October 28, 2019 - Issue: Vol. 165, No. 170 — Daily Edition116th Congress (2019 - 2020) - 1st Session

[Pages H8516-H8519]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




PUBLIC DISCLOSURE OF DRUG DISCOUNTS AND REAL-TIME BENEFICIARY DRUG COST 
                                  ACT

  Ms. SCHAKOWSKY. Madam Speaker, I move to suspend the rules and pass 
the bill (H.R. 2115) to amend title XI of the Social Security Act to 
provide greater transparency of discounts provided by drug 
manufacturers, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 2115

       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 ``Public Disclosure of Drug 
     Discounts and Real-Time Beneficiary Drug Cost Act''.

     SEC. 2. PUBLIC DISCLOSURE OF DRUG DISCOUNTS.

       Section 1150A of the Social Security Act (42 U.S.C. 1320b-
     23) is amended--
       (1) in subsection (c), in the matter preceding paragraph 
     (1), by inserting ``(other than as permitted under subsection 
     (e))'' after ``disclosed by the Secretary''; and
       (2) by adding at the end the following new subsection:
       ``(e) Public Availability of Certain Information.--
       ``(1) In general.--In order to allow the comparison of 
     PBMs' ability to negotiate rebates, discounts, direct and 
     indirect remuneration fees, administrative fees, and price 
     concessions and the amount of such rebates, discounts, direct 
     and indirect remuneration fees, administrative fees, and 
     price concessions that are passed through to plan sponsors, 
     beginning January 1, 2020, the Secretary shall make available 
     on the Internet website of the Department of Health and Human 
     Services the information with respect to the second preceding 
     calendar year provided to the Secretary on generic dispensing 
     rates (as described in paragraph (1) of subsection (b)) and 
     information provided to the Secretary under paragraphs (2) 
     and (3) of such subsection that, as determined by the 
     Secretary, is with respect to each PBM.
       ``(2) Availability of data.--In carrying out paragraph (1), 
     the Secretary shall ensure the following:
       ``(A) Confidentiality.--The information described in such 
     paragraph is displayed in a manner that prevents the 
     disclosure of information, with respect to an individual drug 
     or an individual plan, on rebates, discounts, direct and 
     indirect remuneration fees, administrative fees, and price 
     concessions.
       ``(B) Class of drug.--The information described in such 
     paragraph is made available by class of drug, using an 
     existing classification system, but only if the class 
     contains such number of drugs, as specified by the Secretary 
     (but not fewer than three drugs), to ensure confidentiality 
     of proprietary information or other information that is 
     prevented to be disclosed under subparagraph (A).''.

     SEC. 3. REQUIRING PRESCRIPTION DRUG PLAN SPONSORS TO INCLUDE 
                   REAL-TIME BENEFIT INFORMATION AS PART OF SUCH 
                   SPONSOR'S ELECTRONIC PRESCRIPTION PROGRAM UNDER 
                   THE MEDICARE PROGRAM.

       Section 1860D-4(e)(2) of the Social Security Act (42 U.S.C. 
     1395w-104(e)(2)) is amended--
       (1) in subparagraph (D), by striking ``To the extent'' and 
     inserting ``Except as provided in subparagraph (F), to the 
     extent''; and
       (2) by adding at the end the following new subparagraph:
       ``(F) Real-time benefit information.--
       ``(i) In general.--Not later than January 1, 2021, the 
     program shall implement real-time benefit tools that are 
     capable of integrating with a prescribing health care 
     professional's electronic prescribing or electronic health 
     record system for the transmission of formulary and benefit 
     information in real time to prescribing health care 
     professionals. With respect to a covered part D drug, such 
     tools shall be capable of transmitting such information 
     specific to an individual enrolled in a prescription drug 
     plan. Such information shall include the following:

       ``(I) A list of any clinically-appropriate alternatives to 
     such drug included in the formulary of such plan.
       ``(II) Cost-sharing information for such drug and such 
     alternatives, including a description of any variance in cost 
     sharing based on the pharmacy dispensing such drug or such 
     alternatives.
       ``(III) Information relating to whether such drug is 
     included in the formulary of such plan and any prior 
     authorization or other utilization management requirements 
     applicable to such drug and such alternatives so included.

       ``(ii) Electronic transmission.--The provisions of 
     subclauses (I) and (II) of clause (ii) of subparagraph (E) 
     shall apply to an electronic transmission described in clause 
     (i) in the same manner as such provisions apply with respect 
     to an electronic transmission described in clause (i) of such 
     subparagraph.
       ``(iii) Special rule for 2021.--The program shall be deemed 
     to be in compliance with clause (i) for 2021 if the program 
     complies with the provisions of section 423.160(b)(7) of 
     title 42, Code of Federal Regulations (or a successor 
     regulation), for such year.
       ``(iv) Rule of construction.--Nothing in this subparagraph 
     shall be construed as to allow a real-time benefits tool to 
     steer an individual, without the consent of the individual, 
     to a particular pharmacy or pharmacy setting over their 
     preferred pharmacy setting nor prohibit the designation of a 
     preferred pharmacy under such tool.''.

     SEC. 4. SENSE OF CONGRESS REGARDING THE NEED TO EXPAND 
                   COMMERCIALLY AVAILABLE DRUG PRICING COMPARISON 
                   PLATFORMS.

       It is the sense of Congress that--
       (1) commercially available drug pricing comparison 
     platforms can, at no cost, help patients find the lowest 
     price for their medications at their local pharmacy;
       (2) such platforms should be integrated, to the maximum 
     extent possible, in the health care delivery ecosystem; and
       (3) pharmacy benefit managers should work to disclose 
     generic and brand name drug prices to such platforms to 
     ensure that--
       (A) patients can benefit from the lowest possible price 
     available to them; and
       (B) overall drug prices can be reduced as more educated 
     purchasing decisions are made based on price transparency.

  The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from 
Illinois (Ms. Schakowsky) and the gentleman from Texas (Mr. Burgess) 
each will control 20 minutes.
  The Chair recognizes the gentlewoman from Illinois.


                             General Leave

  Ms. SCHAKOWSKY. Madam Speaker, I ask unanimous consent that all 
Members may have 5 legislative days in which to revise and extend their 
remarks and include extraneous material on H.R. 2115.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Illinois?
  There was no objection.
  Ms. SCHAKOWSKY. Madam Speaker, I yield 4 minutes to the gentlewoman 
from Virginia (Ms. Spanberger), an author and supporter of this bill.

[[Page H8517]]

  

  Ms. SPANBERGER. Madam Speaker, I rise in support of my bill, H.R. 
2115, the Public Disclosure of Drug Discounts Act.
  First, I thank my colleagues Congressman Arrington and Congressman 
Boyle for their partnership on this bipartisan legislation. I thank 
Congresswoman Slotkin for her cooperation and commitment to our 
efforts. And I thank Congresswoman Schakowsky for her work here today.
  Madam Speaker, if we are going to make substantial long-term progress 
on the issue of prescription drugs, we can't be afraid to work in a 
bipartisan manner, and I thank my colleagues for joining me in this 
fight.
  I also thank Chairman Pallone and Chairman Neal for their dedicated 
work on tackling prescription drug costs and the Committee on Energy 
and Commerce and the Committee on Ways and Means for voting to advance 
our bill and making this floor vote possible.
  This bipartisan bill would help address the number one concern facing 
central Virginia's working families, chronically ill, and seniors--the 
rising cost of healthcare.
  In every community in the Seventh District of Virginia, from 
Chesterfield to Culpeper, the extremely personal effects of rising 
prescription drug costs are on full display. Whether at a coffee shop, 
town hall, or street fair, I always hear yet another heartbreaking 
story from a mother, a father, a grandparent, or a young adult 
struggling to afford their prescription drugs. People genuinely feel 
helpless, and it is due to no fault of their own.
  In many cases, steep costs have forced them to make nearly impossible 
decisions. A costly, lifesaving medication could mean buying fewer 
groceries for their family. It could mean reluctantly selling their 
home. It could mean saving less, or nothing at all, for their 
retirement or their kids' education. And even for those who are 
healthy, there is an overwhelming fear: What if I get sick, or what if 
a loved one gets sick, and we can't afford the medication?
  Back in August, I held a roundtable with patients, pharmacists, and 
healthcare providers in Henrico County to discuss this community-wide 
issue. Together, we talked about the financial challenges caused by 
overpriced drugs, but we also discussed the issue of pharmacy benefit 
managers, PBMs.
  To those in the healthcare industry, PBMs are known as the middlemen 
between drugmakers, health insurers, and pharmacies. But for many 
Americans, PBMs remain a mysterious player within the prescription drug 
marketplace.
  Operating in the murky world of drug negotiation, there are few 
windows into the value of the rebates and discounts PBMs receive from 
drug companies. Effectively, they are a black box in the long supply 
chain from the pharmaceutical company to the patient.
  During our roundtable in Henrico, one local pharmacist described how 
PBMs continue to enjoy record profits thanks to the pharmaceutical 
industry, while patients and pharmacists get stuck with unsustainable 
costs.
  Right now, the three largest PBMs control three-quarters of the U.S. 
prescription drug market. There seems to be little transparency. And 
where there is zero transparency, there is rarely room for 
accountability or oversight.
  If we don't cast sunlight into this black box, patients will continue 
to be left in the dark about the effect of PBMs on the prices of 
specific drugs. The Public Disclosure of Drug Discounts Act would be a 
step toward bringing greater transparency to this broken system.
  The principle behind my bill is simple. Let's take the information 
already provided to the Federal Government and make it public.
  PBMs are already required to declare rebate data, discounts, and 
generic dispensing rates to HHS, but under my bill, this information 
would be posted publicly for the general public to see.
  Beyond the principle of my bill, the goal is even simpler: lowering 
drug costs for our neighbors.
  By sharing this information online with American consumers and 
businesses, we would give seniors, families, and pharmacists a better 
sense of how PBMs could be influencing excessive prices. And we would 
start to address one of the root causes of our prescription drug 
affordability crisis.
  In central Virginia and across the country, families should not be 
racked by a constant uneasiness about their financial well-being simply 
due to rising drug costs. They shouldn't be forced to accept silently 
the undisclosed results of PBM negotiations that could be bankrupting 
them.
  We need to show the American people that we want to see progress on 
this vital economic issue and that we are hearing their stories, seeing 
the problems that exist, and actually moving to reform a prescription 
drug marketplace that too often seems to be working against the best 
interests of American patients.
  Today, I call on my colleagues to pass the Public Disclosure of Drug 
Discounts Act because we are long overdue for meaningful actions that 
can turn the tide.
  Mr. BURGESS. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, I rise to speak in support of H.R. 2115, the Public 
Disclosure of Drug Discounts and Real-Time Beneficiary Drug Cost Act.

  This bill includes three provisions that passed through the Committee 
on Energy and Commerce in July as part of a larger transparency 
package, at that time called the METRIC Act.
  The first provision aims to hold pharmacy benefit managers 
accountable in the negotiation of rebates by requiring the Secretary of 
the Department of Health and Human Services to make rebates, discounts, 
direct and indirect remuneration fees, and other information available 
on a public website. This policy includes a requirement that this 
information be displayed in such a way that it maintains the 
confidentiality of individual drugs and plans.
  What I believe is the most important provision is the one that 
requires prescription drug plan sponsors to include real-time benefits 
information in electronic prescribing in Medicare. As a physician, I 
recognize how important it is for doctors to have as much information 
at their disposal in prescribing appropriate medications for their 
patients.
  Madam Speaker, I thank my fellow Texans, Jodey Arrington as well as 
Pete Olson, for bringing forth this policy.
  In the past few years, we have begun to see the success of the 21st 
Century Cures Act actually come to life. New treatments and new cures 
are coming to the market at an exciting pace, providing great promise 
for America's patients.
  It is important that doctors be able to see and compare the prices of 
these medications so that they can help their patients assess their 
options. Price transparency at the point of prescribing will provide 
physicians with information regarding what would or would not be 
covered under their patients' insurance and would help them discuss 
what would be the most affordable options that are available to their 
patients.
  While there are a lot of factors that doctors must consider when 
prescribing their patients' medications, medication adherence is 
essential. If patients cannot afford their drugs, the stage is set for 
a lack of adherence to the recommended regimen.
  We have all heard the stories of patients showing up at the pharmacy 
counter to pick up their prescriptions, at which point they learn it is 
unaffordable. This policy would help reduce the number of prescriptions 
left at the pharmacy counter, not picked up due to cost concerns.
  The American Medical Association testified at our drug supply hearing 
in May that ``access to accurate patient coverage and cost-sharing 
information at the point-of-care would streamline the process, reduce 
burden for the physician and the patient, and speed delivery of the 
most appropriate care.''
  I agree with that statement, and I am pleased this legislation would 
improve access to real-time benefits data, further informing quality 
and doctor-patient decisionmaking and improving patient access to 
affordable medications.
  Madam Speaker, I urge Members to support H.R. 2115, and I reserve the 
balance of my time.
  Ms. SCHAKOWSKY. Madam Speaker, I yield 3 minutes to the gentlewoman 
from Michigan (Ms. Slotkin) on this legislation.

[[Page H8518]]

  

  Ms. SLOTKIN. Madam Speaker, I thank Congresswoman Schakowsky and 
Congresswoman Spanberger.
  Madam Speaker, I rise today to speak in support of my bill, the Real-
Time Benefits Act, which has been incorporated into the bill before us 
today.
  The bill started with a very simple request from seniors in my 
district. People want to know how much a prescription will cost before 
they pick it up at the drugstore, and they deserve to know that it is 
the best possible price that they can get.
  This bill does that very thing. It provides Medicare patients with 
the information they need about the cost of the prescription and 
whether there are generic alternatives, as well as the best pharmacy 
for the best deal before they even leave the doctor's office.
  Right now, here is how the system works. A patient goes to the 
doctor, gets a prescription, and walks out. Then they take it to a 
local pharmacy, fill it, and pick it up. It is right then, at the 
counter, in front of everyone else, that they actually find out the 
price of their bill.
  There is no advanced warning, no comparison shopping, no offer of 
generics, and no way of knowing if a different pharmacy could have it 
cheaper. By the time you get to the pharmacy, they have you over a 
barrel. This bipartisan bill would fix that.
  Here is how it works. Insurers would be required to provide 
information to a common system, a real-time benefits tool, which 
doctors would access through their electronic prescribing program. 
Doctors and patients could then sit together to receive real-time 
updates, right in the doctor's office, on the price of the drug based 
on the patient's insurance plan, as well as the price of any other 
cheaper drugs available.
  This real-time benefits tools will also list the price differences at 
each pharmacy--Rite Aid versus CVS--to allow physicians to make sure 
that the patients are getting the lowest possible prices.

                              {time}  1830

  This not only lowers out-of-pocket costs for seniors, but it 
increases much-needed price transparency into our system.
  Imagine if, every time you went to the doctor, both you and your 
physician could see the differences in the prices of drugs. This is the 
kind of all-American competition we need when it comes to our 
prescription drugs.
  To be clear, the cost of prescription drugs is the number one issue I 
get asked about in my district. People come up to me in the grocery 
store. They grab my arm. They ask me why their medication has increased 
by 200 percent in cost in the past 5 years.
  Connie, a constituent of mine in Brighton, spends $10,000 a year on 
Humira for her Crohn's disease, even though she is on Medicare.
  Joanna, who lives in my hometown of Holly, Michigan, was hospitalized 
for several days due to complications because she could not afford her 
inhaler. Her complex health needs require a number of medicines, so she 
literally rations her medicines in order to keep them manageable, and 
she still spends hundreds of dollars each month.
  This is wrong, and our constituents, regardless of party, are asking 
us to do something about it.
  Democrats and Republicans have both said the right things about the 
cost of prescription drugs. They have talked the talk. They now must 
walk the walk.
  I am incredibly proud to have brought forth this bipartisan 
legislation tonight. I urge my colleagues to join me in voting ``yes'' 
to promote transparency and competition.
  Mr. BURGESS. Madam Speaker, I yield 3 minutes to the gentleman from 
Georgia (Mr. Carter), a pharmacist by profession and a very valuable 
member of the Health Subcommittee of the Committee on Energy and 
Commerce.
  Mr. CARTER of Georgia. Madam Speaker, I thank the gentleman for 
yielding.
  I rise to speak in support of H.R. 2115, the Public Disclosure of 
Drug Discounts Act. I am very glad to see this bill, which was part of 
the METRIC Act Representative Schakowsky and I passed out of Energy and 
Commerce, being moved through the House floor. This is important 
legislation that brings desperately needed transparency to our drug 
supply chain.
  So much of the debate around how we can lower drug prices in this 
country has been focused on drug manufacturers. This bill highlights 
the need for reforms throughout our entire drug supply system. 
Specifically, this bill shines a spotlight on the middlemen in our drug 
supply chain: the pharmacy benefit managers, or PBMs.
  For context, three PBMs control almost 80 percent of the marketplace, 
and while originally designed to primarily process claims data, these 
companies are now some of the largest corporations in the country. For 
the year 2019, the major PBM companies had a higher projected revenue 
than Facebook, Amazon, Apple, Netflix, and Google combined.
  Again, for this year, 2019, the major PBM companies had a higher 
projected revenue than Facebook, Amazon, Apple, Netflix, and Google 
combined.
  In a time where patients are facing higher and higher drug costs, it 
is clear that more transparency of these middlemen is desperately 
needed, at the very least. This bill, H.R. 2115, will require PBMs to 
report information on all of the rebates, fees, and discounts they 
extract before a drug ever reaches patients.
  PBMs argue that it is actually better for patients that the PBMs 
extract all of these increasingly high rebates and fees because they 
pass those discounts on to the insurance plans to lower premiums.
  While I completely disagree with that premise, this bill will finally 
allow all of us to see for ourselves exactly how much of a cut these 
middlemen are taking out of the system.
  Transparency is absolutely critical if we are going to lower drug 
prices for patients, and this bill is a big step in the right 
direction.
  I applaud Representatives Spanberger, Arrington, and Boyle for their 
leadership on this bill, as well as my Energy and Commerce counterpart, 
Congresswoman Schakowsky.
  Madam Speaker, I urge my colleagues to support H.R. 2115.
  Ms. SCHAKOWSKY. Madam Speaker, I am prepared to close now just by 
saying the cost of prescription drugs is an issue on the minds of all 
of our constituents, in a bipartisan way, all across the country, and 
this bill will provide much-needed transparency around the activity of 
pharmacy benefit managers, or PBMs.
  You heard very eloquent statements from our colleagues on this issue. 
I am going to close now and just say I hope that all of our colleagues 
will vote for this legislation.
  Madam Speaker, I yield back the balance of my time.
  Mr. BURGESS. Madam Speaker, I yield 3 minutes to the gentleman from 
Texas (Mr. Arrington), coauthor of this legislation.
  Mr. ARRINGTON. Madam Speaker, I thank my friend and fellow Texan, Dr. 
Burgess, for yielding me time to speak.
  Madam Speaker, I rise today in support of H.R. 2115, legislation I 
was proud to help lead and support, alongside Congresswoman Spanberger, 
which will provide greater transparency to the discounts negotiated 
between insurance companies and drug manufacturers through what are 
known as pharmacy benefit managers, or PBMs.
  One of the reasons why drug costs have spiraled out of control is 
because discounts negotiated by PBMs are shrouded in secrecy. Americans 
are left in the dark about the rebates, and we have no idea where the 
value of those rebates go.
  But we know this: We know they are not going to our seniors. We know 
they are not going to them at the point of sale. This has created a 
system that is confusing and overly complicated, particularly for our 
seniors.
  My greatest concern is that the value, again, of these rebates is 
being passed to our seniors, who need the relief desperately.
  The answer to this drug affordability crisis is not to impose more 
government control, which would only further distort the market, 
further confuse our seniors, and increase costs on all Americans. 
Instead, we need to activate the forces of competition and provide 
patients with more transparency in this process so that they are 
empowered to know exactly what their options are and what they are 
paying for each time they visit the pharmacy.

[[Page H8519]]

  This legislation will help ensure that rebates go toward reducing the 
cost of drugs for our seniors as well as the cost to the American 
taxpayer.
  Additionally, I am thankful this legislation includes the text of my 
bill, the Shop Rx Act. This provision, which I carried in committee 
with the support of both Republicans and Democrats, requires drug plans 
for seniors to offer realtime information regarding the various options 
of drugs and their associated costs.
  By providing seniors with access to the readily available and 
relevant information they need in order to be real consumers, we will 
empower them with the knowledge to choose the options that best fit 
their needs and their budget. Once consumers have more information, 
they will have more choices, and insurers will have to actually compete 
for their business, which will ultimately bring down the cost of drugs.
  Madam Speaker, I believe this legislation will help transform the 
system from one in which patients are often powerless victims to one in 
which they have true bargaining power and real control over their 
healthcare needs. I am proud to support it, and I encourage my 
colleagues to do the same.
  Mr. BURGESS. Madam Speaker, I yield 3 minutes to the gentleman from 
Montana (Mr. Gianforte), a valuable member of the Health Subcommittee.
  Mr. GIANFORTE. Madam Speaker, I thank the gentleman for yielding.
  Far too many Montanans can't afford the prescription drugs they need. 
They shouldn't have to leave the pharmacy counter empty-handed because 
costs are too high. Montanans need access to affordable medications, 
which is why reducing drug prices is one of my top priorities.
  To lower costs, we need more transparency in our healthcare system. 
We need to shine a light onto the opaque drug pricing process. Our 
commonsense, bipartisan bill before the House today will shine that 
much-needed light.
  The Payment Commission Data Act gives Congress' nonpartisan think 
tanks MedPAC and MACPAC greater access to drug pricing data. Armed with 
this data, they can better advise Congress about who is being a bad 
actor in the drug supply chain. It will help Congress address 
prescription drug prices more effectively.
  We all want to ensure the American people can buy more affordable 
prescription drugs. I believe the bipartisan approach we have here 
should be a working model for how to move forward, not simply ramming 
through partisan bills.
  Madam Speaker, I urge my colleagues to vote ``yes'' on this 
commonsense reform to lower drug prices.
  Mr. BURGESS. Madam Speaker, I urge passage of this bill, and I yield 
back the balance of my time.
  Mr. SCHRADER. Madam Speaker, I rise today in support of H.R. 2115, 
the ``Public Disclosure of Drug Discounts Act'' introduced from my 
friend and colleague, Ms. Spanberger.
  While I believe something must be done to bring down the cost of 
drugs, I also know that unless we have a better view into the process 
of how a patient's cost is calculated, we will continue to struggle to 
address the problem. That's why I support this important piece of 
legislation that requires PBMs to report on all the price concessions 
and factors that contribute to determining the net cost of a drug.
  PBMs play an important role in our healthcare system as the 
intermediary negotiating drug prices in the current marketplace. But 
only if we understand the actual cost of the drug can we ensure that 
consumers are getting a fair shake. The bill before you today is 
comprehensive, as it requires PBMs to report the amount of rebates, 
discounts, direct and indirect remuneration fees, administrative fees, 
and any other price concessions. The Secretary will make this 
information available publicly in a way that aggregates the information 
by class of a drug to protect the negotiation process but also provide 
insight into any discrepancy between the negotiated drug's net cost and 
the price a patient pays for that drug.
  Addressing any healthcare problem requires a comprehensive approach. 
There is no one entity that is solely responsible for the high cost of 
drugs. We need transparency in our healthcare system. This bill had 
bipartisan support throughout the Committee process and similar 
measures have had support in the Senate. I am proud that we continue to 
work on measures that will help address one of the most concerning 
issues of our time, the exorbitant price of prescription drugs, and I 
thank leadership for bringing this measure to the floor today.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentlewoman from Illinois (Ms. Schakowsky) that the House suspend the 
rules and pass the bill, H.R. 2115, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Ms. SCHAKOWSKY. Madam Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this motion will be postponed.

                          ____________________