[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.
____________________