Statements on Introduced Bills and Joint Resolutions
Floor Speech
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Mr. MERKLEY. Mr. President, Canadian historian Michael Bliss wrote in his 1982 book, ``The Discovery of Insulin,'' that ``[w]ith insulin, the stone was rolled away, and diabetes became a matter of the quality of life, not speed of death.''
For thousands of years, human beings have battled diabetes. When the pancreas stops producing insulin, all kinds of bad things happen--heart attacks, stroke, blindness, kidney failure, foot disease, foot amputations, small blood vessels throughout the body being impacted by that high blood sugar. In some cases, within months, individuals waste away, fall into diabetic comas, and die.
All that changed about a century ago thanks to the work of four Canadian scientists--Frederick Banting, Charles Best, J.B. Collip, and John Macleod. These four men discovered how to extract, develop, and refine a pure form of insulin that could be injected into the human body. It changed the world.
Thirty million Americans--almost 10 percent, 9.4 percent, of the American population live with type 1 or type 2 diabetes today. Of those 30 million, 7.4 million depend on insulin for their survival, but one- quarter of the people who depend on insulin for their survival have had to ration their insulin in the past year because of the extraordinary, over-the-Moon cost of this drug that was developed a century ago.
Rationing the drug, and therefore producing episodes or enduring levels of high blood sugar, has extensive health consequences. It does a lot of damage. Diabetic Americans are being gouged by the drug companies, and it needs to stop.
Today I am introducing, in partnership with Senator Durbin, the End Price Gouging for Insulin Act to end this egregious practice. I want to ensure that every single one of those 7.4 million Americans who need insulin to survive can afford it. I want to ensure that not a single person has to ration their insulin. I can tell you that vision of every person having affordable insulin is what the four scientists who invented it nearly 100 years ago envisioned. They didn't ask for great wealth from their work. They did receive recognition. A Nobel Prize went to two of them for their role in this. They certainly weren't asking for huge payouts or a high price. Do you know what they did? For the health of humanity, they sold their patent to the University of Toronto for $3 to make insulin available to the world. All they cared about was saving lives. They wanted everyone who needed it to have it.
What do we see today? Almost a century later, the price of insulin is going higher and higher with the extensive greed of the companies that produce it. Over the last decade, the companies selling the four most popular types of insulin have tripled the price of their product-- essentially the same product. They tripled the price. Nova Nordisk has two of these drugs; Sanofi has one; Eli Lilly has another--and they all tripled the price.
In 2012, the average price of insulin was about $234 a month. By 2016, it was $450 a month. Now we have seen it continue to rise since 2016. They have some explanations. There are some who say: Well, it is due to their vast input into research and development. Remember, these are drugs invented a century ago. Sure, there are slight variations, yes, but the money is going largely to profit.
There are those who say the price is higher because more people need it. More people buying it means more efficiencies, which means the price should drop. The nonprofit Health Care Cost Institute looked at the rising cost of insulin and said the excuses given by the drug companies just straight out aren't true. ``It's not that individuals are using more insulin or that new products are particularly innovative or provide immense benefits. Use is pretty flat,'' said Ms. Fugelsten Biniek, one of the authors. ``And the price changes are occurring in both older and newer products.''
The reason the prices are going up--the companies are charging more-- is because they can because we don't negotiate the price of drugs in America by law for Medicare.
These companies have some tricks up their sleeve. One is that when the generic competition gets all lined up, they proceed to pay the generic companies not to produce the generic drug, resulting in sustaining the price gouging in America.
Now, I think this practice is ``pay to delay.'' I think it is a horrific predatory practice. It is a noncompetitive practice. It should be against the law, but we are not doing our job to make it against the law, apparently.
The other thing is they make slight changes. They produce a new patent on every tiny, microscopic change--it is called the evergreening of patents--so then they can line up a vast array of lawyers and say: If you produce generic insulin, we will go after you in every which way. We have more lawyers than you have, and we have deeper pockets than you have. So good luck.
The result is a continuation of the extensive price gouging of Americans. A quarter of those 7.4 million Americans who need insulin to treat their diabetes are rationing their prescriptions. Sometimes that means just straight out skipping the doses altogether.
Folks from Oregon have written to me, people like Richard from Beaverton, OR.
Richard needs three lifesaving medications to get by, including the insulin Humalog, which costs over $1,800 a year. Richard doesn't have $1,800 to spare. He is 77 years old, blind, and recently finished chemo treatments for bladder cancer. Through it all, he has continued to work odd jobs to supplement his Social Security to be able to put food on the table for him and his wife, to be able to keep their house, and try to pay for those prescriptions.
Another constituent whom I will call Antonio is 58 years old and is living with type 1 diabetes, but like so many others, he has trouble affording the prescription. Antonio either uses insulin samples that he finds in his truck, which are about 10 years old, or he rations out the insulin that he does have to make it last until his monthly disability check comes in, which is when he can afford to get a new refill on the prescription.
This is a terrible strategy for managing an illness. It has led to hospital stays, diabetic ketoacidosis, kidney failure, visual impairment, and other diabetes-related ailments. Yet, from Antonio's perspective, what can he do? He can't afford the massive price increases these major drug companies have put on insulin. As for the generic he would like to buy, those same companies are blocking it from coming to market.
There is also Maria. Maria has sores on her feet because of her diabetes. She has been to the emergency room several times for foot infections. It turns out that her feet keep getting infected because she is forgoing her insulin to be able to afford basic necessities for her family--food, the cost of her housing, and transportation.
It turns out Maria's insurance doesn't cover the $50 copay on diabetic shoes or her insulin or the injection medication that she takes to reduce her insulin needs, all of which would have reduced or eliminated the need for Maria to go to the emergency room. Yet her insurance does cover the emergency room visits. So, time and again, with her not being able to afford the medicine, that is where Maria ends up.
Another Oregonian whom I will call Phillip is living with type 2 diabetes. He said he takes less insulin than his doctor has prescribed. Why? He isn't able to afford the prescription. Yet Phillip doesn't want his provider to know any of this, because he is embarrassed about it. So his blood sugars are routinely at high levels and are doing a lot of damage to his body. It has led to the diabetic-related complications of severe kidney damage, visual impairment, peripheral vascular disease, and heart disease.
Think about this for a moment. The pharmaceutical companies are gouging him on the price, but it is Phillip--he who has the diabetes-- who feels embarrassed. Shouldn't it be the other way around? Shouldn't the companies be embarrassed about gouging Americans? I think so. The drugmakers are profiting off of sick Americans, and their predatory practices are designed to keep competitors from coming to the market. These are American citizens who are being affected while living in one of the wealthiest nations on the planet--the United States of America. Yet they can't afford a century-old drug that is meant to be freely shared with the world.
It doesn't have to be this way. The same kind of insulin that costs $373 here in the United States costs $47 in Australia. Why? The Australian Government negotiates the price. It is past time we stood up for the American people and put an end to the price gouging of Americans.
In France, the drug Lantus is $47. In Australia, it is $54. In Germany, it is $61. In the United Kingdom, it is $64. In Canada, it is $67. In the United States of America, it is $373. That is six times the median price of the drug in these other developed nations.
Why don't we insist that the companies that get all kinds of benefits from being here in America sell to Americans at the median price or at the average price--either one--which is what they sell to the rest of the developed world? Why is it a fair price for every other country, but it is gouging for Americans?
Americans pay the price. Those who have diabetes but who cannot afford that insulin start rationing it and start to see the devastating impacts on their bodies--from the kidneys, to the vision, to the feet, to the heart disease. Then they end up in the hospital, as well, with there being more costs to the U.S. healthcare system. Don't we care about the health of Americans? Are we here to protect greed for these companies or the health of Americans?
Senator Durbin and I have introduced a bill that says you can't charge more in America than the reference price that is charged in key developed countries around the world--Canada, Australia, Japan--or charge more than the median price in the group of eight of the largest European nations. It doesn't even have to be the lowest price in the world under this formulation. This is called a reference price bill, wherein we essentially attach ourselves to the fair prices charged to the rest of the world.
The drug companies will say: We want to make more money so we can do more research.
Well, raise your price on these other countries while you are dropping the price for the United States. That is a pretty simple solution that ends the price gouging in the United States of America.
If a company violates this reference price, then it pays a fine of 10 times the difference between the reference price and the price it charges Americans. Where does that money go? It goes to the research and development of new drug products in our bill.
That is the vision. There is no reason that Americans should be paying six times the median price of other developed countries--six times. This is not 6 percent more or 60 percent more, which would be outrageous. This is six times the price charged to other developed countries.
It is way past time that we stood up for the American people, not the greed of the pharmaceutical companies. It is way past time that we stood up for sick Americans like Richard and Antonio and Maria and Phillip and millions more in every one of our States. Millions of Americans are forced to ration their insulin or skip doses altogether because of corporate greed. It is way past time to end the price gouging of Americans.
Let's put this bill on the floor, and let's pass this bill for our citizens across this great land.
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