Culture, the idea of seeing the man in front of the tank, many of us have all seen that, at least if your speedy we believe this hearing to go live to discussion from axios on Prescription Drug prices. Well hear from Senate Finance amity church are progressing but first former fda commissioner Scott Gottlieb and later senator Debbie Stabenow of michigan. This is live coverage on cspan2. And real quick, it could have been to one of our events before, we try to keep things short and sweet, four segments of interviews. We want you leaving here feeling smarter about what we talked about, and this particular is what drug pricing in america which obviously will continue to be an issue going into 2020. So with that in mind i like to welcome our first guest, senator chuck grassley. [applause] good to be here with you, bob. Thanks for coming. All right. I think its only, its a good place to start by talking about your constituents. What are they still telling you about their own drug prices in drug costs . What are you hearing from them . Im hearing that theres some prices that are ridiculous, but most often hear about how drug prices are contributing to the high cost of healthcare insurance. And i think they see that theres too much secrecy in healthcare pricing, not enough information about pricing. And i think that they feel that congress can do something about it. What i read that democrats want to do isnt all that different than what republicans want to do. I have a good working relationship with senator wyden, ranking democrat on the committee i chair, the finance committee. And ive had conversations with house members and i believe we have a real opportunity this time with senator wyden and i working together. And what ive heard from the house wants to do, that we can put together a bicameral Bipartisan Legislation to drive down drug prices. In addition to what i do on the finance committee weve had both leaders of the h. E. L. P. Committee which as health in there. They have some jurisdiction over it, and weve been communicating very close together. Hopefully get products out of both senator alexanders committee working very closely with patty murray, the democrat Ranking Member there, and to put together a package from that two my Committee Second brought up yet this year in the United States senate floor. Why havent some of one of issues thats been around for a while, one of the piece of legislation the crates, basically law where he to prevent brandname manufacturers from stop giving their samples to generic. Theres things like low hanging fruit. Seems like something, why is it still exists . It Something Like that still hasnt been able to pass, why should we be optimistic of bigger package could be passed . I guess why well, obviously a game out of committee that i chaired last time on a vote of 165 16fivef leak. Its already out of the Commerce Energy committee in the house of representatives, berryville, very much a bill similar to what we get through the United States senate and i would expect that has enough going for it. Weve even had pharmaceutical companies before our committee for hearing and some of them said they would support it. I dont think they said that here though, but i think they feel the heat now to support it. Another one that comes out of the Judiciary Committee as well thats got a lot of movement on it in the house of representatives is this a four delay scheme where a Pharmaceutical Company will, the brandname runs out, the patent runs out and to make a deal wih the generic company. If you keep her generic off the market we will pay you x number of dollars for extemperatures to do it. So youre basically keeping up the brand patent price for a longer time. We have several things we want to accomplish. Get some of these schemes they keep generics off the market to get generics on the market faster. Another one would be to have Greater Transparency and pricing with transparency and pricing yet to get more accountability. The marketplace ought to work. The consumer with more knowledge ought to be able to make a better choice. And those are the things that are a combination. Now, if you say why legislation cant be passed, whether its low hanging fruit, im not so sure thats as lying as some of his other stuff we are dealing with. The schemes of pbms, for instance, here you have a list price up here. What goes into the list price . Shouldnt the public know what goes into the list price . And you have the rebates. I think last year 170 billion of rebates. Where do. Where do the rebates go . To the benefit the consumer, the Interns Company or do they benefit the pbms . And we ought to know that, shouldnt we . And the president way last june made a speech on Prescription Drug pricing. Is going to get prices down. So already we have some regulations out by secretary azar to make sure that the rebate goes to the consumer. Now, hes got the authority to do that for medicare, but doesnt have the authority to do it throughout the Pricing System. System. And it seems to me thats our job to make it more encompassing. Some of the things you talk about like a four delay, theres a very smart law professor, reducing first floater in january, its one of those things where its okay, but she said, do not mistake them for serious reforms to the underlying drivers of the drug pricing problem. Again it goes through both things might be helpful, but how do you actually get at the items were it will bring drug spending down . That might be addressing the schemes that involve funny business on the side, but will they really addressed what we as a nation spent on drugs . It seems like there some healthy skepticism. Let me give you an example, infusion drugs as an example. Some of them now are very, very expensive and it probably work. But when there is an incentive because the people that deliver the drug to the consumer, the healthcare professionals, if its 6 of 100,000 drug versus 6 of a billiondollar drug, you can understand theres a perverse incentive to use the milliondollar drug. Maybe the 100,000 drug would do the job. So you take away those perverse incentives as one way of doing it. Now, in another area, what i want to say to you, with medicaid its kind of the opposite. We ought to be looking towards, indicates that medicaid, mostly for people that are low income and theres a lot of lifesaving things through gene therapy and other lifesaving drugs that are very, very expensive. So we need to set up a Medicaid Program so people on medicaid and take advantage of that and maybe it would be as simple as spreading out that paying for over a long period of time instead of billion dollars today instead of maybe spread out over five years as an example Million Dollars need to make those drugs available for people that are low income. You mentioned rebate, and rebates are the dollars between, that, when a drug manufacturer and pharmacy benefit manager appreciate a price. Drug manufacture pays a rebate to gain formulary access to be higher a higher preferred list. You alluded to a rule that spending out there that drug rebate will from the Trump Administration hasnt been solidified yet. You had a hearing earlier this year with seven pharmaceutical ceos and executives, and a member you asked, your last question, will you lower your drug prices if this thing comes to fruition . And a lot of them said oh, yeah, sure. Some of them had quite a bit yeah, but only if it also occurs in commercial. Do you believe them . No. [laughing] so let me, lets go back. At this point theres kind of fingerpointing. You know, the pbms when the pharmaceutical companies. A month before we had the pharmaceutical companies for hearing and he blames the pbms. Youve got to stop the fingerpointing, and thats why, take the secrecy out of all this pricing. And make sure that we know exactly how the process works. If you would want to see how complicated the pbm role is in all this between making of the drug and research on the drug and getting it to the consumer, last week i believe wall street journal had something online that showed how complicated this process is your people ought to take a look at that. You cant understand it and we ought to be able to understand it. And for instance, the federal government is one of the, may be the biggest purchaser of drugs in the entire country, and we are spending a lot of taxpayers money and we ought to be responsible for spending and you ought to know what gets into the price. I do want to get into another issue you alluded to an earlier, just the federal government being an large purchaser. One of the programs is Medicare Part d. Yes. What substantial changes could be made to part d, other than the rebate rule, that would actually i think a lot of people who read part d has a lot of wild incentives and weird setups and the benefits are designed now. What substantial reforms could be made there and actually put into law because a lot of people are missed about this . To save the consumer money and to save the taxpayers money. Right now theres a big push to get to the donut hole and get into catastrophic coverage. Because thats what the taxpayers comes in. Taxpayers cover 80 of catastrophic. The federal government pays for a large portion of it. And the more you get in, a higher price is, the more the taxpayer will be paying. Theres an incentive for the entrance companies and for the pharmaceutical companies to get people in the catastrophic very soon, and so get them through the donut hole. So we want to take away that incentive by having the Insurance Companies and the pharmaceuticals pay a greater part of the cost, put a cap on what outofpocket expenses would be, and say the taxpayers money in the process. But the whole idea is to do away with the incentive to quickly getting people into the catastrophic. Just to be clear, youre basically talking about introducing pharmaceutical manufacturers having to pay some of that percentage in the catastrophic. Currently pharmaceutical Companies Pay nothing and youre suggesting why dont we propose something what they pay a percentage now. Im sure there would be critical about. Of course, but then is just the opposite today. They are incentivized to getting people quickly into catastrophic by the more expensive drugs, as an example. We will have to leave it there. I appreciate you coming on, senator chuck grassley. Thank you. [applause] now stay to four a word from our sponsor, pfizer. Stay tuned for a word from our sponsor, pfizer. All right, were back and i would like to welcome our next guest, senator Debbie Stabenow. [applause] good to be with you. Good to see you. Thank you,. Absolutely. All right. I see a lot of heads but its awfully dark out there. I started this out with senator grassley with this question. Ill start the same with you. Drug prices im sure youre all the time from your constituents about what are they saying and if you can name names about drugs, especially angered about, feel free to name those names. Well, and let me first start i saying that senator grassley whos a good friend of my deserves a lot of credit for holding hearings. He is very sincere wanting to address this issue, and it is the time weve had the Drug Companies ceos or pbms in before the finance committee. I think since ive been on the committee which was since 2007. 2007. I appreciate that very much. The Fastest Growing art of healthcare costs i hear about from individuals, from people come from hospitals, from doctors is the cost of Prescription Drugs, bar none. And then the drug and i can probably tell you some it has to me about it. Certainly we seen the cost of insulin, you know, triple in the last 15 years. Weve seen there so many examples of this. By the way, insulin was first created in 1921 by two canadian doctors who in the first patient was treated in 1922. I think its off patent. Im not sure at this point, and they believe because it was something so important to people that they should not be paid for it. So they sold their patented university of toronto for three canadian dollars. Now since that time weve seen a tripling in the last 15 years, folks paying as much as 50,000 a year for something that two canadian doctors thought they shouldnt be reimbursed for. Ill just mention one other example, that is we now have an opioid epidemic. In 2005 the generic version of naloxone was sold for one dollar a mile. One dollar. We have an epidemic. And now we seek cost as hot as 4000 while youre the Public Sector as taxpayers were paying for lawenforcement, hospitals and so on to pay for 150 basically okay to backpack or send five dollars to something the cost one dollar. Why . Because they can at this point. Thats why. Theres an pickets need more and costs a lot. Count me in category been pretty upset about the Pricing System in our country and the fact that this is medicine. This is lifesaving. This is folks trying to on a daily basis be able to take care of themselves and their families. This is not okay. Senator grassley right before he left mention outofpocket cap even for Something Like medicare. Some commercial drug plans do that. Would you want to see Something Like that for the federal programs where seniors and low income folks dont have to pay more than x dollars a month for the drugs . That seems like something that has the 20 cost something, there would be an offset but whats your perspective on it outofpocket cap . It depends. I supported inflation accounts in part d. We can look at part d. The question of does it raise premiums, costs, whos paying . It depends on how its designed, but i think we should back up because instead of just this conficker sisson, everybody agrees with that and i agree with senator grassley, transparency is critical. It is come called akita. Everybody points like this. But theres a simple to do this. Medicare part b should be negotiating best price, period. Take out all this other stuff. The v. A. Pays 40 less, 40 less for the same medicines, and there is no reason other than benefiting the pharmaceutical industry that we are not using the purchasing power of medicare. That is the number one, anything we do short of that is not truly addressing this. And on naloxone that i mentioned a moment ago, this president s own commission on the opioid epidemic, given the epidemic the government should negotiate most price on naloxone or narcan as we call it, which hasnt happened yet and ive been calling on that since it was recommended. It was a good recommendation but why in the world we wouldnt use a negotiating power works we can with rebates and this and that, its a great little system here, but the bottom line is when you get done, we have the highest prices in the world. The folks are not negotiating very well. Image and medicare price negotiation. Thats not an option right now and i know you introduce legislation to try to get that done but it seems like such an anathema to certain legislatures or legislator to even consider it. So how do you persuade people that medicare negotiation is a good idea . If we think about, we do price for certain things already. We do it for hospitals and doctors services. We do for everything. How do you convince people that its something that is a worthy idea and something that could get across to the president s desk . Citizens have to rise that the aarp has says this is the number one priority. People who pay, businesses, hospitals, doctors, families, seniors have to stand up and be louder than the pharmaceutical lobby which is a largest lobby here. Its the largest lobby in washington, d. C. How big are they . Oh, my goodness. I counted up especially now. Fifteen lobbyist under. You tallied those that were registered. It goes up during part d. D. That number went up when we writing the part d bill. Its about 15 or senator, and so citizens, and i think citizens are getting to the point because this come on that exaggerating. This is life or death for people. And the greatest country in the world where we as taxpayers pay the bulk of the research, basic research which i support. I think its not fair to say to a business you take all the risk on basic research when you have no idea if there will be an outcome for that. So i think we should be doing that, but i think it was between, something between like 20082016 we as taxpayers paid about 200 billion to develop drugs. During the time there were 210 drugs developed, and taxpayers helped pay for developing all of that. The Companies Take it, go to commercialization. Thats fine. They can write the research off their taxes. We subsidize again if to make o the end and they have 70 patent. In some case with so many patterns they may be covered for three years or something. But at the end of that subsidization and support, i think american taxpayers just need to bill due by the medicine. We deserve that, and we pay more than can we pay the highest prices in the world and what i ask the Drug Companies to make a profit, and every other country they said yes if they just make more here. Why . Because they can. And on top of it every other country benefits from the Research American taxpayers are paying for, which i support research, but we at the end of it should be able to afford the medicine for our families. Thats all. At what point would you consider looking at the drug company devotes a product they get a government grant for certain amount of time. Is that peer to time too long . Is it is that the conversation e should be having a so . I think we need a definite look at the patent system. Because seven years is one thing, but you can get multiple patents so you change something a little bit. You take naloxone, you put it into an inhaler, you get a new patent, call it narcan. Theres all kinds of ways to keep things going on patents. As i mentioned the number one drug is humira and they have i think its over 130 patents. When asked at the heari