[Congressional Record Volume 169, Number 202 (Thursday, December 7, 2023)]
[Senate]
[Pages S5841-S5842]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                            Medicare Part D

  Mr. GRASSLEY. Madam President, I come to the floor to celebrate 20 
years since the passage of the Part D Medicare prescription drug 
benefit. Tomorrow, December 8, is that day.
  There was a time when the seniors of America on Medicare didn't have 
access to nationwide prescription drug benefits, so, as I indicated, 20 
years ago tomorrow, President George W. Bush signed into law a 
nationwide prescription drug benefit for our Nation's seniors.
  At that time, I was chairman of the Finance Committee, and I was 
proud to be the lead author on Medicare Part D. It wasn't easy. It took 
several years to bring Members of both political parties in the Senate 
and the House, along with a President--in this case, President Bush--to 
accomplish this monumental task.
  As I remember, both political parties were blaming each other over a 
period of maybe 5 or 6 years for why we didn't have a prescription drug 
bill and probably blaming each other. Throughout 2001, 2002, and 2003, 
I led bipartisan negotiations that eventually produced the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003, which is 
the official title of that legislation.
  In 2003, I said this, a quote from that period of time:

       Medicare is part of our country's social fabric. We're not 
     only saving it, but we're also improving it.

  Of course, that still rings true today.
  Today, 52 million seniors are voluntarily enrolled in a Medicare Part 
D plan, because it is not a requirement of Medicare. In 2023, 804 
stand-alone prescription drug plans were offered across the Nation, 
with the average Iowan having over 20 plans to choose from to meet 
whatever their special needs are. Over the lifetime of the program, the 
average annual Medicare Part D base beneficiary monthly premium has 
been between $27 to $36 a month.
  I remember some of the discussions that we were having back then as 
we tried to develop this legislation. We thought to ourselves that we 
had to be very careful that the initial premiums were not over $40 a 
month because we figured that was just too high for anybody to 
participate in this new program. We knew or at least thought at that 
time that they would continue to go up according to inflation, but, as 
you can see, after 27 years, the base beneficiary monthly premium is 
still well below $40 a month, which obviously is quite a surprise to 
those of us who were involved at that time in writing this legislation 
but a very positive surprise.
  Access and affordability have been a key hallmark of the Medicare 
Part D Program, but so has good stewardship of the taxpayers' dollars. 
In the first decade of the program, the nonpartisan Congressional 
Budget Office projected that Medicare Part D would cost taxpayers 
roughly $550 billion for that decade. It ended up costing $353 billion, 
which was 36 percent less than the nonpartisan Congressional Budget 
Office projected in 2003.
  Most Federal projections of cost of almost any government program 
always tend to be much greater than CBO estimated. So this is another 
one of those pleasant surprises that have come out of what we thought 
would actually materialize as we were writing this legislation.
  I know that seniors have appreciated this nationwide prescription 
drug benefit and its use of a market-based approach. A market-based 
approach is pretty important because a lot of people like to have one 
single government

[[Page S5842]]

program that dictates to each participant only that one choice, and 
that is the choice the government offers. In this particular case, we 
know we have had plenty of choices to meet the needs of Americans in 
different ways according to their likes.
  Recently, I have been told by my constituents how Medicare Part D has 
helped make their lives easier.
  There is a lady by the name of Kay from Mount Vernon, IA, who wrote 
this:

       I am 100 percent satisfied with Medicare Part D. It's given 
     me peace of mind and cost savings that make room in my budget 
     for other living expenses.

  Julie from Dubuque, IA, said this:

       I wouldn't possibly be able to afford oncological care 
     without this insurance. My advice for Iowans becoming 
     eligible for Medicare: Sign up for Medicare Part D. Use a 
     trusted source to navigate all the plans. I'm glad to have 
     choices, not one-size-fits-all.

  An Iowan who volunteers with the Senior Health Insurance Information 
Program said this:

       As a SHIIP volunteer--

  SHIIP is the Senior Health Insurance Information Program--

     I like to help people find the best plan to fit their needs 
     and their finances. One individual was taking 35 daily 
     prescription medications that would have cost $10,000 per 
     month without Part D. For this Iowan, Medicare Part D was by 
     definition, lifesaving.

  I am glad Medicare Part D has benefited these seniors.
  Medicare Part D has shown that empowering patients with health plan 
transparency and choice can bring about significant savings for 
patients and taxpayers.
  Even though Medicare Part D has been around for at least 20 years, I 
have consistently conducted oversight and worked to make it better for 
seniors and taxpayers. During Medicare Part D's implementation, I held 
the Center for Medicare and Medicaid Services accountable and 
consistently conducted oversight that ranged from making sure seniors 
could access their prescription drugs all the way to ensuring that 
taxpayer dollars were wisely spent.
  I have also worked to advance commonsense reforms for seniors, for 
providers, and for taxpayers. Twenty years ago, we modernized Medicare 
to improve access for seniors while ensuring fiscal sustainability for 
taxpayers.
  I don't know why for sure, in 1966 when Medicare was set up, why it 
didn't include prescription drugs, but I assumed at that particular 
time that prescription drugs were about 1 or 2 percent of the cost of 
medicine in the United States or the delivery of medicine in the United 
States. Today, I think it is somewhere between 15 and 20 percent.
  These patient-centered principles that I have talked about can be 
applied to the latest front in the fight to lower prescription drugs by 
shining sunlight on powerful drug middlemen called pharmacy benefit 
managers. By bringing transparency to the PBM industry, we will empower 
patients, employers, providers, and insurers to make informed decisions 
based on the true value, if any, that PBMs provide.
  When consumers are empowered, they can demand change or pursue better 
alternatives. Unleashing market forces that foster innovation and apply 
downward pressure on prices is the way to get there.
  The Senate has an opportunity to take action to reduce costs for 
patients and taxpayers alike. We should let the successes of Medicare 
Part D's patient-centered approach guide us.
  Now, my colleagues are going to say that I took advantage of 
commemorating 20 years of Part D being a successful program for seniors 
and keeping drug costs down for seniors to take a whack at PBMs. But I 
think we all ought to think in terms of these powerful middlemen 
between the companies and you as the consumer or the local pharmacy, 
and we don't have any idea what they are doing. We know they have 
something to do with setting prices, setting rebates, determining what 
drugs are in what formularies, but beyond that, we don't know whether 
the rebates they give benefit the insurance companies, the 
pharmaceutical companies, the PBMs themselves, the pharmacies, or you 
as a consumer, and we ought to know that.
  Senator Wyden, my Democratic friend--he and I traded off sharing the 
Finance Committee from time to time. He and I started working on PBMs 
probably about 5 years ago. We were the only two who were interested in 
it, but it has reached a stage where at least four committees of the 
U.S. Senate and one committee of the House of Representatives have put 
out bills to make the opaque environment in which PBMs operate more 
transparent.

  Now, we aren't saying that what they are doing is wrong; we are only 
saying we ought to know what they are doing for the benefit of the 
consumer but also for the benefit of the American taxpayer because, 
through Medicare and Medicaid, government is the biggest purchaser of 
drugs in the United States, and maybe we can save the taxpayers some 
money.
  So besides being here on the floor of the U.S. Senate to praise the 
Congress in 2003 for passing the prescription drug Part D program for 
Medicare, I didn't want to lose the opportunity to urge action on PBM 
legislation so that we can know what is going on with the pricing of 
drugs, the formularies, and who benefits from it because, with 
transparency, there brings accountability. Maybe transparency won't be 
enough when we are all done, but I wouldn't know where to tell you to 
go if you wanted to change some law right now to transform this system, 
but I think transparency will do a great deal of good.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Booker). The Democratic whip.
  Mr. DURBIN. Mr. President, I want to first rise to congratulate my 
colleague from Iowa. I am glad that he has told the story for all to 
hear about Medicare Part D and the benefits that he has brought to his 
State and mine and to the Nation. It was a remarkable achievement, and 
I congratulate him on the anniversary of enacting that legislation.
  I say, even though we are of different political parties, we are 
friends, and we find common ground, and we have repeatedly. One of the 
issues we are both fighting for now is that of a simple disclosure on 
the television ads for prescription drugs to tell consumers across 
America what they cost. What a radical idea--the cost of the drug. We 
think--and we share the belief--that disclosure to the consumer is 
important, and an understanding of how some of these drugs--which, I 
guess, have become so common in our daily lives that we can actually 
not only print out but spell Xarelto--that we ought to know what it 
costs so that those who think it might be the right drug for them will 
at least have an idea of the thousands of dollars a month they have to 
pay for these drugs.
  It is not a radical idea. We passed it before in the Senate, and it 
was signed by the President. Questions were raised, so we are at it 
again. Like your prescription drug Part D, this is something that helps 
basic consumers in Iowa and Illinois, and I am proud to be a part of 
that effort with the Senator. I congratulate him again on that 
achievement.

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