Prescription Drug User Fee Amendments of 2007
Floor Speech
PRESCRIPTION DRUG USER FEE AMENDMENTS OF 2007 -- (Senate - May 03, 2007)
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Mr. SANDERS. Mr. President, I congratulate my colleague from North Dakota for the extraordinary and comprehensive outline of this issue that he has made not only today but in the past.
Mr. President, every single day in this Congress, and throughout America, people sit down and eat their lettuce and tomato and their salads. Their tomatoes come from Mexico, Latin America, and their lettuce comes from Latin America. Other foods they eat come from as far away as China. Billions of dollars of food imports come into this country, but I don't hear anybody in this body standing up and saying, oh, we have a problem about food safety or food coming from other countries. They come in.
There is a problem--and I don't hear it too often here, but somehow the U.S. Government, with the FDA, cannot regulate a small number of drug companies so that we can safely bring in prescription drugs from Canada and other industrialized countries so that, as a result, we can substantially lower the cost of medicine for millions and millions of Americans. This is absurd. Of course, we can safely regulate the flow of medicine coming into this country.
The real issue is not the safety of medicine. The real issue is the power of the pharmaceutical industry, the most powerful industry in terms of lobbying impact in the United States of America. If you think the oil companies are powerful, take a look at the drug companies. If you think the banks are powerful, take a look at the drug companies. Today, we are living under a Medicare Part D prescription drug program that was written by the drug companies, for the drug companies. Today, billions of dollars of taxpayer money goes into research and development for new medicines that go to benefit the drug companies, while the American people do not get reasonable prices for the products they help to produce.
Mr. President, since 1998, the pharmaceutical industry has spent over $900 million on lobbying activity--$900 million. That is more than any other industry. Today, there are over 1,200 prescription drug lobbyists right here on Capitol Hill and throughout this country. Do you know what their job is? Their job is to make sure in the United States of America we continue to pay, by far, the highest prices in the world for the medicine we use.
If you have a chronic illness, there is a strong likelihood you will be paying two times as much for the same medicine as our friends in Canada or Europe pay. Why is it that the same medicine, manufactured in the same factory, costs us, in some cases two times, and in some cases three times, as much money as it costs our Canadian and European friends?
The answer is pretty simple. It has everything to do with the power of the pharmaceutical industry and the enormous amounts of money they spend on lobbying, on campaign contributions, on advertising, and the pressure they put on Members of the United States Congress.
Mr. President, I have been involved in this issue for a number of years. I have been involved in it in an emotional way because I was the first Member of Congress to take constituents over the Canadian border to purchase, in that case Tamoxifen, which is a widely prescribed breast cancer drug that ended up costing Vermont women one-tenth the price they had to pay in the United States.
In our country today, there are people struggling very hard with terrible illnesses who have no health insurance and who need their prescription drugs. Some of them simply cannot purchase their prescription drugs. Some are taking money out of their food budget to buy their prescription drugs. We are a great nation in many respects. But the time is long overdue for Members of the Senate, for Members of the House, to reclaim this institution from the powerful special interests.
Today is a day of reckoning. This is very important legislation. This can drive the price of prescription drugs down by 25 to 50 percent. Let's stand together and, for those Members who are wavering on the issue, who think they cannot vote for it, I hope at least they will support cloture to allow us to continue this debate and to finally lower the cost of prescription drugs for the American people.
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Mr. SANDERS. Mr. President, I rise in strong opposition to the Cochran amendment. We should be very clear. For anybody who is interested in prescription drug reimportation, for anybody who is interested in lowering the cost of prescription drugs in this country from 25 to 50 percent, for anybody who is interested in standing up for the working families of this country who are getting ripped off every day by outrageously high prescription drug costs, the Cochran amendment is a poison pill. To vote for the Cochran amendment is to vote against prescription drug reimportation; it is to kill the Dorgan amendment.
The idea of asking permission from the Secretary of Health and Human Services, from the Bush administration, who have already gone on record rather firmly and decisively in opposition to reimportation, is to simply mask your vote. The Bush administration represents the pharmaceutical industry. They will kill prescription drug reimportation. To ask their permission to go forward is simply to kill prescription drug reimportation. So anyone who is serious about lowering the cost of prescription drugs will not be supporting the Cochran amendment.
The unfortunate reality is, in the United States of America we continue to pay, by far--it is not even close--the highest prices in the world for prescription drugs. Because of the escalating cost of medicines, many of our fellow Americans, many working people, many people with chronic health problems, simply do not get their prescriptions filled. I am sure in Montana the experience is the same as it is in Vermont. People tell me they walk into the drugstore and cannot believe the prices they are being charged. They can't afford those prices. I have talked to pharmacists, as I suspect the Chair has as well, who have been embarrassed. They have seen tears coming out of people's eyes when they have told them the cost of their medicine.
Meanwhile, as a result of the power of the pharmaceutical industry, we have the highest prices in the world, and those prices are rising every single day. In fact, tomorrow, if an American walks into a pharmacy and the pharmacist says to that person: I am sorry to have to tell you this, but the cost of your medicine went up 50 percent, or 75 percent, we can do nothing about it. Unlike the rest of the industrialized world--Canada, Europe--where they understand prescription drugs are an integral part of a whole strategy regarding health care, we let the drug companies do anything they want to do.
As the first Member of Congress to take constituents across the Canadian border to enable them to pay substantially lower prices than they were paying in the United States, I have seen firsthand what it means to people's lives when they get the drugs they need at a price they can afford. I will never forget--never forget--when in 1999 I brought a busload of Vermonters over the Canadian border. Many of the women there were struggling with breast cancer, fighting for their lives, and they didn't have a whole lot of money. They went to Montreal and purchased Tamoxifen, a widely prescribed breast cancer drug, which at that time--at that time--was one-tenth the price they were paying in the United States. Imagine that. Fighting for your life, not having a lot of money, and needing a drug. Suddenly, they looked at the price they were paying and they literally could not believe it.
Mr. President, I ask unanimous consent that a chart which compares prices in the year 2005--so the prices may be different today, but as of April 2005, a price comparison between United States prices and Canadian prices, and United States prices and German prices.
There being no objection, the material was ordered to be printed in the Record, as follows:
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Mr. SANDERS. Mr. President, let me talk about a few of the drugs.
Actos is a drug for diabetes. As of 2005, in the United States, the price of that drug was $116. For the same number of pills and the same milligrams, it was $50.62 in Germany. Twice the price--same product, same company, same factory, but less than half the price in Germany.
For Celexa, a drug for depression, it was $85 in the United States and $35 in Germany. Same company, same product. Clarinex was $77 in the United States and $38 in Germany. On and on it goes--sometimes more, sometimes less but often half the price in Germany, and different prices in Canada but often the same end result.
The very simple question the Members of the Senate have to ask themselves is: Why is it that in the United States we have to pay the highest prices in the world for our medicine? Why is it that at a moment in history when we are eating food products from farms in Mexico and in Latin America, produced in China, and they are coming to our kitchen tables today, why is it that anybody here can say with a straight face it is OK for products all over the world to come into this country from tens of thousands of farms, but in terms of a handful of major drug companies, somehow we cannot regulate the flow of those medicines from Canada, for goodness' sake, into the United States?
Give me a break. That argument is so totally absurd as to be almost beyond the laugh test. This debate has nothing to do with drug safety. All of us are concerned about drug safety, and the Dorgan amendment has page after page after page of regulations making sure the FDA-approved medicines that come into our country will be safe.
What saddens me very much is that in many ways the American people have given up on this issue in terms of the ability of their own government to act, and they have taken matters into their own hands. I don't know what goes on in Montana, but in the State of Vermont thousands of people in our State go over the Canadian border. They go to the Canadian drugstores and buy the products they need. It is not a big deal, and they save substantial sums of money.
There was an estimate a few years ago, and I don't know what those numbers are today, but there was an estimate several years ago that about 2 million Americans were buying their medicine in Canada. What the Dorgan amendment is about is simply saying that it is a little bit absurd for Americans to have to get in their cars and drive to Canada to get the drugs they need; that it might make more sense for our pharmacists to be able to purchase that medicine, our prescription drug distributors to be able to purchase that medicine so, in fact, Americans could take advantage of the lower prices at their own local drugstore.
That is what we want to do. We don't want all of America to have to go to Canada or Germany to buy reasonably priced medicine. We want those products sold in this country at an affordable price.
I think many Americans are wondering: Well, how does it happen that a product made by an American drug company--at a time when the taxpayers of this country, by the way, spend billions of dollars in research and development for drugs that go to the drug companies--that in the midst of all this, how does it happen that we pay two or three times as much as our neighbors in Canada or our friends in Germany or throughout Europe? How does that happen?
Well, the answer is pretty simple. The answer is pretty simple. The answer has everything to do with the way we do politics in this country and the enormous power of large multinational corporations and the enormous power of lobbyists who represent those corporations. Let me quote from a Washington Post article of Friday, January 12, 2007. It is a front page article.
This is what it says. This is January 12, 2007:
This month alone [i.e. January] the Pharmaceutical Research and Manufacturers of America [PhRMA] spent more than $1 million on full-page newspaper ads touting the success of the existing Medicare drug system.
Drug companies spent more on lobbying than any other industry between 1998 and 2005--$900 million, according to the nonpartisan Center for Responsive Politics. They donated a total of $89.9 million in the same period to Federal candidates and party committees, nearly three-quarters of it to Republicans.
``You can hardly swing a cat by the tail in Washington without hitting a pharmaceutical lobbyist,'' said Senator Charles E. Grassley, Republican of Iowa, a key sponsor of the 2003 legislation that created the current program.
That is what we are dealing with today, and we should not kid ourselves. The pharmaceutical industry, year after year, turns out to be one of the more financially successful industries in our country. According to Fortune magazine, the top 19 pharmaceutical companies in 2005 made $42.1 billion in profit; in 2004 the profit margin was almost 16 percent, three times higher than the average Fortune 500 company.
That is what you have. We have a situation where millions of Americans are struggling to pay their prescription drug costs. We have a situation where many Americans simply cannot afford the medicine they desperately need. We have a pharmaceutical industry which, year after year, enjoys some of the highest profits of any industry in this country. We have an industry which pays its CEOs very exorbitant salaries. We have an industry which has an estimated 1,200 paid lobbyists in this country, many of them former leaders of the Republican and Democratic Parties. We have an industry that makes huge amounts of campaign contributions. We end up with a situation in which we pay by far the highest prices in the world for prescription drugs.
Senator Dorgan quoted a study from the CBO, I believe it was, that suggests we could save some $50 billion over a 5-year period if we move to prescription drug reimportation. In this body we have people who get up every day and tell us how wonderful they perceive unfettered free trade to be. It is not a problem when American workers are thrown out on the street because factories are moved to China where people are paid 30 cents an hour; hey, that is part of the global economy. No problem there. There is no problem when food comes into this country from China and our farmers lose money. No problem. That is part of the global economy.
But somehow, amazingly enough, when an aspect of free trade works for the average American and not for a large multinational corporation, suddenly we do not like unfettered free trade. Suddenly we cannot reimport prescription drugs from Canada--from Canada, which neighbors us, obviously--from a handful of drug companies. We cannot do that. I think that argument is very absurd.
Let me conclude. A vote for the Cochran amendment is a vote to kill prescription drug reimportation, pure and simple. The Bush administration has said they will not go forward with reimportation. Let us defeat the Cochran amendment. Let us pass the Dorgan amendment. Let us lower prescription drug costs in this country by 25 percent to 50 percent. Perhaps even more important, let us show the American people that the Congress has the courage to stand up to the most wealthy and powerful lobby on Capitol Hill.
I yield the floor.
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Mr. SANDERS. Mr. President, the debate we are now having is an extraordinarily important debate; in fact, it will be one of the most important votes we will be casting this year.
This vote is about whether we stand with the American people, millions of whom are having a very difficult time paying their prescription drug bills or whether we stand with the most powerful and greedy lobby on Capitol Hill, and that is the pharmaceutical industry which has spent extraordinary sums of money to make sure the American people pay outrageously high prices for the medicine they desperately need.
I wish to briefly examine a chart which talks about the very high profit margin of the pharmaceutical industry. One of the reasons why the pharmaceutical industry can spend so much money on lobbying, on campaign contributions, on advertising is because of the profits they make year after year.
In 2004, drug companies ranked as the third most profitable industry in the United States with a 15.8-percent profit margin, which is about three times higher than the profitability of a median Fortune 500 company, which is at about 5.3 percent. This is in 2004. This comes from the Kaiser Foundation.
What we can also see, and what this chart tells us, is the extraordinary profits the drug companies are making from particular drugs. Epogen is the drug. Amgen is the company with profits of $2.5 billion. Taxol is the drug; the firm is Bristol-Myers Squibb, $2.1 billion for one drug, and on it goes. They are profitable year after year. The pharmaceutical industry continues to be one of the most profitable industries in this country.
I have another chart. One of the issues I look forward to discussing with Members of the Senate is the fact that as taxpayers in our country, we contribute billions and billions of dollars to the National Institutes of Health, the universities, the foundations for the very noble and important purpose all of us support: to create drugs that will address the major illnesses facing us, whether it is cancer, diabetes, AIDS, whatever it may be. We have spent billions and billions of taxpayers' dollars in a sense subsidizing the drug companies and, in fact, taxpayers do not get any reasonable price returns from them. We just give them the money.
Here is an example. Taxol is a very important and widely used medicine. According to a 2003 GAO report, the NIH spent $484 million on research for Taxol, Bristol-Myers Squibb spent $1 billion and subsequently earned $9 billion in profits.
In other words, American taxpayers are paying twice: once in the form of underwriting pharmaceutical research and the second time in the form of monopoly prices.
When we talk about the drug companies, we should also deal with the issue they often bring up. PhRMA is a very powerful lobbying group, the most powerful trade group on Capitol Hill. What they tell us is they need these very high prices, they need all of the taxpayers' money because they are putting all of that into research and development. Don't we all want new drugs for diabetes, cancer, AIDS, and a dozen other terrible illnesses? This chart tells us something a little bit different.
This chart tells us the pharmaceutical industry spends far more for marketing--and goodness knows we have seen their ads on television over and over again, and guess who is paying for those ads. We are, in terms of high prices for the drugs, far more for marketing than for research and development.
Let me get back to the thrust of what this debate is all about, and let me be very clear. As I mentioned a little while ago, the Cochran amendment is a poison pill. If anyone is serious about prescription drug reimportation, if people are serious about lowering the cost of prescription drugs from 25 to 50 percent, if people are serious about standing up for consumers in this country, they will vote against the Cochran amendment.
So that no Senator has any doubt about what is going on, Mr. President, I ask unanimous consent to have printed in the Record a Statement of Administration Policy, dated May 1, 2007, from the President's office, and I will quote from the bottom of page 2, where there it is in black and white. This is a two-page letter. It says:
As a result, if any such importation provision were included in the final version of the bill presented to the President, the President's senior advisers would recommend that he veto the bill.
There being no objection, the material was ordered to be printed in the RECORD, as follows:
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Mr. SANDERS If you are voting for the Cochran amendment, which says, well, we want the Secretary to certify we can go forward, what you are voting for is to kill reimportation. The White House was honest enough to make that very clear. So it would seem to me that for those people who want reimportation, you have to vote ``no.'' If you don't want reimportation, then you can vote for it. But that is the simple reality.
There is another issue which I understand was raised a little while ago--I was not on the floor at that moment--and that dealing with the Clinton administration's attitude toward reimportation. I must say when I was a Member of the House, I was very involved in this issue. I was one of the leaders in the House in fighting for prescription drug reimportation. Back in the year 2000, we worked very closely with the Clinton administration and with then Secretary of Health and Human Services Donna Shalala to craft and pass reimportation legislation. During that process, the Clinton administration came to support reimportation over a period of time.
Unfortunately, as many in this Chamber remember, it was during that debate on reimportation that the Senator from Mississippi first offered the certification language he is putting forward today. So he has been doing this for quite a while. It is true Secretary Shalala refused to implement the reimportation legislation passed in 2000 as a result of this certification. I know opponents of reimportation like to characterize Secretary Shalala's refusal to implement reimportation because she believed reimportation was impossible to make safe. That is the argument we hear over and over again: Hey, it is not us. Even the Clinton administration said reimportation could not be made safe. But what I must say, as straightforwardly as I can, is that argument is not accurate. It is not right.
In her December 26, 2000, letter to President Clinton dealing with this issue, Secretary Shalala outlined several ``flaws and loopholes'' that would prevent the legislation from being effective. As someone who was active in the debate of 2000, let me also say it is a fact that these ``flaws and loopholes'' were identified prior to the passage of that legislation, but opponents of reimportation refused to address them because they knew those flaws and loopholes would be fatal.
The legislation being offered today by Senator Dorgan addresses each and every one of those flaws and loopholes identified by Secretary Shalala. So let me say this again. If anyone comes to the floor of the Senate and says the Clinton administration thought reimportation should not go forward because there were flaws in it that could not be dealt with, that is simply inaccurate. What Secretary Shalala said is, there are concerns I have, and these concerns have got to be addressed. Well, guess what. Senator Dorgan's legislation does just that.
Let us take a look at her letter. Mr. President, I ask unanimous consent that the letter I am referring to be printed in the Record.
There being no objection, the material was ordered to be printed in the Record, as follows:
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Mr. SANDERS. Mr. President, the first flaw Secretary Shalala identified was the lack of any requirement that the drug manufacturers give importers permission to use the FDA-approved labeling for imported medicines.
The Dorgan amendment addresses that concern.
The second flaw identified by Secretary Shalala was the lack of any ban on drug companies discriminating against foreign companies that export medicines to the United States.
The Dorgan amendment addresses that concern.
The third flaw identified by Secretary Shalala was the 5-year sunset in that version of the bill. That sunset would limit the public benefit from the investment the public would be making to put a safe reimportation system in place. In other words, she was saying, why should we go through all this effort if we are to only have a 5-year process.
The Dorgan amendment addresses that concern.
Finally, the Secretary noted the absence of a long-term income stream to fund enforcement of the reimportation system.
The Dorgan amendment addresses that concern.
In short, to characterize Secretary Shalala's letter as one that says reimportation is unsafe is to mischaracterize the essence of that letter. What Secretary Shalala was critical of was poison pills, what she called ``flaws and loopholes'' that were put in, or allowed to remain in the bill at the bidding of the pharmaceutical industry so they could defeat reimportation.
I have been involved in this issue for a long time, and that is what the drug companies do. Every day there is another reason why we can't go forward to lower the cost of prescription drugs. Every day there is another reason why we have to pay the highest prices in the world for prescription drugs. We have 1,200 lobbyists, no doubt many of them running around right now knocking on doors, to make sure our people continue to pay the highest prices in the world.
Secretary Shalala wrote in her letter that she, in fact, hoped Congress would fix the flaws and close the loopholes in that 2000 legislation of 7 years ago, and this is what she wrote to President Clinton:
Mr. President, the changes to the reimportation legislation that we have proposed can and should be enacted by the Congress next year.
In other words, in 2001. Let me repeat that. Secretary Shalala wrote to President Clinton:
Mr. President, the changes to the reimportation legislation that we have proposed can and should be enacted by the Congress next year.
Unfortunately, it has taken 7 years of work to bring us to where we are today. This should have been done years ago. Under the Republican leadership, there was no question we could not get to first base on reimportation. I hope things have changed now.
Let me conclude by saying that anyone who comes up here and says they are for reimportation but they are voting for the Cochran amendment is in fact not for reimportation. Anybody who comes up here and says, well, even the Clinton administration said we could not do that, I am afraid also that is not accurate and I think they are quoting Secretary Shalala, who was then Secretary of Health and Human Services, out of context.
As I have mentioned before, I have been through these battles with the
drug companies before. There is nothing the pharmaceutical industry will not do--nothing--in order to make sure they remain one of the most profitable industries in America. They will say anything, do anything, and put any kind of pressure they can on Members of the Senate or Members of the House.
Today, we have an opportunity to do something important. For many years there was growing concern in this country about a do-nothing Congress, about a Congress that was worried far more about the wealthy and the powerful than the needs of ordinary Americans. The elections in November have changed that. We have new leadership here. I hope very much that under this new leadership we will all summon up the courage to stand up to the drug companies, the most powerful, the most greedy lobby and industry right here on Capitol Hill, and that we will go forward and we will pass this legislation to lower the cost of prescription drugs for all Americans.
Mr. President, I yield the floor, and I suggest the absence of a quorum.
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