Prescription Drug Costs

Floor Speech

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Mr. CASSIDY. Madam President, I am going to speak about the drug affordability act, what people in Washington call the Grassley-Wyden bill.

I am renaming that bill. I am going to rename that bill to what I call the ``Making Coronavirus Medicines Affordable Act,'' and I want to address drug affordability from the perspective of coronavirus and address it from the perspective of a physician.

First, people ask: How is this different than regular flu? Ten thousand people die a year from flu. Why is this so different from that?

Well, again, as a physician, let me speak to that. Each of us, however old we are, have been exposed to flu, either by the flu vaccine or a flu infection, as many years as we have been alive. So when someone is exposed to the flu, they have a whole kind of armamentarium of antibodies. When the flu virus comes into your body, those antibodies mobilize, and it is not an exact fit to block the effects of the flu virus, but it is a pretty good fit. So for an infection which otherwise might cause problems, the effect is blunted and the symptoms are either absent or minimized.

As it turns out, the flu virus kills the very young, who have never before been exposed to the flu virus before, or the very old, whose immune systems are no longer working as well. Even though they have been previously exposed, their body is more vulnerable.

Now, as for coronavirus, nobody's body has ever seen that before. For everyone, this is a brand-new infection, and there is not a library book of immunologic responses that enable us to fight back against this virus. For all of us, if you will, it is a sucker punch to our health. We turn around, and, boom, it hits us.

Now, in terms of who it can kill, again, it seems to cause problems in newborns--the very young--but it also causes problems not just in the very old but in the older but not so very old.

In China we have learned that if someone is over 50 and they have an underlying medical condition, they are at increased risk. If you are over 60, you are at even more risk. So unlike influenza, where typically the person who dies would be 75 or 85 and in a nursing home, in terms of coronavirus, it might be somebody with high blood pressure or diabetes, heart disease, cancer, or a lung disease, who is otherwise living life, walking around the streets. They get hit with this virus, and, all of a sudden, they have a problem.

Now, we are going to find a cure. Sooner or later, we will come up with medicines that help somebody who is infected get well. The question is, Will those medicines be available to you? That is what we need to be concerned about.

So what does it mean? Well, first there have been reports that both because of the infection raging through China and a decision by India, it is possible that some of these drugs will not be available.

In China, they make the raw ingredients that are shipped to India, and they make the medicines. Well, China is not producing as many of the raw ingredients, and India has put an embargo on the export of some of those drugs to the United States.

At least of the drugs they have embargoed that I saw a list of recently, none of those medicines are medicines that we think might ultimately help fight coronavirus. So even though we have a problem with supply chain, so far there is no evidence it will impact the ability of a medication, whenever it is discovered, to be available here in the United States.

But there is another issue. Can the senior citizen who is most vulnerable afford the medicine?

Let me put this up.

Under the current structure of Medicare Part D, the senior citizen-- the personal Medicare Part D--pays a certain amount of money until they go into the so-called catastrophic coverage phase. Now, pharmaceutical manufacturers and pharmacy benefit managers manipulate that list price to more quickly move the senior citizen into her catastrophic phase, and when she is in her catastrophic phase of our Medicare Part D benefit, she must pay 5 percent of whatever is the price of that drug. Even--imagine this--if that drug costs $1 million a year, she would have to pay 5 percent of it under the current structure of the Medicare Part D benefit.

I just posted a video on my Facebook page, and an oncology nurse, Kathy at East Jefferson General Hospital in New Orleans, was speaking about how this benefit design, where the senior has to pay 5 percent, no matter the cost, is so harmful in terms of her ability to get certain cancer drugs to cancer patients.

Now, imagine it is a coronavirus drug--a cure for coronavirus that we know is going to eventually be here, and it can be priced. You name the price; we are going to pay it. Or can we? Can someone afford 5 percent of $100,000 or 5 percent of $50,000? Is it imaginable that such a medication would be priced as such?

It is totally imaginable.

We need to enact what the chairman of the committee calls the Grassley-Wyden bill but which I call the ``Making Coronavirus Drugs Affordable Act.''

What we would do with this bill is change the Part D benefit so that when a senior pays up to a certain amount, period, it is stopped. She or he pays no more. And no matter how much that coronavirus drug is priced, she or he will not pay above a certain amount.

If they price it at $100,000, under current law you are paying 5 percent of that. Under this law, you would not. The out-of-pocket exposure, if you will, is capped. By the way, it also caps it for the taxpayer, which saves you and me as taxpayers--all of us as taxpayers-- a heck of a lot of money as we attempt to balance the Federal budget and as we attempt to preserve the life of the Medicare Program.

So I will point out that we are going to have a cure for coronavirus sooner or later, but if a senior citizen or anyone cannot afford that cure, it is as if the cure had never been invented. We need both for the cure to be invented and we also need for it to be affordable. Otherwise, it would not be available.

By the way, somebody may tell you they are supporting another bill either in the House of Representatives or here in the Senate. This is the only bill out there which is bipartisan. This is the only bill out there which has a chance to pass. This is the only bill that can protect senior citizens, not only by being good policy but by being signed into law by the President of the United States. The President of the United States has signaled that he, indeed, would sign this law.

Now, the ``Making Coronavirus Drug Affordable Act'' does other things as well. It caps out-of-pocket expenses. It lets patients pay over time. If they know they are going to have a big amount in January, they don't have to pay it all in January. They can pay it a little bit in January, February, March, and all the way through the end of the year. It protects patients from price gouging, but it still preserves incentives for these cures to be invented.

As we look for a holistic response to the coronavirus infection, we must keep in mind that drugs have to be affordable. So I am asking all my fellow Senators to support the ``Making Coronavirus Drugs Affordable Act,'' also known as the Grassley-Wyden bill, and for Senator McConnell to bring it to the floor.

With that, I introduce my colleague from Montana, Steve Daines, to continue this discussion.

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