing Medicare 
     insulin model, Part D redesign efforts, and reported 
     bipartisan work in the Senate to provide insulin cost relief 
     for American patients who are struggling. The House should go 
     back to the drawing board and focus on more bipartisan 
     opportunities.

  Mr. SMITH of Nebraska. Madam Speaker, I yield such time as he may 
consume to the gentleman from Arizona (Mr. Schweikert), who is an 
expert in health policy.
  Mr. SCHWEIKERT. Madam Speaker, you do realize what is going on here, 
and I am going to be a little sarcastic because I am frustrated.
  Insulin prices are outrageous.
  But why is it outrageous?
  The fact of the matter is our regulatory mechanic and our payment 
mechanic are the very things that broke this, and here you do a piece 
of legislation that will break it more.
  Please, I beg of the majority: Hire an economist. And I will walk you 
through some of the facts on it. So, Madam Speaker, you are doing a 
bill here where you are going to subsidize the dollar amount in the 
back, but you are still going to keep the regulatory mechanics the way 
they are in their archaic designs, and then you are going to be joyful 
that individuals will pay what, $35 a vial?
  At the same time we are subsidizing it billions and billions and 
billions of dollars.
  Does anyone have a subscription to an aggregator on healthcare policy 
on your side?
  You do realize, there is a co-op coming out of the ground right now 
that is going to be $50, $55 for a box of five. It is lower than your 
subsidized price. And this is their market price.
  If you were doing something good for society, you would actually be 
moving this covax to the top of the regulatory stack and say: We want 
them to get permitted and licensed as fast as possible because they are 
still a year plus away. But it is being built right now, and you are 
about to screw up the solution. And if you really, really, really, 
really care about people--remember, I represent the population with the 
second highest number of diabetes. I represent a Tribal community that 
is number two in the world. Come with me some time and let me introduce 
you to people who have had their feet cut off. If you actually care 
about solving the misery, then read the science journals that made it 
clear last November, December, the success.
  We know how to cure. And for my friend over here, you have a family 
member type 1--I know I need to go through the Speaker--but a family 
member with type 1, we know how to cure it now. And there is even the 
next generation of this. We have even learned how to do the stem cell, 
the isolate cell, tag it with a CRISPR so you can do a bio-foundry, 
meaning it doesn't have to come from your skin cells, we can basically 
now cure type 1 and the same technology will work for type 2. But we 
are going to have to deal with some societal issues. If you want to end 
the misery in society don't build more clinics, don't do a subsidy, get 
this technology to people.
  And for those of us who are fiscal hawks and actually care about 
where we are going, you do realize that 31 percent of all Medicare 
spending is just diabetes. Thirty-three percent of all healthcare 
spending is diabetes. And so the brain trust here decides: Hey, let's 
subsidize this by billions and billions and billions and billions and 
billions of dollars, screw up the movement to actually have cures to 
actually have a co-op provide the product dramatically less expensive.
  Remember, the co-op is going to bring it in cheaper than the 
subsidized price without all the taxpayer money.
  Please, I know the virtue signaling here is powerful. The economics 
are crap.
  The SPEAKER pro tempore. The gentleman is reminded to direct his 
remarks to the Chair.
  Mr. KILDEE. Madam Speaker, to my friend from Arizona, I appreciate 
his passion. I wish it were true that he had somehow cured diabetes. It 
would be great news for my daughter and so many other Americans who say 
that they are looking for that cure. In the meantime, while we are 
working to get there--and I appreciate the effort, I do, because I am 
on board, I am completely on board with the notion that we ought to 
cure this terrible disease--however, until that day comes, let's make 
sure that the people who depend on insulin in order to stay alive can 
live to see that day that I know he and I both are looking forward to.
  Madam Speaker, I yield 1 minute to the gentleman from New Jersey (Mr. 
Pascrell), who is my colleague from the Ways and Means Committee.
  Mr. PASCRELL. Madam Speaker, the Affordable Insulin Now Act will cap 
out-of-pocket insulin costs at $35 a month--not a miracle by any 
stretch of the imagination. And anyone who supports legislation in this 
order and others where we address other diseases obviously, we are 
working on new situations just about every month. So because you are 
working on it and you are trying to find a balance of the free market, 
and where the price goes without fixing the price of what something 
will cost, I mean, we have been called worse things than Socialists. 
When you come to this debate, I'll settle on that word.
  Well, what does that mean?
  You want to get into a debate about socialism?
  I served in the Armed Forces. I fought for my country. I am tired of 
being called names.
  Seven million Americans who use insulin want to stay alive. The 
average insulin costs rose 54 percent. We have heard that before.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. KILDEE. Madam Speaker, I yield the gentleman an additional 30 
seconds.
  Mr. PASCRELL. Madam Speaker, when insulin was discovered, Warren 
Harding was the President and the New York Giants won the World Series, 
yet there was no television to watch the New York Giants.
  Insulin costs are a national disgrace. For a drug discovered over 100 
years ago, $1,000 price tag for a single vial is an outrage. You know 
it, and I know it.
  So get beyond the argument that we are all a bunch of Socialists 
because we want to help people. We are doing what the folks sent us 
here to do. We can't do it on every drug. We need the technology. The 
gentleman from Arizona is right on target. It will save lives.
  If we can't do that, then what the heck are we doing here?

  The SPEAKER pro tempore. The gentleman is reminded to direct his 
remarks to the Chair.

[[Page H4042]]

  

  Mr. SMITH of Nebraska. Madam Speaker, it is interesting listening to 
the debate here. Certainly my colleague, Mr. Doggett, I think very 
appropriately pointed out:

       This bill does not lower the price of insulin by one penny. 
     It just simply shifts around who pays for what.

  We have seen that pattern in healthcare across America for some time 
now, and I would hope that we could learn from that.
  Madam Speaker, I reserve the balance of my time.
  Mr. KILDEE. Madam Speaker, I yield 1 minute to the gentlewoman from 
California (Ms. Chu), who is a member of the Ways and Means Committee.
  Ms. CHU. Madam Speaker, I rise today in strong support of H.R. 6833, 
the Affordable Insulin Now Act.
  I will never forget the day a constituent in my district showed me 
his bottle of insulin. He told me that one day while traveling in 
Canada he found he forgot it, so he went to a pharmacy. He found that 
that same bottle of insulin that he buys here in the U.S. for $200 cost 
only $25 in Canada, the exact same product.
  He started calculating how much it would cost him to fly to Canada 
once every 3 months, and then asked himself: Why are Americans the only 
ones paying these exorbitant prices?
  Nobody should have to sacrifice just to afford medicine. That is why 
today's bill is so important. By capping the cost of insulin at $35 a 
month, this bill will ensure that monthly costs for millions of 
families are truly affordable. It is time to prioritize the needs of 
our people so that every American can afford to stay alive.
  Mr. SMITH of Nebraska. Madam Speaker, I yield myself the balance of 
my time to close.
  Madam Speaker, I think that this discussion that we are having here 
today is important. I also believe that we need to work together on 
solutions to actually reduce the cost of insulin, again, not just 
shifting around who pays for what. But certainly I am willing to give 
my colleague on the other side more information about the information 
Mr. Schweikert was sharing. He is very knowledgeable on the subject. He 
certainly works with his constituents a lot, constituents in need. And 
we know that literally millions of people across America are in need 
for lower-cost insulin. We owe them, I think, a much better approach 
than just simple government intrusion and more government involvement 
shifting around the cost.

                              {time}  1515

  I was a bit alarmed earlier when I heard that we should maybe make 
Medicare prescription coverage more like the VA. We need to remember 
that the VA offers roughly 50 percent of the options for participants 
compared to Medicare. I don't think we want to reduce the choices that 
seniors would have with their formularies within Medicare part D. If 
anything, we should make sure they have more choices. We know that more 
choices in the marketplace bring down the price, and we need to focus 
in that direction.
  Madam Speaker, I urge a ``no'' vote on this bill. We owe the American 
people a diligent effort, working together to truly reduce the cost of 
insulin.
  I yield back the balance of my time.
  Mr. KILDEE. Madam Speaker, I yield myself the balance of my time.
  Madam Speaker, I appreciate my colleagues' support of this 
legislation. This is important legislation.
  I will say this: I understand the points that have been made on the 
other side. As a father of a type 1 diabetic, I am one of those many 
millions of families that pay very close attention to the important 
research that we think ultimately may lead to a cure for diabetes, so I 
embrace the suggestion made on the other side that we have hope for a 
cure. I have hope for a cure. Ever since my daughter was diagnosed, I 
have been waiting for that moment, as she has, for that cure to appear. 
If it is just outside our grasp, let's do everything we can to get 
there.
  But that is not what this legislation is intended to attack. It 
doesn't mean we ignore that. It means we continue to push.
  I have worked with my colleague on this side of the aisle, 
Congresswoman DeGette, to try to do everything we can to find these 
cures. But in the meantime, let's make sure that there is not a 
diabetic who is standing at the pharmacy counter with lifesaving 
medication just beyond their reach, not because it is unavailable but 
because it is unaffordable to them.
  I take the point that while this legislation doesn't do what we all 
would like to do--and that is to reduce the overall cost of medication 
through the way markets actually work, negotiation between a buyer and 
a seller. I mean, that is the way the free market works. Let's let the 
free market work and not have law that allows the seller to dictate to 
us the price of a drug that can save lives and make huge profits while 
there are people in a pharmacy reaching for a drug that they can't get 
because the price is too high. This legislation will help save lives in 
the immediate term.
  I hope there is a day when Democrats and Republicans can come 
together to establish policy that would allow negotiation on the 
overall price of these lifesaving medications. That would be a 
solution. We support it; you oppose it. In the meantime, let's do this 
and save some lives.
  Madam Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The gentleman from California (Mr. 
DeSaulnier) and the gentlewoman from North Carolina (Ms. Foxx) each 
will control 10 minutes.
  The Chair now recognizes the gentleman from California.
  Mr. DeSAULNIER. Madam Speaker, I yield myself such time as I may 
consume.
  Today, I rise in support of the Affordable Insulin Now Act.
  On top of weathering the economic fallout of the global pandemic, 
Americans are still paying far too much for insulin. This is 
particularly frustrating, given that these are not the prices that 
consumers in the rest of the world pay. The most commonly used form of 
insulin costs 10 times more in the United States than in any other 
developed country.
  Tragically, there have been recent reports of deaths of patients with 
diabetes because they cannot afford the insulin they need to stay 
alive.
  The Affordable Insulin Now Act would take a historic step to lower 
the cost of insulin and cap out-of-pocket costs at $35 per month. This 
means individuals with private insurance could save up to $500 per 
year.
  This bill ensures affordable access to lifesaving medication for the 
more than 37 million people in the United States who have diabetes and 
the over 7 million Americans who rely on insulin to maintain their 
health and well-being.
  Madam Speaker, it is past time, but today it is time to finally 
deliver on our promise to ensure that all Americans can get the 
medication they need and they deserve to stay healthy and thrive. The 
Affordable Insulin Now Act brings us one step closer to that promise.
  There is certainly more work to be done. I look forward to working 
with my colleagues to get the cost of prescription drugs under control 
and to build upon this important first step.
  Madam Speaker, I urge all of my colleagues to please support this 
bill, and I reserve the balance of my time.
  Ms. FOXX. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I rise in opposition to H.R. 6833.
  Americans are rightly concerned about the price of prescription 
drugs, but Democrats are trying to solve this problem in the wrong way, 
as usual. Instead of discussing bipartisan, commonsense legislation to 
address the rising costs of prescription drugs, we are debating H.R. 
6833. This radical bill is another attempt by the left to advance a 
government takeover of prescription drug pricing.
  Don't be fooled. This legislation is a Trojan horse. H.R. 6833 claims 
to address insulin prices, but what it actually does is opens the door 
to government price controls without addressing the root problem, which 
is the rising cost of insulin.
  H.R. 6833 won't lower costs. It is a smokescreen that will raise 
premiums for workers and seniors when inflation is at a 40-year high.
  Why are Democrats knowingly raising healthcare premiums on the 
majority of Americans when so many Americans are struggling to pay for 
gas and put food on the table? Four out of five Americans in large 
group plans already pay under $35 a month for insulin. This

[[Page H4043]]

bill will raise healthcare costs for the vast majority of working 
Americans.

  When insurers are required by the Federal Government to cover an 
insulin product, this allows manufacturers to raise the price of 
insulin indiscriminately. Since insurers can charge only $35 a month 
out of pocket to the patient, the insurer must make up for the 
increased cost of insulin by raising premiums for all beneficiaries. 
With a lack of competition in the market, this bill removes the 
bargaining power insurers use to keep insulin prices low, leading to 
increased insulin prices and higher premiums.
  This legislation will only worsen the root problem of high insulin 
prices, which is a lack of competition in the market. H.R. 6833 will 
lead to fewer approved generic insulin brands, making the insulin 
monopoly even worse. If Democrats really want to decrease the price of 
insulin, they should pave the way for more competition, not less.
  This legislation will cost taxpayers $11 billion, giving the Centers 
for Medicare and Medicaid Services $1.5 million in fiscal year 2022 to 
administer these drug-pricing caps. Trusting the Washington bureaucracy 
to manage drug pricing and distribution is a mistake. This legislation 
would be the largest expansion of Federal control over Americans' 
private health insurance since ObamaCare.
  We must stop the Federal Government from wedging its foot in the door 
of our healthcare system and moving us one step closer to a socialist, 
single-payer system for Medicare for All. In fact, this week, the chair 
of the Progressive Caucus said she was ``fighting to make it the law of 
the land.''
  H.R. 6833 sets a dangerous precedent. If the Federal Government can 
set prices for insulin, what is to stop it from implementing price 
controls for every drug on the market or in every other sector of the 
economy?
  The free market is the reason the United States outpaces every other 
country in developing lifesaving cures and treatments, particularly 
countries with socialized medicine. Federal drug-pricing mandates will 
discourage medical innovation, resulting in fewer cures, which will 
keep Americans from receiving the therapies they rely upon.
  Instead of perpetuating Obama-era schemes to expand Federal controls 
over Americans' health insurance, the Biden administration and 
congressional Democrats should bring to the floor H.R. 19, the 
bipartisan Lower Costs, More Cures Act.
  Every single provision in H.R. 19 has bipartisan support. Lawmakers 
on both sides of the aisle agree that this legislation will lower 
healthcare costs and protect America's status as a leading healthcare 
innovator.
  Furthermore, H.R. 19 sets a new standard in healthcare affordability. 
This bill caps seniors' out-of-pocket insulin costs at only $50 a month 
in the Medicare program. It also allows for high-deductible insurance 
plans to cover insulin before a deductible kicks in, and it increases 
the availability of low-cost options for treatment in the marketplace.
  The cost of insulin, like most healthcare costs in this country, are 
climbing rapidly. Yet, total Federal control is not the solution.
  H.R. 6833 is a perfect example of legislative trickery. This bill 
will lower out-of-pocket costs for insulin for a minority of Americans 
by bloating premiums and other healthcare costs for the majority of 
Americans and leave our healthcare system worse off.
  Supporting socialist drug pricing isn't a solution, which is why I am 
rejecting this one-sided, harmful bill. I urge my Democrat colleagues 
to support the Lower Costs, More Cures Act, bipartisan legislation that 
will lower drug costs for Americans without limiting access to cures.
  Madam Speaker, I reserve the balance of my time.
  Mr. DeSAULNIER. Madam Speaker, I yield 3 minutes to the gentlewoman 
from Georgia (Mrs. McBath), a lead sponsor of this legislation and a 
member of the Education and Labor Committee.
  Mrs. McBATH. Madam Speaker, I really appreciate Mr. DeSaulnier giving 
me a few moments of time.
  Madam Speaker, I rise today in support of H.R. 6833, the Affordable 
Insulin Now Act.
  I want to take this time just to talk about the cost of healthcare 
and prescription drugs for all those in our community. It is a topic 
that I hear about every single day from my constituents, and it is 
something that touches the lives of every single American, whether you 
have diabetes or not.
  Today, we will be voting on a bill that will actually provide 
desperately needed relief to some of the most vulnerable patients in 
the United States, in Georgia and all across this Nation.
  There is no time off when you live with diabetes. It is a constant, 
ever-present disease that influences every aspect of your life. Listen 
to those who gave testimony about what they live with every single day 
with this chronic disease.

  In 1920, before insulin was discovered, it would have been 
exceptional for those who had diabetes to live longer than 1 or 2 
years. But over the past 100 years, we have been able to save lives 
with insulin. For over 100 years, it has remained the most effective 
treatment that we have.
  Over 100 years later, some estimates state that diabetics spend 
around $6,000 a year alone on insulin. This is just absolutely 
unconscionable for a drug that has been saving lives for over 100 
years. We can and must make it more affordable for Americans who need 
it to live.
  That is why I joined my colleagues, Angie Craig and  Dan Kildee, who 
I find to be healthcare champions, in introducing this critical 
legislation.
  It is just really very simple. The Affordable Insulin Now Act would 
cap out-of-pocket costs of insulin products at $35 per month for 
Americans with health insurance.
  This bill brings a measure of certainty and affordability to every 
American who needs insulin to continue living a healthy life.
  Yes, I have heard arguments this afternoon that this doesn't take 
care of every individual in the country, specifically those who are 
uninsured. We know that. I assure you, we are not completely satisfied 
with this either. But if our Republican colleagues would come to the 
table with us, with any measures that you have--compromise, come to the 
table, consensus. Help us build the ability to make sure that every 
American in this country, whether they are insured or not, has the 
ability to be able to afford this lifesaving drug. We welcome that from 
you because people every single day are dying right beneath our noses. 
I am here to save lives.
  I look forward to passing this vital legislation out of the House of 
Representatives today, and I look forward to continuing to fight for 
passage with Senator Warnock in the Senate.
  As the President so rightly stated, this legislation can and will 
save lives, and it is long overdue.

                              {time}  1530

  Mr. DeSAULNIER. Madam Speaker, I reserve the balance of my time.
  Ms. FOXX. Madam Speaker, I yield 1 minute to the gentleman from 
Wisconsin (Mr. Grothman).
  Mr. GROTHMAN. Madam Speaker, it is a good-sounding bill. Everyone 
knows drug costs in general are too high, and insulin costs in 
particular are way too high. But it is a bill with a simple answer.
  We look at a problem and solve the problem by having the Federal 
Reserve eventually print more money, $15.5 billion over 10 years.
  I realize you feel you have a pay-for here, but it is just by 
delaying another program by another year. And as a practical matter, 
this bill spends $15.5 billion more over 10 years than we would without 
the bill.
  We are already told this source of funds--we already used this type 
or source of funds in the infrastructure bill. It is just grabbing 
another year.
  Why don't we just require PBMs to pass on their rebates to the 
patients as intended? That is something that would cost the Federal 
Government, in my mind, no new money. It would be a significant 
reduction in cost for the individual.
  I appreciate that so many people on the majority side of the aisle 
would like to work together with us, and it shouldn't be difficult to 
find a solution to this problem that is fair to all concerned.
  Mr. DeSAULNIER. Madam Speaker, I yield 1 minute to the gentleman from 
Texas (Mr. Castro), a member of the Education and Labor Committee.
  Mr. CASTRO of Texas. Madam Speaker, I rise in support of the 
Affordable Insulin Now Act which would cap

[[Page H4044]]

out-of-pocket insulin costs at $35 per month and help fight the scourge 
of diabetes.
  In 2019, as chair of the Congressional Hispanic Caucus, I organized 
meetings with leading insulin producers to confront them about the 
strain their prices are putting on the American people.
  In each of those meetings, I said the same thing; that for millions 
of Americans, including a disproportionate number of Latinos, access to 
affordable insulin is a matter of life and death.
  And for me and many of us, those aren't just numbers. Four months 
before I graduated from college in 1996, my grandmother died of 
complications from diabetes. If we fail to bring down the price of 
insulin, more families will suffer just like mine did.
  But our responsibility is to all our constituents, not just those 
with insurance. So I co-sponsored Representative Doggett's amendment to 
extend the benefits of this bill to the uninsured, and I hope we will 
make that happen in the days to come.
  But this bill is an important step forward, and I urge my colleagues 
to support it.
  Ms. FOXX. Madam Speaker, I yield 2 minutes to the gentleman from 
Virginia (Mr. Good).
  Mr. GOOD of Virginia. Person Speaker, and I say ``Person Speaker'' 
because I am not a biologist. And out of respect to our Supreme Court 
nominee, I don't feel qualified to say Madam Speaker.
  But I do rise in opposition to this bill. The Affordable Insulin Now 
Act is just more of government controlling your healthcare.
  Today, Democrats are using insulin as the gateway to their dream of 
fully socialized medicine where Joe Biden and his accomplices in 
Congress have more control over your healthcare than you or your 
doctor. After all, they got to decide whether or not you got a vaccine, 
and they fired you if you didn't obey.
  If Democrats succeed in setting the price of insulin at $35, the 
negative effects will ripple across the entire healthcare market.
  I invite my Democrat colleagues to read my sophomore economics 
textbook to confirm what happens when you implement price controls.
  It is estimated the average annual cost for the private sector of 
compliance with this mandate is $2 billion. Not that Democrats care 
about billions of dollars, the way they throw around trillions of 
dollars. Don't tell them what comes after a trillion.
  But we all remember the lies of ObamaCare. Please, say it with me. If 
you like your doctor, you can keep your doctor. Come on. This is 
participatory. If you like your healthcare plan, you can keep your 
healthcare plan. As a matter of fact, costs are going to go down. None 
of that was true.
  And, instead, American families found themselves with plans they 
didn't like, but at least they cost more, so it was a lose-lose.
  Premiums will rise again if this bill becomes law because setting 
prices, again, has consequences, something our economically illiterate 
Democrat friends apparently don't understand, or maybe they do.
  American innovation has brought amazing, lifesaving treatments to the 
healthcare market, but that research and development comes at a cost, 
like any other good or product or service in this country.
  Don't we all want the best drugs, the best medicine, and the best 
healthcare? Instead of going with the Democrat default government-
knows-best, one-size-fits-all mentality, we need to embrace free market 
principles.
  Mr. DeSAULNIER. Madam Speaker, I yield 1 minute to the distinguished 
gentleman from New York (Mr. Jeffries).
  Mr. JEFFRIES. Madam Speaker, I thank the gentleman for yielding.
  What is the difference between us and them that was just on full 
display?
  We care about everyday Americans. They don't.
  We make life better for everyday Americans. They don't.
  We get things done for everyday Americans, and they don't.
  Insulin is a drug that is lifesaving and life-sustaining. It has been 
around for more than 100 years. It is off patent. There are no research 
and development costs associated with it.
  Yet so many Americans pay approximately $4,000 a year for insulin. 
That is unacceptable, un-American, and unconscionable. And that is why 
Democrats are doing something about it.

  The Affordable Insulin Now Act will lower out-of-pocket costs to $35 
per month. That is not fiction. That is fact. That is not hyperbole. 
That is help that is game-changing for everyday Americans. Once again, 
Democrats deliver for the people.
  Ms. FOXX. Madam Speaker, I believe I have the right to close, so I 
will reserve the balance of my time.
  Mr. DeSAULNIER. Madam Speaker, I yield 1 minute to the gentlewoman 
from New York (Mrs. Carolyn B. Maloney of New York).
  Mrs. CAROLYN B. MALONEY of New York. Madam Speaker, I thank the 
gentleman for yielding.
  Insulin prices in the United States are the highest in the world. I 
support the Affordable Insulin Now Act, a bill that would cap patient 
costs at $35 a month. It would make lifesaving medicine affordable for 
millions of Americans living with diabetes.
  My committee's investigation found that since the 1990s, insulin 
manufacturers have been raising the price of this lifesaving medicine 
despite no improvements to the drug, while making record profits.
  The price gouging has harmed Americans. More than one in four 
Americans with diabetes report having to ration insulin, and some have 
died.
  Nearly 2 million New Yorkers have diabetes. Capping out-of-pocket 
costs to $35 a month is an important step that Congress can take to 
reduce insulin costs for patients with diabetes.
  Let's make prescription drugs affordable. Vote for this bill.
  I thank Representatives Kildee, Craig, and McBath for their 
leadership in authoring this bill.
  Ms. FOXX. I reserve the balance of my time.
  Mr. DeSAULNIER. Madam Speaker, I yield 1 minute to the gentleperson 
from Virginia (Ms. Spanberger).
  Ms. SPANBERGER. Madam Speaker, I have been so pleased to hear 
colleagues across the aisle speak in favor of competition and price 
negotiations.
  I hope that they will follow through in their commitment to 
supporting competition and negotiation and co-sponsor Lower Drug Costs 
Now, H.R. 3.
  But that is not the bill we are talking about today. Today, we are 
talking about the Affordable Insulin Now Act, a bill that would make 
changes in the lives of the more than 630,000 Virginians who are living 
with diabetes.
  The Affordable Insulin Now Act would finally make sure that every 
affected child, teenager, family member, every American can afford the 
insulin that they need.
  People living with diabetes do not have the choice of whether to 
purchase insulin or not. They depend on it to stay alive. People like 
my constituent, Joshua Davis, a 13-year-old Virginian with type 1 
diabetes who accompanied Dr. Jill Biden to the State of the Union 
Address earlier this year.
  I am proud to co-sponsor this legislation to make sure that no 
American is skipping lifesaving doses of their insulin or making 
choices between whether they take their insulin or put food on the 
table.
  I am grateful to my colleagues for leading this effort.
  Ms. FOXX. Madam Speaker, I reserve the balance of my time.
  Mr. DeSAULNIER. Madam Speaker, I yield 1 minute to the gentleman from 
Louisiana (Mr. Carter).
  Mr. CARTER of Louisiana. Madam Speaker, I thank the gentleman for 
yielding.
  Louisiana has the second highest diabetes mortality rate but only the 
11th highest number of cases. The rate of diabetes among Blacks, 
Hispanics, and Native American adults in the State is 
disproportionately high as compared to other populations.
  Insulin is a lifesaving medicine, allowing people to live healthy 
lives, raise families, and do their jobs. However, many can't afford 
this life-regulating medicine.
  Many Louisianans have to pay over $100 a vial in out-of-pocket costs 
every single month. And some are forced to ration prescriptions, 
risking complications or death. The people must always come before Big 
Pharma.
  Today, we are finally taking action to cut the price of insulin. The 
Affordable Insulin Now Act would cap out-of-

[[Page H4045]]

pocket insulin costs for insulin for a month-long supply at $35 and 
require plans to cover different types of insulin.
  The bill is a strong move in the right direction to ease the burden, 
and we must do this now.
  Mr. DeSAULNIER. Madam Speaker, I yield back the balance of my time.
  Ms. FOXX. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I cannot let go past one of our colleagues saying 
before that we don't believe in helping average people. Yes, we do.
  Republicans are here every day. We are average people. We are here to 
help average people. But what we believe in most of all is freedom for 
Americans.
  And we happen to believe that Democrats don't believe in that, and 
this bill is an exemplar of the fact that they want the government to 
control our lives in every way they possibly can.
  In the past, Democrats and Republicans have worked together to bring 
down the cost of prescription drugs, but Democrats have once again 
pursued politics over progress.
  H.R. 6833 is a massive power grab that will lead our country one step 
closer to socialized medicine. That is not what the American people 
think and want.
  There is no such thing as a free-market system when government 
bureaucrats control prices. This legislation sets an extremely 
dangerous precedent.
  We shouldn't pursue policies that will harm the health and well-being 
of American patients, and we should not knowingly raise healthcare 
premiums on American workers and their families when prices for goods 
are soaring.
  Republicans stand ready to work with Democrats to advance legislation 
that promotes competition, lowers costs for consumers, establishes 
transparency and accountability in drug pricing, and advances the cause 
of freedom.
  H.R. 6833 is not that legislation. I urge my colleagues to vote 
``no,'' and I yield back the balance of my time.
  Mr. NEAL. Madam Speaker, Americans pay too much for insulin. With the 
price hovering at three times what it was 15 years ago, this vital 
medication is not just expensive, it can be completely out of reach.
  Every day, the more than 37 million Americans living with diabetes 
must choose between the insulin they need to stay alive and other basic 
necessities. Just last week, I heard about this issue from a couple who 
live in my district. Both people have diabetes, but one is forgoing 
insulin for the time being due to cost. Last year alone, their 
prescription costs topped $10,000.
  This outrageous expense is unacceptable, particularly since Americans 
pay far more for insulin than patients in similar countries. In some 
cases, American patients pay as much as 10 times the price of their 
counterparts in other nations.
  Today's legislation finally rights this wrong. Capping the cost of 
insulin at $35 per month will put the medicine within reach for 
millions of Americans. And we do this responsibly, by delaying the 
prior administration's Rebate Rule. Bringing down the cost of insulin 
will also help to close health inequities that skyrocketing drug costs 
exacerbated.
  This is an important and welcome step in lowering the cost of 
prescription drugs in this country. More must be done, and that's why 
in the Build Back Better Act, we empowered the Secretary to negotiate 
prescription drug prices for Medicare, capped Medicare Part D out-of-
pocket costs, and required drug companies to pay a rebate if their 
prices outpace inflation. We will not stop until these commonsense 
reforms are signed into law.
  I applaud Ways and Means member, Congressman Dan Kildee, for his work 
in bringing this legislation to the floor, and I urge all of my 
colleagues to support the Affordable Insulin Now Act.
  Mr. ESPAILLAT. Madam Speaker, I rise in support of H.R. 6833, the 
Affordable Insulin Now Act, to cap the out-of-pocket price for one 
month's supply of insulin at $35.
  Insulin was discovered nearly 100 years ago and costs less than $10 a 
vial to manufacture.
  Yet there are millions of American families with insurance that are 
paying hundreds of dollars a vial.
  No family in America should be forced to choose between buying 
insulin for their child and putting food on the table.
  It's past time that this Congress says no to big pharma lining their 
pockets, at the expense of lives of the American people.
  Ms. JACKSON LEE. Madam Speaker, I rise to speak in strong support of 
H.R. 6833, the Affordable Insulin Now Act. The bill is simple and gets 
to the urgent need to limit cost-sharing for insulin under private 
health insurance and the Medicare prescription drug benefit.
  Specifically, the bill caps cost-sharing under private health 
insurance for a month's supply of selected insulin products at $35 or 
25 percent of a plan's negotiated price (after any price concessions), 
whichever is less, beginning in 2023.
  The bill caps cost-sharing under the Medicare prescription drug 
benefit for insulin products at:
  $35 in 2023 regardless of whether a beneficiary has reached the 
annual out-of-pocket spending threshold, and
  $35 beginning in 2024 for those who have not yet reached this 
threshold.
  The subject of the bill is public knowledge and well known by members 
of this body.
   I have worked closely with the healthcare community that serve 
Houstonians to ensure that programs are receiving the appropriate level 
of federal support.
  One of the most difficult challenges are the hurdles to healthcare 
created by lack of health insurance such as a lack of access to 
necessary medications due to the high costs of many prescription drugs.
  Diabetes is a life-threatening disease that disproportionately 
affects communities of color.
  Diabetes is associated with serious health problems, including heart 
disease and stroke, kidney failure, and blindness.
  There are 15,000 Medicare beneficiaries in the Eighteenth 
Congressional District who have been diagnosed with diabetes.
  These individuals are my constituents and I know that on average, 
each of them pays 4.8 times the cost of similar medication in 
Australia, 3.6 times the cost in the United Kingdom, and 2.6 times the 
cost in Canada.
  Additionally, in the Eighteenth Congressional District, 26.7 percent 
of residents are uninsured.
  For example, an uninsured resident of this congressional district 
pays 23 times more for this brand of insulin than their counterparts in 
Australia, 15 times more than they would in the United Kingdom, and 13 
times more than they would in Canada.
  The consequences of these staggering costs are not benign.
  Many patients often speak of having to make heartwrenching decisions 
about what to buy with the commonly fixed incomes attendant to seniors.
  Many medical professionals indicate that the high prices for 
prescription drugs are a function of a lack of competition, and 
authorizing Medicare to create a program to negotiate drug prices may 
be an estimable way to lower the cost of prescription drugs.
  All told this reflects a disturbing trend: in our country, the cost 
of branded drugs tends to go up, whereas in other countries, the costs 
tend to go down.
  Before insulin the prognosis for diabetics was bleak.
  Over the past two decades, manufacturers have systematically and 
dramatically raised the prices of their insulin products by more than 
tenfold--often in lockstep.
  In 2017, diabetes contributed to the death of 277,000 Americans and 
was the primary death for 85,000 of those individuals
  That same year diagnosed diabetes cost the United States an estimated 
$327 billion--including $237 billion in direct medical costs and $90 
billion in productivity losses.
  Diabetes drugs, including insulin and oral medications that regulate 
blood sugar levels, play a critical role in helping people with 
diabetes manage their condition and reduce the risk of diabetes-related 
health complications.
  Although insulin is the most well-known diabetes medication, diabetes 
patients are often prescribed other oral drugs to use in place of or 
alongside insulin.
  Many of these non-insulin products used to regulate blood sugar 
levels are brand drugs that lack generic alternatives.
  In recent years, the high prices of diabetes drugs have placed a 
tremendous strain on diabetes patients as well as the federal 
government, which provides diabetes medications to more than 43 million 
Medicare beneficiaries.
  Because Medicare lacks the authority to negotiate directly with drug 
manufacturers, Medicare beneficiaries pay significantly more for their 
drugs than patients abroad.
  Patients who are uninsured or underinsured and must pay for their 
drugs out of pocket bear an even greater cost burden.
  I thank the committees on Energy and Commerce, Ways and Means, and 
Education and Labor for the work they have done to bring H.R. 6833, the 
Affordable Insulin Now Act to the floor for a vote.
  I encourage my colleagues on both sides of the aisle to vote in 
support of H.R. 6833.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 1017, the previous question is ordered 
on the bill, as amended.
  The question is on engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.

[[Page H4046]]

  



                           Motion to Recommit

  Mr. BUCSHON. Madam Speaker, I have a motion to recommit at the desk.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Mr. Bucshon moves to recommit the bill H.R. 6833 to the 
     Committee on Energy and Commerce.

  The material previously referred to by Mr. Bucshon is as follows:
       Strike all after the enacting clause and insert the 
     following:

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Lower Costs, More Cures Act 
     of 2022''.

     SEC. 2. TABLE OF CONTENTS.

       The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.

                    TITLE I--MEDICARE PARTS B AND D

                 Subtitle A--Medicare Part B Provisions

Sec. 101. Improvements to Medicare site-of-service transparency.
Sec. 102. Requiring manufacturers of certain single-dose container or 
              single-use package drugs payable under part B of the 
              Medicare program to provide refunds with respect to 
              discarded amounts of such drugs.
Sec. 103. Providing for variation in payment for certain drugs covered 
              under part B of the Medicare program.
Sec. 104. Establishment of maximum add-on payment for drugs and 
              biologicals.
Sec. 105. Treatment of drug administration services furnished by 
              certain excepted off-campus outpatient departments of a 
              provider.

                  Subtitle B--Drug Price Transparency

Sec. 111. Reporting on explanation for drug price increases.
Sec. 112. Public disclosure of drug discounts.
Sec. 113. Study of pharmaceutical supply chain intermediaries and 
              merger activity.
Sec. 114. Making prescription drug marketing sample information 
              reported by manufacturers available to certain 
              individuals and entities.
Sec. 115. Sense of Congress regarding the need to expand commercially 
              available drug pricing comparison platforms.

              Subtitle C--Medicare Part D Benefit Redesign

Sec. 121. Medicare part D benefit redesign.

              Subtitle D--Other Medicare Part D Provisions

Sec. 131. Allowing the offering of additional prescription drug plans 
              under Medicare part D.
Sec. 132. Allowing certain enrollees of prescription drug plans and MA-
              PD plans under Medicare program to spread out cost-
              sharing under certain circumstances.
Sec. 133. Establishing a monthly cap on beneficiary incurred costs for 
              insulin products and supplies under a prescription drug 
              plan or MA-PD plan.
Sec. 134. Growth rate of Medicare part D out-of-pocket cost threshold.

                           TITLE II--MEDICAID

Sec. 201. Medicaid pharmacy and therapeutics committee improvements.
Sec. 202. GAO report on conflicts of interest in State Medicaid program 
              drug use review boards and pharmacy and therapeutics 
              (P&T) committees.
Sec. 203. Ensuring the accuracy of manufacturer price and drug product 
              information under the Medicaid drug rebate program.
Sec. 204. Improving transparency and preventing the use of abusive 
              spread pricing and related practices in Medicaid.
Sec. 205. T-MSIS drug data analytics reports.
Sec. 206. Risk-sharing value-based payment agreements for covered 
              outpatient drugs under Medicaid.
Sec. 207. Applying Medicaid drug rebate requirement to drugs provided 
              as part of outpatient hospital services.

                TITLE III--FOOD AND DRUG ADMINISTRATION

                       Subtitle A--Pay-for-Delay

Sec. 301. Unlawful agreements.
Sec. 302. Notice and certification of agreements.
Sec. 303. Forfeiture of 180-day exclusivity period.
Sec. 304. Commission litigation authority.
Sec. 305. Statute of limitations.

             Subtitle B--Advancing Education on Biosimilars

Sec. 321. Education on biological products.

                      Subtitle C--Other Provisions

Sec. 331. Clarifying the meaning of new chemical entity.

                      TITLE IV--REVENUE PROVISION

Sec. 401. Safe harbor for high deductible health plans without 
              deductible for insulin.

                         TITLE V--MISCELLANEOUS

Sec. 501. Payment for biosimilar biological products during initial 
              period.
Sec. 502. GAO study and report on average sales price.
Sec. 503. Requiring prescription drug plans and MA-PD plans to report 
              potential fraud, waste, and abuse to the Secretary of 
              HHS.
Sec. 504. Establishment of pharmacy quality measures under Medicare 
              part D.
Sec. 505. Improving coordination between the Food and Drug 
              Administration and the Centers for Medicare & Medicaid 
              Services.
Sec. 506. Patient consultation in Medicare national and local coverage 
              determinations in order to mitigate barriers to inclusion 
              of such perspectives.
Sec. 507. MedPAC report on shifting coverage of certain Medicare part B 
              drugs to Medicare part D.
Sec. 508. Requirement that direct-to-consumer advertisements for 
              prescription drugs and biological products include 
              truthful and non-misleading pricing information.
Sec. 509. Chief Pharmaceutical Negotiator at the Office of the United 
              States Trade Representative.

  The SPEAKER pro tempore. Pursuant to clause 2(b) of rule XIX, the 
previous question is ordered on the motion to recommit.
  The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Mr. BUCSHON. Madam Speaker, on that I demand the yeas and nays.
  The SPEAKER pro tempore. Pursuant to section 3(s) of House Resolution 
8, the yeas and nays are ordered.
  Pursuant to clause 8 of rule XX, further proceedings on this question 
are postponed.

                          ____________________