Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment for Patients and Communities Act

Floor Speech

BREAK IN TRANSCRIPT

Ms. COLLINS. Madam President, I rise in support of the Patient Right to Know Drug Prices Act, which is legislation that I have introduced with Senators McCaskill, Barrasso, Stabenow, and Cassidy. Our bill has also been cosponsored by Chairman Lamar Alexander and 19 other Senators from both sides of the aisle. This is one of those rare occasions on which we are taking up a bill that has widespread bipartisan support and that is going to really make a difference.

This commonsense bill would ban the use of pharmacy gag clauses--an egregious practice that prevents pharmacists from telling their consumers when they can purchase those prescriptions for less money by paying out-of-pocket rather than by using their insurance. This legislation is action that we can take right now to help lower the costs of prescription drugs for some consumers.

More than half of Americans, as well as more than 90 percent of seniors who are, say, 65 or older, take at least one prescription drug each month. Americans have been estimated to spend nearly $45 billion out-of-pocket each year for prescription drugs. According to a recent poll by the Kaiser Family Foundation, as many as one out of five Americans does not fill a needed prescription because they are unable to afford it.

I witnessed this struggle firsthand recently at a pharmacy in Bangor, ME. When a couple ahead of me in line received their prescription, they were told by the pharmacist that the copay would be $111.

The husband looked to his wife and said: Honey, we just can't afford that.

They turned around and walked away, leaving the prescription behind.

I was so upset when I saw that that I asked the pharmacist: How often does this happen?

His reply: Every day.

Our bill would ensure that pharmacists could volunteer information to customers on how to lower their costs for prescription drugs.

A recent study that was published in the Journal of the American Medical Association found that 23 percent--nearly one-quarter of prescriptions filled through insurance--ended up costing consumers more money than if they had purchased the drugs without using their insurance. Who would think that using your debit card rather than your insurance card to purchase a prescription drug would be less expensive? It is, of course, so counterintuitive that consumers do not think to ask this question of the pharmacists, and gag clauses in contracts prohibit pharmacists from volunteering this information to patients. They prohibit them from telling patients how to obtain the lowest prescription drug prices. Thus, consumers are paying more than they should unless they ask for specific guidance. Americans have the right to know which payment method provides the most savings when purchasing their medications.

By prohibiting gag clauses, our legislation takes concrete action to lower the cost of prescription drugs, saving consumers money and improving healthcare.

More than 40 organizations support our bill that will ban this unfair restriction, including the National Community Pharmacists Association, the American Medical Association, the Alliance for Transparent & Affordable Prescriptions, the ERISA Industry Committee, the Pharmaceutical Care Management Association, and America's Health Insurance Plans. Our bipartisan bill was approved by the HELP Committee, with unanimous support, on July 25. The administration has also condemned gag clauses and is on record as supporting our bill.

Despite this widespread support for banning this egregious practice that restricts the free speech of pharmacists, Senator Lee has filed an amendment that would eviscerate our bill. The Lee amendment would limit the gag clause prohibition to only self-insured employer plans. That would exclude all other employer group and individual market plans. Under the Lee amendment, approximately 85 million Americans would be excluded from protection. Think about that. There are 85 million Americans who are receiving coverage under employer-sponsored plans or in the individual market who would be excluded from this protection. The gag clauses that would be banned in our bill are unconscionable regardless of the type of insurance plan.

We know that patients who do not take their medications experience greater complications. One study has estimated that medication nonadherence costs the healthcare system some $337 billion, not to mention there being poorer health outcomes for the individuals affected.

The Patient Right to Know Drug Prices Act prohibits gag clauses from being used by health plans that are sponsored by employers or offered in the individual market.

The Federal Government's role in regulating these plans and protecting consumers who are served by these markets is already well established. The Employee Retirement Income Security Act--better known as ERISA--was enacted in 1974. Employers who sponsor insurance plans for their employees, as defined by ERISA, are able to deduct the expenses associated with these plans. These expenses are also not subject to the payroll tax. In 2017, the value of the Federal tax benefit for employer-sponsored health insurance was estimated at $260 billion.

I strongly support our State-based system of insurance regulation. Indeed, I spent 5 years overseeing the Maine Bureau of Insurance as Maine's commissioner of professional and financial regulation. Our bill does not change the longstanding deference to States on this issue. Yet I would note that even though ERISA preserves the authority of the States to impose insurance regulations on fully insured plans, these plans must still comply with a multitude of provisions that have been set by the Federal Government, and it has been that way for many, many years. For example, regardless of State law, a fully insured health plan must comply with COBRA and must cover minimum hospital stays after childbirth, reconstruction after a mastectomy, and students who take medically necessary leaves of absence. Also, these plans are prohibited from discriminating based on genetic information.

Unlike Senator Lee's amendment, our legislation would prohibit gag clauses in all group health plans so that no matter how the employer decides to provide insurance coverage, the employees are able to get the best prices for their medications by consulting freely with their pharmacists.

Our bill will also prohibit the use of gag clauses in individual health insurance plans, protecting consumers who don't have employer- provided insurance and who are, rather, purchasing insurance on their own.

Americans who purchase insurance in the individual market may qualify for tax credits to help cover the cost of their policies or they may be eligible for tax-preferred savings accounts, such as health savings accounts established by the Medicare Modernization Act of 2003. Senator Lee's amendment will eliminate the protections our bill provides for these individuals, many of whom already face growing out-of-pocket costs.

We need this bill as a complement to another bill we passed just recently that prohibits these gag clauses for the Medicare Part D prescription plans. This is a companion bill to that legislation.

The bottom line is this: Pharmacists should not be restricted from telling customers if there are other ways for them to purchase needed prescription drugs less expensively. The administration has made banning these clauses a top priority, and this important consumer protection should be written into law.

I urge my colleagues on both sides of the aisle to oppose Senator Lee's amendment and to support passage of S. 2554. Today the Senate can go on record taking a concrete step to help reduce prescription drug prices for some consumers. It makes no sense to exclude 85 million Americans from this protection, as Senator Lee's amendment would do. Reducing prescription drug prices must be a national priority.

I am pleased to yield to the leading cosponsor of this bill, Senator McCaskill.

BREAK IN TRANSCRIPT

Ms. COLLINS. Mr. President, it seems very arbitrary to me to exclude potentially 85 million Americans from the protections this bill would provide when there is such a clear Federal nexus to act in this area.

According to the Kaiser Family Foundation, 58 percent of workers insured in self-insured plans are actually in ``partially insured'' plans. The reason this matters is that some States may attempt to regulate these plans, believing they can, and then have their State laws challenged in the courts and preempted.

Why not take the commonsense approach our bill does and simply ban the use of pharmacy gag clauses--an egregious practice that prevents pharmacists from telling their customers they could purchase their prescriptions with less money by paying out of pocket rather than using their insurance.

We have the support of 40 medical and consumer groups for this bill, and this legislation is action we can take right now to help lower the cost of prescription drugs for some consumers. It has widespread bipartisan support. It came out of the HELP Committee unanimously, and it is supported by the administration. I urge a ``no'' vote on the amendment offered by the Senator from Utah and a ``yes'' vote on the underlying bill.

BREAK IN TRANSCRIPT

Source