Prescription Drug Costs

Floor Speech

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Mr. GRASSLEY. Mr. President, I am here to discuss with my colleagues issues dealing with the work of the Senate Finance Committee and possible legislation that hopefully will come up this summer to keep healthcare costs down, particularly prescription drugs.

In the process of doing that, I want to set the record straight on an issue that affects every American who is eligible for Medicare. More specifically, I am here to talk about efforts to reduce the rising cost of prescription medicine.

Prescription drugs save lives. Millions of Americans like myself wake up every morning and take their daily medication, but there is something that has become a very tough pill to swallow for an increasing number of Americans, and that is paying for the rising cost of prescription drugs.

I applaud President Trump for turning up the volume on this issue last summer. That is when the President announced his administration's blueprint to lower drug costs for all Americans. He found out--and we all found out--that is a goal that has widespread support that includes Republicans and Democrats, as well as urban and rural Americans.

Of course, the President can only do so much--whatever law passed by Congress allows the President to do and that doesn't solve all the issues. So even though I applaud the President, that doesn't mean I exclude in any way the responsibility of Congress to take action.

There are many good ideas to build upon that share broad, bipartisan, bicameral support. There is one policy, however, that some Members are talking about that I don't agree with, and that is repealing what is the noninterference clause in Medicare Part D. I would like to explain why Congress kept the government out of the business of negotiating drug prices in the Medicare program. Some 16 years ago, when I was formerly chairman of the Finance Committee, I was a principal architect of the Medicare Part D program.

For the first time ever, Congress, in 2003, added an outpatient prescription drug benefit to the Medicare program. Maybe I ought to explain for my colleagues why it took between 1965 and 2003 to include drug benefits in the Medicare program. Remember, in 1965, prescription drugs or drugs generally didn't play a very big role in the delivery of medicine like they do today, but over time, they have become more important.

That is why great support at the grassroots, both bipartisan and bicameral, evolved into what we call the Medicare Part D program, adopted in that year, 2003. So we came to the conclusion that adding the prescription drug benefits for seniors was the right thing to do, but it needed to be done in the right way--right for seniors and right for the American taxpayers. By that, I mean allowing the forces of free enterprise and competition to drive costs down and drive value up.

For the first time ever, Medicare recipients in every State had the voluntary decision to choose a prescription drug plan that fit their pocketbooks and their healthcare needs.

The Part D program has worked. Beneficiary enrollment and satisfaction are robust. The Part D marketplace offers consumers better choice, better coverage, and better value; yet here we are again. It has been 13 years since Part D was implemented, and once again, I am hearing the same calls to put the government back into the driver's seat of making decisions on what you can take in the way of pills or what your doctor might be able to prescribe to you based upon what a formulary might be. We want the private sector to decide the formulary, not the government. So these people happen to be the same backseat drivers who think that centralized government knows everything and knows best.

As the Senator who, once again, chairs the committee with jurisdiction over Medicare policy, I am not going to let Congress unravel what is right about Medicare Part D. Remember, I was a Republican leading the charge to add a new benefit to a government program. A lot of people think that is very uncharacteristic of a Republican, but I told you why I did that: because medicine was becoming an increasing part of the delivery of quality healthcare. So you heard me correctly, I was a Republican chairman working with my Democratic ranking member, Max Baucus, to accomplish Part D. We negotiated an agreement to add prescription drug coverage for seniors.

For me and other Republicans--namely President George W. Bush--there were a few key caveats. First, it must be voluntary. Second, beneficiaries would share the cost with the taxpayer because having skin in the game keeps check on spending and on utilization. Third, we must allow competition--not government mandates--to drive innovation, curb costs, expand coverage, and improve outcomes. It wouldn't work if the Federal Government interfered with delivery of medicine and dictate which drugs would and would not be covered. That is why we wrote a noninterference clause in the law.

My friend, Senator Wyden, the current Democratic ranking member of the Finance Committee, voted for final passage in 2003. By the way, we are having very good bipartisan cooperation in our Finance Committee on, hopefully, legislation to be debated in our committee in June in regard to lowering drug costs.

The noninterference provision expressly prohibits Medicare from, one, negotiating drug prices; two, setting drug prices; and, three, establishing a one-size-fits-all list of covered drugs. That list is called a formulary. I remember that many of my friends on the other side of the aisle voted for this policy; yet some are now pushing for repeal of that provision.

Here is a list of Democrat leaders who supported and voted to ban Medicare from negotiating drug prices: when he was in the Senate, Senator Biden; Senator Kennedy; Senator Baucus; Senator Reid, the former majority leader; Senator Schumer now in the Senate; Leahy; Durbin; Stabenow; Cantwell. On the other side of the Capitol, the list included Speaker Pelosi and chairman of the Ways and Means Committee, Chairman Neal.

There is something else that I have learned in all my years talking healthcare policy with Iowans at my annual 99 county meetings where I enjoy a Q and A with whatever agenda my constituents call upon me to discuss with them.

At the end of the day, Iowans don't want the government prescribing lifesaving medications. Iowans want to make those decisions with a physician who is treating them. Last year, 43 million out of 60 million Medicare recipients were enrolled in the Medicare Part D program. That is the vast majority of Medicare beneficiaries nationwide that don't have coverage through a past employer or similar coverage from another source.

Plan sponsors design different plan choices and compete for beneficiaries based on what those plans cover and what they cost. Beneficiaries can pick from many options, with over 3,000 plans offered across 34 geographic areas. In other words, you don't have one plan dictated by the government. Most beneficiaries were covered by a prescription drug plan, and a growing number were covered by a Medicare advantage prescription drug plan.

The Part D base premium amount is low and has remained stable over many years. Looking back to our negotiations in 2003 to get this bill to the President of the United States, we wondered how high these premiums would go, and we were fearful they would just go out of the atmosphere and that they would not be stable like they have been over a long period of time. So the noninterference clause ensures that plan sponsors create plan options that respond to what the beneficiaries-- not the government--says it should be.

The nonpartisan congressional scorekeeper, the Congressional Budget Office, has repeatedly stated that repealing this noninterference clause would not save money, unless there was a restricted formulary. As I stated, we wrote this bill in 2003 so the government wouldn't get between you and your doctor on what you ought to have in the way of prescription drugs. So in regard to the cost, I asked CBO to update, and they did. CBO sent me a letter stating the same thing.

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Mr. GRASSLEY. Mr. President, repealing the noninterference clause means a restricted formulary, which places limits on the drugs that are available to seniors, maybe excluding some drugs that your doctor wants to prescribe for you. I don't believe that Medicare beneficiaries want the government interfering in that process.

Then, as policymakers, we must keep in mind that we are making decisions that affect healthcare choices for the people whom we are elected to represent.

Let's all remember to first do no harm. Repealing the noninterference clause may sound good, but not even a spoonful of sugar will help that bad dose of policy medicine go down.

I come to the floor today to hope that I can put this issue to rest and, as we try to work in a bicameral and bipartisan way to reduce drug costs, that we don't get held up by people who want to do something different by having the government more involved, when it isn't going to save any money and will restrict formularies. It will get the government between you and your doctor.

In other words, I am trying to save Part D. It has been a great success. It is accepted by the people. Let's keep drug costs down without having this issue interfere with our process.

We need to preserve the foundation of private enterprise on which Part D is based--in other words, the marketplace working. We need to get to the real work of reducing prescription drug costs.

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