December 12, 2019 - Issue: Vol. 165, No. 199 — Daily Edition116th Congress (2019 - 2020) - 1st Session

[Pages H10235-H10236]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                       FAIR PRICES, BETTER CURES

  The SPEAKER pro tempore (Mr. Beyer). Under the Speaker's announced 
policy of January 3, 2019, the gentleman from Nebraska (Mr. 
Fortenberry) is recognized for 60 minutes as the designee of the 
minority leader.
  Mr. FORTENBERRY. Mr. Speaker, I went to the doctor recently for a 
common ailment, and he prescribed an antibiotic.
  I said, Well, Doc, let's check the price on that before we go any 
further. He said, Oh, don't worry about it. It is commonly used 
throughout the world. It is about $6.
  Well, guess what? It was $6 dollars in the year 2011; and now the 
list price is about $430.
  Now, I have insurance provided by the House of Representatives, which 
I am thankful for, but even with that, it is still close to $200. And 
then you have to start searching for a coupon to try to bring it down a 
little bit more.
  So why does an antibiotic, that just a few years ago cost $6 now cost 
over $400 if someone has to pay cash?
  Why? Why?
  This is one of the premier questions before this body. And we debated 
this today in a prescription drug bill, and it was a robust debate and 
a good debate. And as I said earlier, I commend my Democrat colleagues 
for raising the issue and putting something on the table.
  There were substantive policy disagreements with that bill. There is 
a realistic fear that if that bill became law, which the President said 
he will not sign, that we would undermine America's leading role in 
inventing lifesaving drugs. But there are real considerations as to how 
to contain costs.

                              {time}  1545

  We should be focused on negotiations and government programs.
  I also commended my Republican colleagues for having an alternative 
answer by coalescing all the bipartisan solutions that are innovative, 
that have come from both sides, and putting it together in one package 
that presented an alternative. But that didn't pass, either.
  So we are stuck. We are right back to where we are.
  But I only tell my own personal story not because this is about me. 
That is a simple issue, the little problem that I had. Many other 
Americans are suffering grievously from this ever-escalating, 
skyrocketing prescription drug problem.
  Let's just take, for instance, the case of insulin. About 30 million 
Americans suffer from diabetes and need insulin.
  I want to show you something here. Here is an important chart, Mr. 
Speaker. It starts down here in the year 2011. Basically, this is a 
chart that shows the price of insulin in 2001, about $35, and here we 
are today, approaching $300.
  So, what is happening? That is about a 1,000 percent increase. Is 
insulin pretty much the same drug? Yes, there have been some 
modifications and improvements. There have been. Justifying a 1,000 
percent increase? No, absolutely not.
  What is going on here? The price of insulin has gone up dramatically, 
and there has to be a reason for it. Big pharmaceutical companies and 
middle management, responding to bad government policy, have created a 
huge mess in this healthcare space.
  Not just this problem with insulin, but the average annual cost of a 
brand name drug has more than tripled in the past decade. Families with 
diabetic children, seniors on Medicare, and others face prohibitively 
high costs for these lifesaving drugs, and they deserve better.
  I want to show you something else right quick, if I could. This is a 
chart of the last 5 years. Going back to the issue of insulin again, 30 
million or so Americans need this drug.
  This is a difference between what is called the average net price and 
the average list price. We have about $400 here 5 years ago. Now, we 
are up to almost $600.
  But look at this net price. What does that mean? Well, the net price 
is the price, basically, that the manufacturer is getting. The middle 
sector here, the marketing sector here, is getting a much higher price.
  So what is a solution? We didn't come up with a good solution today 
in debate on the House floor. So what is a real solution? Well, because 
we can't seem to solve the overall problem with one large piece of 
legislation, why don't we start with something very small? But it is 
not small to people affected by diabetes.
  Why don't we just take this particular drug and allow the 
manufacturer to sell it directly to the patient? Again, we have an 
average price of about $600 and a net price of $135. That huge cost 
savings that could be attained by a person in need by simply being able 
to pay this price is what I am talking about here.
  I have dropped a piece of legislation, and I am really hopeful that 
it rallies Republicans and Democrats away from the big construct that 
we can't necessarily agree on, but we should continue to work toward, 
which involves major structural change. Why don't we do something that 
is very, very specific to one group of Americans that is suffering from 
exorbitantly high prices?
  Basically, now, under this one-line bill, manufacturers would be 
allowed to sell insulin directly to a patient. It is just one line.
  I am from Nebraska. Many people write to me and ask: Why does 
legislation have to be so complicated? Why don't you make it a single 
page? I have made this a single line, one line.
  What we do when we do this is we begin to cut out these layers upon 
layers of management and bureaucracy that have driven the price upward, 
while being fair to the manufacturer and without undermining America's 
system of innovation that leads the world in producing lifesaving 
drugs.
  Nonetheless, we have added this problem, or this middle management, 
if you will, to the way in which we dispense drug prices. That is part 
of the problem of why they have gone up so fast, especially around 
drugs like this. Again, not necessarily a brand-new formulary. No 
extraordinary innovation has happened over the last number of decades, 
some changes, some modifications and improvements, but no way to 
justify these price increases.
  I think this would be a good idea that actually could unite us, to 
get us away from the large philosophical differences when we discuss 
how we move forward, ensuring that we both find fair prices and better 
cures without undermining the good, innovative, leading industry in the 
United States, but an industry that has a real problem, that really 
ought to be rallying around solutions that I am suggesting here.
  That is just one idea, but I am hopeful it is a start because this 
idea actually pulls a thread. It is specific enough to affect tens of 
millions of Americans. It would be so beneficial to lower costs, yet 
without infringing upon the dynamics of a good market system that we 
have.
  I think this is an answer. Perhaps, this could be a good start.
  Besides this one-line solution, Mr. Speaker, another obvious solution 
here should be the acceleration of generic drugs. Drug companies, 
however, have a long history of slow-walking generic drug approval 
through legal maneuvers, anticompetitive prices, and patent extensions.
  I have been given a unique responsibility in helping to lead the 
House Appropriations Subcommittee on Agriculture, Rural Development, 
Food and Drug Administration, and Related Agencies, which has oversight 
responsibility for the Food and Drug Administration. Through our 
focused efforts,

[[Page H10236]]

the FDA is reforming the generic approval process.

  Cracking down harder on pharmaceutical companies that are exploiting 
loopholes to modify patents for not-so-unique drugs is one way to grow 
generics. Currently, even a small modification in a drug can be enough 
to get it approved by the Patent and Trademark Office.
  In 2018, an analysis found that patent protection for 70 percent of 
the 100 best-selling drugs was extended at least once. This is a 
significant cost driver.
  According to the FDA, the Food and Drug Administration, when generic 
competition exists, prices are often 80 percent to 85 percent less than 
brand-name drugs. With 90 percent of generic prescriptions available 
for less than $20 for patients with insurance, that translates into 
very real savings for families across this country.
  The Government Accounting Office says that generics can save the 
United States healthcare system--get this--well over $1 trillion in a 
10-year window.
  We could spend another hour speaking about the financial difficulties 
that we are having. We have a good, strong, growing economy. Many 
people are finally, thankfully, finding access to meaningful work, and 
there is an appropriate upward pressure on wages in this country.
  But what erodes that? The escalating cost of healthcare. For people 
who are in need of lifesaving drugs, this is fundamentally unfair.
  Again, our efforts at trying to move generics faster to market, 
identify abuse, and stop it can result in savings like this. This is 
huge. This is good public policy, and we are working on it.
  Another important piece of legislation allows the pharmacist to tell 
a patient about therapeutically equivalent but less costly drugs as an 
alternative method that is less expensive. For a small number of 
lifesaving but rarely used what we call orphaned drugs, we also need to 
prevent single corporations from exploiting a small market niche of 
desperate patients who sometimes find themselves in a life-or-death 
struggle.
  Further, Mr. Speaker, I would suggest this: Getting at another root 
cost driver of prescription drugs, we need to change how we procure 
drugs in large public programs. Our government, through Medicare, 
Medicaid, TRICARE, and other programs, is the largest purchaser of 
prescription drugs in the world. The Department of Health and Human 
Services, however, is prohibited by law from negotiating with 
manufacturers what it pays, but not the Department of Veterans Affairs, 
by the way.
  There is broad bipartisan consensus in Congress, as well as with the 
White House, that this policy needs to change. We should be 
negotiating. I should note that was part of the earlier bill submitted 
to the floor--again, substantive policy disagreements that could 
potentially undermine America's leading role.
  But that aspect of this in the Democratic bill that was submitted is 
an important public policy initiative. Again, I commend my colleagues 
in that regard.
  Mr. Speaker, a prescription drug should do two simple things. It 
should cure disease, but at a fair price. And as we have seen today, 
there were two very large bills debated, but unfortunately, in this 
political environment, one is a Democratic bill, and one is a 
Republican bill, and no consensus exists.
  But after the smoke clears, I hope that reasonable people will make 
way and will make a pathway for the right solutions and not political 
anger.
  This system is sick. Our people deserve better cures at fairer 
prices.
  Mr. Speaker, I yield back the balance of my time.

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