December 11, 2019 - Issue: Vol. 165, No. 198 — Daily Edition116th Congress (2019 - 2020) - 1st Session

[Pages H10117-H10122]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                PRESCRIPTION DRUG POLITICS OVER PROGRESS

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 3, 2019, the gentleman from Georgia (Mr. Carter) is recognized 
for the remainder of the time until 10 p.m. as the designee of the 
minority leader.


                             GENERAL LEAVE

  Mr. CARTER of Georgia. Madam Speaker, I ask unanimous consent that 
all Members have 5 legislative days in which to revise and extend their 
remarks and include extraneous material on the topic of this Special 
Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Georgia?
  There was no objection.
  Mr. CARTER of Georgia. Madam Speaker, I am thankful to have this 
opportunity tonight.
  Obviously, the subject matter that we have been discussing here, 
prescription drug prices, is something that is very important to all 
Americans, and I am very happy that we are finally getting around to 
this.
  Madam Speaker, as a practicing pharmacist for most of my career, I 
take the issue of drug pricing very personally. In fact, it is one of 
the primary reasons that I wanted to come to Congress, to do something 
about it.
  I had the honor and privilege of practicing pharmacy for over 30 
years. I was the one at the front counter who had to tell the patient 
how much the medication was.
  I was the one who witnessed the mother in tears because she couldn't 
afford the medication for her child.
  I was the one who witnessed the senior citizens trying to make 
decisions

[[Page H10118]]

between whether they were going to buy their medications or buy their 
groceries.
  I was the one on the other side of the counter. I committed myself to 
do something about that once I became a Member of Congress, and I am 
glad to see that we are finally doing that.
  I want to preface my remarks by saying this: I truly believe that 
those on the other side of the aisle and we on this side of the aisle 
want the same thing. I truly believe that. I truly believe that we all 
want to lower prescription drug prices, and I truly believe that we can 
do just that. I truly believe that we need to do just that.
  However, there are some differences here. Those experiences that I 
had on the other side of the counter have driven me to work hard on 
bipartisan solutions to lower drug costs for patients since coming to 
Congress, but particularly during this last year. However, it seems 
that every time I get my hopes up that we will work together to pass 
meaningful policies to help the American people afford their 
medications, the Democrats have put politics over progress.
  In the spring, I was proud to work with my friend Congressman 
Schrader, in a bipartisan way, on the BLOCKING Act to increase generic 
competition in the marketplace. Again, both of us wanted the same 
thing. We worked on this together, in a bipartisan fashion.
  But what happened? Speaker Pelosi paired our bipartisan drug pricing 
bill up on the floor with political poison pills. Politics over 
progress.
  This summer, I worked with Congresswoman Schakowsky to strike a deal 
to pass a comprehensive drug transparency bill, the METRIC Act. 
Unanimously, it passed out of committee. Republicans and Democrats 
voted for it.
  But what happened? Different versions of these policies we had struck 
a bipartisan agreement on were added to the Speaker's bill before us 
today. Politics over progress.
  This fall, Energy and Commerce Committee Republicans were close to 
striking a bipartisan deal with our friends across the aisle to cap 
out-of-pocket spending for seniors on Medicare.
  What happened? Our Democratic colleagues walked away from those 
bipartisan negotiations to double down on a partisan bill that we know 
is dead on arrival in the Senate. Politics over progress.
  This holiday season, Energy and Commerce Committee Republicans 
introduced a bill, H.R. 19, the Lower Costs, More Cures Act, to make 
one last, earnest effort to pass good, bipartisan drug spending 
policies that could be signed into law this year and immediately help 
patients--immediate help for patients.
  My hope is that we can come together because, as I said before, we 
all want the same thing. We all need the same thing. My hope is that we 
can come together and support the Walden amendment and pass the 
bipartisan Lower Costs, More Cures Act instead of this deeply partisan 
H.R. 3.
  My hope is that my Democratic colleagues stop putting politics over 
progress and join us to pass bipartisan drug pricing reforms that 
actually can be signed into law and will help patients.
  Madam Speaker, we have a number of people here today who want to 
speak on this. I know that I am going to have some personal stories 
that I want to share, and I think some of my colleagues are going to 
have some personal stories as well, real-life situations, real people, 
real problems, real diseases. This is what we are talking about here.

  There is no reason in the world that this should be a partisan issue. 
Never, in my over 30 years of practicing pharmacy, did I ever go to the 
counter and say: Okay, are you a Republican or are you a Democrat? No, 
never did that happen, and it should not happen. And it should not 
happen in the Halls of Congress, either. There is no excuse, no reason, 
that should ever happen.
  Madam Speaker, I yield to the gentleman from Kentucky (Mr. Guthrie), 
a gentleman on the Energy and Commerce Committee.
  Mr. GUTHRIE. Madam Speaker, I thank the gentleman for yielding.
  Madam Speaker, I rise today to bring attention to the consequences of 
the drug pricing bill H.R. 3.
  There is no doubt we must act to lower prescription drug prices for 
Americans and for Americans to pay only their fair share. However, this 
bill is not the right path.
  We often hear stories about the way other countries pay for their 
drugs and other country payment systems. What you don't often hear are 
stories about patients who are unable to receive care and access to 
lifesaving drugs because of the limitations in their country.
  For Louise Moorhouse, we have examples of how much less is offered in 
these other countries, but it is personal. For example, Louise 
Moorhouse is a teacher in England. Hope was within reach when she 
enrolled in a trial for Kuvan, a drug used to treat PKU, a rare genetic 
metabolic disorder. If left untreated, the disease can result in mild 
to severe neurological issues.
  When Louise was in the clinical trial for Kuvan, she was able to eat 
and function like anyone else. Sadly, Louise discovered after the trial 
that the drug that helped her live a more normal life was not covered 
by the United Kingdom's National Health Service.
  Despite the agency's acknowledgment of the drug's efficacy, as the 
drug is not covered by the NHS, she no longer has access to this drug. 
Instead, she has returned to taking 80 pills a day, in conjunction with 
a highly restrictive diet.

                              {time}  2130

  In the United States, we have access to innovative drugs. The keyword 
is ``access.''
  When people talk about H.R. 3, what they want to say is that we can 
completely transform the way we pay for drugs and never talk about or 
never even acknowledge the way we completely transform the way we 
receive and have access to drugs. We know that from the Congressional 
Budget Office.
  There are other studies that say we can lose 100 different cures that 
are coming down the path. So, as Americans want relief from 
prescription drug prices, Americans also want access to these 
innovative drugs.
  President Carter is alive today because of access to one of his 
experimental drugs that are becoming lower cost and more affordable for 
everyone.
  My point is there doesn't have to be a choice. We can have both. We 
can have lower prices and not completely lose access to these drugs and 
continue the great innovation that we have.
  That choice is H.R. 19. It is a bill that will be on the floor 
tomorrow. Every bit of it is bipartisan. Every single piece of it has a 
Republican and a Democrat cosponsor. It is something we know the Senate 
will take up and the President will sign and give relief to the 
American people and continue to give access to the great innovations 
that we have.
  Madam Speaker, I hope that we can take that bill up tomorrow, and I 
thank the gentleman for yielding.
  Mr. CARTER of Georgia. Madam Speaker, I thank the gentleman 
especially for making the point that is true: We can have both. We can 
lower drug costs; we can continue with innovation; and we do not have 
to stymie innovation. We can achieve what both sides want to achieve 
without stymieing innovation and without cutting out research and 
development.
  Madam Speaker, I want to bring up another situation in which modern 
medicine has played a role. I will give you an example of where 
research and development has resulted in miracle cures.
  Duchenne muscular dystrophy is another terrible disease that 
predominantly impacts males and is a result of a genetic mutation that 
inhibits the body from producing the chemical needed to make your 
muscles work.
  As with the other diseases that we are going to mention tonight, it 
has a significant impact on those who are affected. But, fortunately, 
we have a drug to treat it.
  Exondys is a drug developed to treat a particular group of people 
suffering from Duchenne, and it was the first treatment of its kind 
approved by the FDA. That means that these people for whom this was 
developed would be able to have their bodies develop the protein 
necessary to stimulate muscle development and activity. In other words, 
it can help to improve the daily

[[Page H10119]]

lives of these people with that particular type of muscular dystrophy.
  Once again, I can't stress how much of an impact these incredible 
cures that I have witnessed during my lifetime have. During my 
professional practice, I have seen nothing short of miracles of people 
being able to get their lives back and being able to extend their lives 
and live a healthy life.
  This therapy that we are talking about right here, Exondys, is not 
available in any other country if you needed it. You have to come to 
the United States, Madam Speaker. That is the only place that it is 
available. It is not available in these other countries.
  The gentleman from Kentucky just mentioned about all these 
medications that aren't available in other countries. This is an 
example of one that we are talking about right here. Our focus has to 
continue to be on the cutting edge of drug development.
  Madam Speaker, I yield to the gentlewoman from Washington (Mrs. 
Rodgers), who is my good friend and a valuable member of the Energy and 
Commerce Committee. Representative Rodgers brings an outstanding 
portfolio of experience, and we appreciate her very much.
  Mrs. RODGERS of Washington. Madam Speaker, I thank my friend and 
colleague from Georgia, Representative Buddy Carter, very much for 
bringing us all together.
  Many of us are members of the Energy and Commerce Committee. We are 
on the forefront, and we are committed to making sure that lifesaving 
drugs and treatments are more affordable. It is a top priority, and I 
appreciate the gentleman's leadership as a pharmacist on the front 
lines of so many of these lifesaving and life-changing treatments.
  We hear it every day from seniors, people with disabilities, and 
patients that they are anxious for results. The good news is that we 
are leading. The Trump administration has led on this front to deliver. 
The FDA is breaking records for the amount of generic drugs that are 
being approved right now. That is the key to bringing down the costs of 
prescription drugs.
  I am also so proud of the bipartisan work that we did in the Energy 
and Commerce Committee 3 years ago to get the 21st Century Cures 
legislation signed into law. Thanks to 21st Century Cures, we are 
continuing to lead. America has led for 70 to 80 years. Because of this 
legislation, we will continue to lead.
  However, that is all threatened with H.R. 3. It means fewer cures.
  I think about my dad. He has diabetes. My mom struggles with heart 
issues. My grandma had dementia, and my son was born with an extra 21st 
chromosome, Down syndrome. Because research has given my son an 
opportunity to live and to reach his full potential, his life 
expectancy is today longer than ever.
  Let's keep moving forward. H.R. 19, the Lower Costs, More Cures Act, 
helps us move forward. It includes bipartisan solutions that President 
Trump can sign into law this year.
  We should be building upon the work that we did with 21st Century 
Cures. We want to see more generic drugs come to the market faster and 
finally make insulin more affordable for our seniors, lower out-of-
pocket spending, cap the doughnut hole, access new medicines and cures, 
and require price transparency. Every single provision is bipartisan.
  Unfortunately, the Speaker and the Democrats are moving forward in a 
partisan exercise directing the Federal Government to set drug prices, 
and it will stop innovation. America will fall behind as the global 
leader, and we can see what impact that has all over the world: 
hundreds and hundreds of fewer drugs entering the market.
  I want to stand on the side of innovation and more breakthroughs 
helping millions of people with the ravages of disease that they 
encounter every day.
  Madam Speaker, I thank the gentleman for his tremendous leadership on 
this issue.
  Mr. CARTER of Georgia. Madam Speaker, I guarantee you that every 
person who has the honor and privilege of serving in this august body 
has a story just like that and knows someone or has a family member who 
has been impacted by a disease and whose quality of life has been 
improved by the fact that we have had medications available--everyone 
in this Chamber, everyone who has the honor and privilege of serving in 
this Chamber.
  Again, as I have said all along, we all want the same thing. We all 
need the same thing. As Representative Guthrie said earlier, we can 
have the same thing without stopping innovation and without stopping 
research and development.
  Madam Speaker, I yield to the gentlewoman from Indiana (Mrs. Brooks), 
who is another invaluable member of the Energy and Commerce Committee. 
Representative Brooks is a gentlewoman who brings, again, an 
outstanding portfolio of experience, and we appreciate her very much.
  Mrs. BROOKS of Indiana. Madam Speaker, I rise today to thank my 
colleague, the only pharmacist in the House, Buddy Carter from the 
great State of Georgia, who has brought us together to talk about the 
importance of lowering costs and making sure we can continue to focus 
on more cures.
  I also rise today in opposition to H.R. 3. We know that Americans pay 
far too much for the drugs at the pharmacy counter, something that my 
colleague knows better than anybody, and it is our duty to come 
together to find solutions that are solutions to lower costs of drugs 
while protecting innovation and future drug development in our country.
  But, unfortunately, H.R. 3, which we are scheduled to vote on 
tomorrow, jeopardizes that American innovation and patient access to 
care. The nonpartisan CBO estimates that, under H.R. 3, approximately 
15 fewer drugs will be introduced over the next decade, and about 30 
fewer drugs over the following decade, and then a 10 percent reduction 
annually, afterwards, into perpetuity. This means that over 40 
potential cures will not be discovered over the next 20 to 30 years.
  So let's talk about what that means.
  It might mean there might not be a cure for breast cancer, maybe no 
cure for diabetes and no cure for Alzheimer's, diseases that we know 
impact Americans all across our country.
  We lead the world in innovation, in breakthrough medicines, cutting-
edge technologies, and therapies to save and improve lives. Our peer 
nations have 40 to 60 percent fewer cures--as you just heard from 
previous speakers--compared to what is available in our market.
  In Canada, a country with a nationalized health system, Tori Lacey, a 
21-year-old with SMA type 2, spinal muscular atrophy, is unable to 
access a treatment called Spinraza because it is not covered for those 
with type 2 SMA in Ontario.
  Stringent eligibility criteria for novel medicines prevent Tori, a 
college student, from focusing on her schoolwork and future. So Tori 
must suffer through this genetic neuromuscular disorder that affects 
the nerve cells that control voluntary muscles instead of being granted 
access to this critical drug. In America, Tori would be able to access 
this cure.
  If we lose these 15 drugs over the next decade, again, which drug and 
which disease is going to lose out? Is it breast cancer, a disease that 
claims one in eight women each year?
  Madam Speaker, do I go home and tell my dear, longtime friend Judy, 
who, at one time, was told she had 18 months to live--that was 8 years 
ago--do I tell her: Sorry, we may not be able to work on it, and the 
drug companies that do this R&D may not be able to because we can't get 
our act together to protect innovation?
  Judy has been fighting, for the second time, breast cancer for 8 
years. She has been holding on to hope that next month there may be a 
cure and that next year there may be a cure. But under H.R. 3, those 
chances drop precipitously.
  If we lose 15 drugs over the next decade, will it be diabetes, a 
disease affecting over 30 million Americans, a disease gripping 700,000 
of my fellow Hoosiers?
  This past summer, I visited with a young JDRF advocate, Ella, from 
Indianapolis. Ella was diagnosed with type 1 diabetes at age 4. She is 
an incredible young girl who is advocating on behalf of kids like her 
with diabetes. She came to Washington and shared her story with me.
  She is a gymnast, but with her disease, she has to be incredibly 
careful and monitor her blood sugar constantly. She told me sometimes 
she has

[[Page H10120]]

to sit out at practice due to her blood sugar and that it is very 
annoying to this 11-year-old gymnast. She should be focused on her 
gymnastics and on school, but instead of being a kid, she has to worry 
about her blood sugar and about her insuline pump.
  I hear from constituents like Ella and her family that the technology 
developments in the diabetes space is working to make lives almost 
normal. Diabetes was a death sentence just over 100 years ago. Now, 
diabetics can almost live normal lives.
  But what if we could find a cure?
  Hopefully one day, advancements in medicine technology will allow 
Ella to be that kid, a kid without any worry.
  If we lose these 15 drugs over the next decade, is it the GNAO1 
encephalopathy? It is a rare neurological disorder that causes 
developmental delays, early infantile seizures, and abnormal movements.
  My dear friend and a former House staffer here on the Hill, Emily, 
had to leave my team when she found out that her first child, sweet 
Madeline, was diagnosed with this rare disease. Madeline is now 5 years 
old.
  Madeline, at this point in her life, will never be able to feed 
herself. She will never be able to run around with classmates. She will 
never experience a normal childhood without a cure, let alone more 
answers to this very rare disease.
  We could go on and on and on if we lose 15 drugs over the next 
decade.
  H.R. 3 is so wrong for America. But we have an alternative.
  We came together with H.R. 19, the Lower Costs, More Cures Act, of 
which I am proud to be an original cosponsor. This is a piece of 
legislation that is a bipartisan package, what Buddy Carter was talking 
about. It is focused on lowering drug prices while protecting America's 
ability to lead the world in innovative solutions.
  Our Energy and Commerce Committee enjoys an, actually, very warm and 
bipartisan working relationship on so many bills. We worked across the 
aisle; we held many hearings; we had many markups; and we worked on 
thorny issues together. Our committee actually put forward several 
serious bipartisan measures that could become law. They are part of 
H.R. 19.
  I am not going to go through all of those pieces that are in H.R. 19, 
but one of the things that is so important about H.R. 19 is it provides 
affordability and predicability for patients and seniors.
  Americans don't want a guessing game at the pharmacy counter. H.R. 19 
caps out-of-pocket costs for seniors; it increases competition, which 
is key to getting more generic medicines to the market; it increases 
low-cost options for patients by bringing these generics to the 
marketplace faster; it ends pay-for-delay; it implements CREATES; and 
it eases new product entry to the market.
  I could go on and on.

                              {time}  2145

  These were things that we worked on with our colleagues across the 
aisle, and that is what is in H.R. 19.
  So while H.R. 3 crushes investments in the R&D of new cures, it 
stifles innovation and uses incredibly harsh penalties to squeeze drug 
manufacturers who create these cures. It squeezes them almost out of 
existence in many ways.
  Ultimately, it is the patients who suffer, and it is H.R. 19 that 
will encourage innovation of those cures and protect access to new 
medicines. It will support competition, which will drive down prices 
and lower the cost of medicines, and it does put patients first.
  So I urge my colleagues to support that innovation by opposing H.R. 3 
and supporting the bipartisan H.R. 19, Lower Costs, More Cures Act--
real solutions for Americans.
  Madam Speaker, I thank my colleague for hosting this important hour.
  Mr. CARTER of Georgia. Madam Speaker, just one important point to the 
gentlewoman, really quick: You are right, whether you believe the CBO 
who says that H.R. 3 will result in 8 to 15 drugs not coming to market, 
or whether you believe the Council of Economic Advisers, who says over 
100 drugs won't come to market, even if it is just one drug, that is 
one too many. And I thank the gentlewoman.
  Madam Speaker, I recognize one of the members of our Doctors Caucus. 
We are very blessed in this Congress to have a number of fine 
physicians. Madam Speaker, I yield to the gentleman from Kansas, (Mr. 
Marshall).
  Mr. MARSHALL. Madam Speaker, I thank Congressman Carter for his 
leadership as a community pharmacist.
  You and I have worked together in different cities but on the same 
projects trying to help patients out. And here we are gathered in 
Congress now for this same purpose.
  I thought I might talk about Alzheimer's disease for a little bit 
this evening.
  It is hard to imagine that over 5 million Americans have Alzheimer's 
disease. And I bet there is not a person in this room, a person at home 
watching, that doesn't have a loved one that they have watched them 
suffer and go through the stages of Alzheimer's disease--5 million 
Americans. And it is hard to imagine, in three decades we are going to 
have 14 million Americans with Alzheimer's.
  For the sake of humanity, we need a drug to cure this. And you and I 
both know that we are truly this close, that there are medications in 
the pipeline that are going to help treat Alzheimer's.
  The economic impact of this disease on our country is also 
extraordinary. Right now, we are spending about $300 billion a year 
treating Alzheimer's patients. Again, in three decades, it is going to 
be over a trillion dollars a year. A medication that would cure 
Alzheimer's is going to save this country, literally, trillions of 
dollars.
  When I go back home, people ask me a couple of things. Number one is, 
they want us to lower the cost of healthcare, to lower the cost of 
prescription drugs. But they also want us to balance the Federal 
budget. If we are ever going to be able to balance the Federal budget, 
we have to start driving the cost of healthcare down. And innovation is 
the way that we are going to do this.
  I hope everybody understands that the Democrats' H.R. 3 does just the 
opposite. By their price fixing, they are going to stop innovation. 
Drugs that are going to cure Alzheimer's are never going to come, and I 
haven't even started talking about hepatitis.
  When you and I were in college, and in medical school and pharmacy 
school, there weren't cures for hepatitis, but now we have vaccines for 
it. Hepatitis C was a death sentence. Now we have medication, a 
medication you take, one pill a week for 12 weeks--95 percent cure of 
hepatitis. So that patient that was going to end up with a liver 
transplant that was going to cost $500,000, we have cured them with an 
outpatient medicine.
  I think about all the cures for cancer, CAR-T cell therapy, new 
innovations out there, spinal muscular atrophy--so many things--
cortical blindness. For the sake of humanity, we cannot let H.R. 3 
happen.
  We need H.R. 19, the Lower Costs, More Cures Act. That is what is 
going to drive down the cost of healthcare and bring great solutions, 
great new innovation to this country.
  And again, Madam Speaker, I thank Congressman Carter for leading on 
this very important issue.
  Mr. CARTER of Georgia. Madam Speaker, I thank the gentleman.
  At this time, I yield to the gentleman from Pennsylvania (Mr. Joyce), 
another valued member of our Doctors Caucus.
  Mr. JOYCE of Pennsylvania. Madam Speaker, I thank the gentleman from 
Georgia, a pharmacist, leading this discussion. It is so important the 
leadership that Representative Carter has taken in this role in 
addressing this.
  Madam Speaker, I rise today in strong opposition of H.R. 3. This 
would severely constrain biomedical innovation, limit the access to 
future cures, and ultimately harm so many patients across America.
  While all of us agree that we must act as a Congress to lower the 
cost of prescription medicine, this bill takes a fundamentally 
incorrect approach that would jeopardize Americans' access to new 
medicines and have a negative impact on patient outcomes.
  As a physician, as a legislator, I have witnessed new cures that 
offer hope to patients facing devastating diagnoses.
  As recently as 10 years ago, when I would see a patient presenting 
with metastatic melanoma, the prognosis often would be fatal. Now, 
thanks to the advent of new biologic therapies, patients diagnosed with 
widespread

[[Page H10121]]

metastatic melanoma have a chance to live, a chance to embrace life.
  Let me be clear about this issue. Passing H.R. 3 would deprive 
patients and their loved ones of a chance for a cure.

  Fortunately, we have the alternative in H.R. 19, the Lower Costs, 
More Cures Act, of which I am proud to be an original cosponsor. This 
bill is a package of more than 40 bipartisan provisions that would 
actually become law and have real impact on our patients, on our 
constituents. And in addition, would ultimately lower drug prices.
  Madam Speaker, I am grateful to Mr. Carter for leading this 
discussion and for hosting this Special Order on this crucial topic.
  Mr. CARTER of Georgia. Madam Speaker, I thank the gentleman for the 
invaluable experience that he brings to Congress. That is another 
example of one of the fine physicians that we have in Congress.
  Madam Speaker, I yield to the gentleman from Arizona (Mr. 
Schweikert).
  Mr. SCHWEIKERT. Madam Speaker, I thank the gentleman for letting me 
come and engage in this discussion, and I may want to ask a couple 
questions. And we had my doctor friend from Kansas here a couple 
minutes ago.
  A quick thought experiment: What is the greatest economic threat to 
our society?
  It is actually our inability to have enough resources to pay for the 
promises. So we have made promises in Social Security. But Medicare, if 
you actually look at the 30-year window--and, look, I'm on Ways and 
Means--thanks for letting me intrude--but we have made the promises in 
Medicare really, really difficult. We are talking potentially $103 
trillion of deficit, if you add in Social Security and Medicare, but it 
is mostly healthcare costs.
  Well, it turns out, you can reduce the unfunded liabilities in 
Medicare by 30 percent by just a cure, just a cure for diabetes. I will 
argue the mechanisms in this H.R. 3, this sort of Democrat takeover of 
the pricing mechanisms and the capitalization of the next generation of 
healthcare, does incredible violence to the future.
  Madam Speaker, I don't know if Congressman Carter saw this, but 
remember, this is a reference pricing bill. The underlying secret is 
the efficiencies that are actually being claimed in this bill, they are 
hiding behind something that is really dark, and I don't think they 
have explained it.
  So let's say you are in Great Britain. And what is a year of your 
life worth?
  It turns out in Great Britain, the way they would price a new 
pharmaceutical that gives you a year of quality life, it is a quality-
year adjusted formula, and it is $37,000. So you show up with a new 
drug that is going to give you a year of quality life, but it is 
$37,000. They do not buy it.
  What is your life worth? What is a quality year of your life worth 
for a year? Because this is what the left is about to import into your 
country.
  And understand, there are countries out there that it is down to 
$19,000. If a drug costs more than $19,000, but gives you a year of 
quality life, they don't buy it.
  That is the rationing mechanism that the left is about to import 
here. In many ways, just the stunning cruelty of such a thing--and they 
haven't told the truth that this is actually where much of their 
savings actually come from--is denying you the things that keep you 
healthy.
  And this is the mechanism--and I know it is a confusing chart--but 
functionally, if that outlay crosses these numbers, you do not get that 
pharmaceutical.
  Yet, there are crazy things you and I could be doing, just actually 
taking your prescriptions, things we could build into a model. That is 
half a trillion dollars a year we could be saving on our healthcare 
costs just by stepping up and changing the way we do our public policy 
around pharmaceuticals.
  And the left has completely cut us out on the Committee on Ways and 
Means, Republican ideas, on saying there is a whole bunch of things we 
actually agree upon. Stop being so crazy dogmatic with your hate and 
start thinking about people's lives and giving them a future, because 
if we can cure parts of that 5 percent of the chronic condition that is 
a majority of our healthcare spending, we can have a revolution in 
crashing the price of healthcare in this country.
  Mr. CARTER of Georgia. Madam Speaker, I thank the gentleman for his 
excellent points, very well-expressed.
  Madam Speaker, I yield to the gentleman from Virginia (Mr. Griffith), 
another valuable member of the Committee on Energy and Commerce.
  Mr. GRIFFITH. Madam Speaker, I do appreciate all that the gentleman 
has done.
  The bill that we are proposing as the Walden amendment in the nature 
of the substitute, actually deals with an item that we have talked 
about a great deal, and that is pharmacy benefit managers.
  I am going to give the gentleman a second to talk about that, but I 
do want to mention the item that I have been bringing up a lot in 
these, and that is the unconstitutionality of H.R. 3.
  The problem is, as you know--and it sounds shocking, but it is true--
if you don't accept the price the government is paying you, they take 
95 percent of your gross revenues on that drug. That money they take 
from you, that penalty is not tax deductible, doesn't do anything as 
far as what expenses you put into it, so you are actually going to lose 
money.
  Now, as I said in my comments earlier this evening, that is not 
negotiation. That is, as the Godfather would have said in the old movie 
series, ``an offer you can't refuse.'' I wish I could do the voice; I 
can't. But that is a problem.
  And you don't have to believe me. In the committee I brought this 
up--the committee didn't necessarily believe me--but the Congressional 
Research Service has said this bill likely violates the Fifth and the 
Eighth Amendments of the Constitution. This is a nonpartisan group that 
works for Congress that came out and said, Yeah, there are some real 
problems here. When you are being confiscatory, you are not really 
negotiating. It is a problem.

  Now, in our bill that we have put forward that is bipartisan, we have 
some things on a subject both of us are very concerned about, and that 
is pharmacy benefit managers. They are a big part of the problem here. 
Drug manufacturers we need to work on, but their bill doesn't do 
anything on this. Our bill does.
  Madam Speaker, if the gentleman would tell the people just how that 
sham works.
  Mr. CARTER of Georgia. Madam Speaker, just very quickly. Pharmacy 
benefit managers are a big part of the problem. What we have to have in 
the drug supply chain is transparency, and that is what we don't have 
now. PBMs bring no value whatsoever to the system. They don't do 
research and development. All they do is take from the system, so it is 
a big problem.
  Mr. GRIFFITH. Madam Speaker, I would ask the gentleman, if this is 
not true, as I understand it, the PBMs have gone, in some cases, to the 
drug manufacturers, said, Raise your price. We will do rebates. But 
those rebates don't help anybody in the donut hole. Those rebates don't 
help the citizen who is paying a high deductible.
  And what happens is they raise the price. And even with the rebate, 
if you are in one of those insurance companies that gets the rebate, 
and you don't have to pay as much or pay any more, they increase their 
profit margin. And they are making hundreds of millions of dollars that 
we have no idea what they are contributing, as the gentleman was just 
saying.
  Is that true?
  Mr. CARTER of Georgia. Madam Speaker, that is true, and I thank the 
gentleman for bringing that up. And I thank him for his expert witness 
testimony about the constitutionality of H.R. 3, because we both know 
that it is not.
  Madam Speaker, we are very limited for time here right now, and with 
your permission, I want to end with this story:
  Madam Speaker, again, we are talking about real people. We are 
talking about people like Richard Lutz. Richard Lutz was a store 
manager who could be regularly found refereeing youth football, 
basketball, and baseball games around my hometown of Savannah, Georgia.

[[Page H10122]]

  Richard started having memory problems at 62 years of age. He was 
prescribed Aricept to slow down the effects of Alzheimer's, but before 
too long, he needed to have someone with him at all times. His wife, 
Barbara, worked as a nurse, but they couldn't afford for her to stop 
working, too. So Barbara and her four kids did as much as they could to 
rotate as caregivers, and they eventually hired another nurse to help 
out as well.
  Eventually, Richard's memory deteriorated to the point where he lost 
his ability to converse. For the last 11 months of his life, he could 
only respond to his family members with, I love you, too.
  After a 7-year fight with Alzheimer's, Richard Lutz passed away at 
the age of 69. Today, Barbara hears from neighbors and friends when 
they find out someone they know and love gets diagnosed. They reach out 
to her and they ask: What do I do? What do I do?
  Barbara told me: All I can tell them is pray for a cure. Pray for a 
cure.
  Madam Speaker, we want the same thing. We need the same thing. We can 
achieve the same thing. And we can do it without giving up hope for a 
cure for Alzheimer's or all the other diseases that are out there.
  Madam Speaker, I yield back the balance of my time.

                          ____________________