[Congressional Record (Bound Edition), Volume 149 (2003), Part 11]
[House]
[Pages 14656-14657]
[From the U.S. Government Publishing Office, www.gpo.gov]




             ADDRESSING THE HIGH COST OF PRESCRIPTION DRUGS

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Minnesota (Mr. Gutknecht) is recognized for 5 minutes.
  Mr. GUTKNECHT. Mr. Speaker, I rise again tonight to talk about the 
high cost that Americans pay for prescription drugs. I am so lucky. 
Today I got to spend a good part of my day with a true American hero. 
Her name is Kate Stahl. For Members who have not seen it, I recommend, 
and I will submit for the Record, a copy of last week's U.S. News and 
World Report; and they did a story, the title of which is ``Health on 
the Border, Elderly Americans head north and south to find drugs they 
can afford.''
  Featured in the story is this American hero. Her name is Kate Stahl. 
She is an 84-year-old grandmother. She was here in Washington today. 
She wore a little sign. It just said, ``Kate Stahl, Old Woman.'' In my 
opinion, Kate Stahl is an American hero, and she is a patriot. She 
stands on the shoulders of great patriots like the Sons of Liberty who 
threw tea in Boston Harbor, because she has said in this article, and I 
will quote, ``I'd like nothing better than to be thrown in jail.''
  Kate Stahl has thrown herself into this fight for lower prescription 
drug prices. She calls herself a drug runner. She goes to Canada 
regularly to bring back prescription drugs for her friends and 
neighbors who cannot afford them. She is a patriot. Recently, the 
Kaiser Foundation did a study. They found that 29 percent of seniors 
say that they have had prescriptions that have gone unfilled because 
they could not afford them. I do not say shame on the pharmaceutical 
industry. Shame on us. Because we have the power to change it. The 
reason that we pay so much, and no one disputes this, and they have 
charts in here and comparisons of what people pay in Canada, Mexico and 
in Europe. No one disputes the charts. The numbers are always the same. 
America, the world's best market for prescription drugs, pays the 
world's highest prices. No one disputes that.
  But the question is why. The answer I think is pretty simple. Because 
we are a captive market. Because the FDA has literally said that 
Americans, unlike most other people in the world, cannot take drugs 
across the border.
  I am a Republican, and I happen to believe that there is nothing 
wrong with the word ``profit.'' But, ladies and gentlemen, there is 
something wrong with the word ``profiteer.'' They have every right to 
expect a reasonable rate of return on their investment and their 
research, but they should not get it all from American consumers like 
Kate Stahl. Kate Stahl, is she a common criminal? I do not think so. 
But our own government treats her like a common criminal. In the end, 
we are going to have a debate in the next several weeks about 
prescription drugs; and in the end every one of us is going to have to 
decide, will we stand with those brave patriots like Kate Stahl or will 
we stand with the huge pharmaceutical industry? I hope we make the 
right choice.

             [From U.S. News & World Report, June 9, 2003]

                          Health on the Border


  elderly americans head north and south to find drugs they can afford

                            (By Susan Brink)

       It's become something of a joke along the Maine-Canada 
     border. So many busloads of retired people crisscross the 
     line looking for affordable drugs that the roadside stands 
     should advertise, ``Lobsters. Blueberries. Lipitor. 
     Coumadin.'' Except, of course, that such a market in 
     prescription drugs would be illegal.
       These senior long-distance shopping sprees fall in a legal 
     gray zone. But as long as people cross the border with 
     prescriptions from a physician and have them filled for no 
     more than a three-month supply for personal use, customs and 
     other federal officials leave them alone. The trip might be 
     tiring, but people can save an average of 60 percent on the 
     cost of their prescription drugs. For some, that's the 
     difference between taking the drugs or doing without. ``The 
     last bus trip I was on six months ago had 25 seniors,'' says 
     Chellie Pingree, former Maine state senator and now president 
     of Common Cause. ``Those 25 people saved $19,000 on their 
     supplies of drugs.'' Pingree sponsored a bill known as Maine 
     Rx, which authorizes a discounted price on drugs for Maine 
     residents who lack insurance coverage. The law was challenged 
     by drug companies but recently upheld by the U.S. Supreme 
     Court. It hasn't yet taken effect.
       For years, field trips of senior citizens who live near the 
     borders have been organized to roll north to Canada and south 
     to Mexico. People in the middle of the country sometimes 
     found, if their prescription drug costs were especially high, 
     that they could save money on medications even if they flew 
     to Europe. The Internet has made it even easier for people to 
     fill their prescriptions from mail-order pharmacies.
       Figuring out ways to spend less on prescription drugs has 
     become a multi-faceted national movement of consumers, 
     largely senior citizens. The prescription drug bill in 
     America is $160 billion annually, and people over 65 fill 
     five times as many prescriptions as working Americans on 
     average. ``But they do it on health benefits that are half as 
     good and on incomes that are half as large,'' says Richard 
     Evans, senior analyst at Sanford C. Bernstein, an investment 
     research firm. What's more, seniors account for 20 percent of 
     the voting public.
       Face-off. It's little wonder that the May 19 Supreme Court 
     ruling got the attention of drug manufacturers and 
     politicians across the country. The often-over-looked state 
     of 1.3 million tucked in the northeast corner of the country 
     became David to the pharmaceutical industry's Goliath. The 
     face-off began three years ago when state legislators like 
     Pingree began questioning why Maine's elderly population had 
     to take all those bus trips.
       Americans who are elderly and uninsured pay the world's 
     highest prices for prescription drugs. That's because they 
     buy their drugs individually, without the bulk bargaining 
     power of an insurance company or the federal government. 
     Other industrialized countries, like Canada, France, Germany, 
     and Japan, have national healthcare systems and can use the 
     bargaining power of their entire populations to negotiate 
     drug prices and set limits on how much drug manufacturers can 
     charge.
       Though Congress has been debating a prescription drug plan 
     for years, seniors today

[[Page 14657]]

     still have no drug coverage under Medicare. The Maine plan 
     does not provide a drug benefit. Seniors and the uninsured 
     would still purchase their own medicines, but the plan helps 
     them get a discounted price on drugs similar to that 
     available to Medicaid recipients, in effect bringing hundreds 
     of thousands of individual (and powerless) consumers into a 
     powerful negotiating block.
       Teaming the elderly and uninsured with Medicaid recipients 
     gives them bargaining power they've never had before. Drug 
     manufacturers are required to give Medicaid a discount of 
     about 15 percent below the list price or match the lowest 
     price on the market. That creates an incentive to keep the 
     market price as high as possible, says Katharine Greider, 
     author of The Big Fix: How the Pharmaceutical Industry Rips 
     Off American Consumers. But most consumers don't notice the 
     high drug prices, because with health insurance they only pay 
     a small copayment. Only those lacking prescription drug 
     coverage--including many elderly--end up paying full retail 
     price for drugs.
       The law's leverage disturbs the drug industry. It would 
     create formulary, or list of preferred drugs, for this block 
     of patients, similar to those used by many managed-care 
     organizations. If a manufacturer did not lower its prices, it 
     would not be on the state's formulary. Drug companies oppose 
     the law as a quality-of-care issue. ``Under Maine's program, 
     government officials, rather than doctors and patients, would 
     effectively decide which medicines will be available for 
     Medicaid and non-Medicaid patients,'' says a statement from 
     Pharmaceutical Research and Manufacturers of America, the 
     industry's trade organization.
       The Maine drug plan was crafted three years ago, and health 
     officials are now refining a draft of the law to send to the 
     Legislature. But the pharmaceutical industry is far from 
     ready to give up the fight. ``I don't go to any meetings that 
     don't have five lawyers sitting around the table,'' says 
     Peter Walsh, acting commissioner or the Maine Department of 
     Human Services. Even when it goes forward, one small New 
     England state's law won't solve the nation's prescription 
     drug crisis.
       The greater hope for consumers--and the greater threat to 
     the industry--is the clout of about 18 other states that have 
     filed bills similar to Maine's. ``The point at which you get 
     half or more states to do this, it becomes a more and more 
     significant intrusion into the market. And it becomes harder 
     for the pharmaceutical industry to fight back. That's why 
     they had to fight so hard against Maine's law,'' says Sara 
     Rosenbaum, professor of health-policy law at George 
     Washington University.
       Going south. Meanwhile, individual consumers are figuring 
     out their own ways to bypass steep American drug prices. For 
     example, Bill Goff goes to Tijuana, Mexico, four times a 
     year. He flies from his home in Reno, Nev., to San Diego, 
     stays in the Travelodge, rents a car for a day, and crosses 
     the border to visit Carlos Cortez of Farmacia Internacional 
     with a fist-full of prescriptions. He has a host of medical 
     disorders, including rheumatoid arthritis, diabetes, asthma, 
     glaucoma, and osteoporosis. He would spend $32,000 a year on 
     prescription drugs in the United States, but he has cut his 
     annual cost to $9,500, even including travel costs. ``It's 
     not a matter of saving money. It's a matter of living,'' says 
     Goff. ``If I didn't go to Mexico, I couldn't afford the 
     drugs. I'd be dead.''
       Others are skipping the travel altogether, some with the 
     help of 84-year-old Kate Stahl. She is not above using the 
     ``grandmother'' image to further a cause. ``I'd like nothing 
     better than to be thrown in jail. People would say, `Oh, the 
     poor, frail old granny,''' she says with a laugh. ``I can be 
     very frail if I have to.'' Stahl volunteers with the 
     Minnesota Senior Federation, helping people get the forms and 
     information they need to get mail-order prescription from 
     Canada. The plan, called the Canadian Prescription Drug 
     Importation Program (www.mnseniorfed.org), is open to anyone 
     in the United States. But while no one seems ready to throw 
     the likes of Stahl in the slammer, the program's legality is 
     murky.
       Though the Food and Drug Administration says it cannot 
     guarantee the safety of imported drugs (even if they're 
     exported from the United States, then reimported, as many 
     are), individuals filling their personal prescriptions are 
     generally left alone. But the agency has sent warning letters 
     to profit-making drugstores in the United States that help 
     consumers get mail-order prescriptions from Canada, saying 
     that reimporting cheap drugs is a violation of the law and a 
     risk to public health.
       Since Stahl and her organization do not profit from their 
     efforts, so far no one has hassled them. Rep. Gil Gutknecht, 
     a Minnesota Republican, is trying to pass legislation that 
     would make it easier for people to get their drugs from 
     Canada or overseas. Laws to that effect have passed twice 
     before, but both times the FDA protested that it could not 
     guarantee the safety of drugs reimported from Canada, and so 
     the law has not taken effect. Still, Gutknecht is not alone 
     in interpreting present laws in a way that allows people to 
     buy personal three-month supplies of drugs overseas without 
     problems.
       Cortez has a conference table display of brand-name 
     prescription drugs in his Tijuana office. One by one he holds 
     them up. Pfizer's Lipitor, Eli Lilly's Prozac. Merck's 
     Fosamax. They're not loose pills; they are individually 
     bubble-wrapped within sealed boxes. ``We have no doubt that 
     what we're buying is what it is. It comes from world-class 
     labs,'' he says. And the 30 percent of his customers who are 
     American seem to agree.
       He's aware of the irony: a businessman from the developing 
     world profiting on sales to desperate citizens of the 
     wealthiest country on Earth. ``It doesn't get more stark than 
     right here. You can see so clearly: Third World,'' he says, 
     pointing to the roadside squalor in Tijuana, the concrete 
     barriers at dusk crowded with men waiting for nightfall and a 
     risky dash across the border. ``First World,'' he finishes, 
     pointing toward the city of San Diego across the border. ``My 
     business thrives on people coming here from the States. But I 
     shouldn't have people thanking me for making it possible for 
     them to survive when they are from a country like the United 
     States.''

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