Transcripts For CSPAN3 Hearing 20240704 : vimarsana.com

Lets convene our second panel. We think our panelists for being here and sitting through the first panel. Before i introduce our panelists, let me just say a few words. I think that sometimes it is important to take a 30,000 foot look at the symptoms of the best systems under which we live. We do not do this often enough. We go crisis by crisis. In my view, we are living with a Health Care System which is broken and which is dysfunctional. We spend twice as much per capita on health care as any other country on earth. 13,000 every year which is unsustainable. Yet, despite that, 85 million americans are uninsured or underinsured. We are seeing in many parts of this country, unbelievably, above and beyond covid, and decline in our life expected. We have a half billion americans who, every year, experienced bankruptcy which is related to the medical that they have. We saw during the pandemic how unprepared we were for the Major Health Care crisis that hit us. There are a lot of reasons for the dysfunctionality of our Health Care System one is the outrageously high cost of Prescription Drugs in this country. What this means is one out of four patients who received a prescription from their doctor are unable to afford a prescription. How absurd and counterproductive is that . Too many folks that will get sick and maybe end up in the emergency room at higher cost to the system rated to the system. We have seen medicare costs are extraordinarily high because they pay very high prices for the Prescription Drugs that they dispense. Meaning our Deficit National Debt goes higher. At this together and we are losing 60 5000 people a year unnecessarily because they cannot work the medicine they need organ to a doctor on time. The questions we have to ask ourselves is where is our current Prescription Drug model working . I guess it is working for the pharmaceutical industry because they make tens and tens of billions of dollars a year. Their ceos make compensation packages of millions of dollars a year. And yet, millions of people cannot afford the outrageously high prices we pay. The questions we have to ask is how does it happen that we pay all the highest prices of any major country for Prescription Drug . I have been with americans going to canada where they got their medicine they needed at 1 10 the price they were paying in the united states. But i hope we will discuss is the dysfunctionality of the current model and how we advance to a another model. Do we all believes . It is terribly important comforting and Prescription Drugs to lives . Yes. We understand the best road in the world is meaningless if someone cannot afford it . Do we understand we have a huge deficit which is somewhat treated that somewhat attribute into the high cost of Prescription Health care is somewhat treated to the high cost of Prescription Health care. What do people do when they buy Prescription Drugs at the fraction of your people. There are a few things i hope you will be discussing. Senator. Thank, you, chair. My opening remark. [laughter] lets wing it. Thank you all. You each bring a unique perspective to this issue. We emerged from the pandemic with an understanding that however robust bartow was in the past, it was not adequately reposed. The always say generals by the last war by think our general plan for the next. Since you are the general hoping a plan for the next four, there are some things you will be considering guard traditionally far fewer but nonetheless, i look forward to your input. You all have been very impressive resume. Thank you for giving your time to be here. Thank you senator cassidy. Our president reshma roatan drawn, and asus limit our friend, and it is in ensuring state these technologies. Dr. , thank you very much for being with us. Chairman sanders, member cassidy, and the other ranking members. At mesa assistant professor of medicine at your school medicine. With a policy program called neyo collaboration for integrity and transparency. I am also a primary trans commission. I am honored to supply before you today. I remarks reflects my own views not reflect my own views or my employers or whoever i work with. Soon the click of the emergency will come to an end. This reauthorization brings an opportunity to reflect on this period and you live the life we learn from Public Investment that led to Successful Development of vaccines and therapeutics. To inform this legislation, congress will answer the next question. How can we assure the net american because apple measures in direct responses Public Health emergencies in the future. The feedback into the covid nine pandemic, the federal government effectively reviews effectively removed vaccines in risks by granting direct Public Investment as long as severance access and resources across agencies. In return, the American Public who underwrote these have received little if they will have equitable sustainable access and the political emergency period ends. Manufacturers have announced plans to continue building, a mooring this even at lower pendant prices, they have been able to maintain profit. Without interruption. My will locations help, as well as those at higher risk who bear the burden of untethered pricing. Current policies offer some measure of protection to ensure americans. They will too likely confront these indirectly in the form of higher premiums. The federal government is securing vaccines and therapeutics and will bear the expected increase costs. Texture spending, always have medical countermeasures, that there will be less money and Resources Available for other critical and Public Health interventions. Moreover, based on trends we have studied in public and private procurement of another vaccine of influenza, these initial covid19 vaccine prices following the covid19 Public Health period would be the reason for price hikes in the future. First, congress should empower the federal government to exercise necessary leverage without funds for the elements of countermeasures and negotiations for contracts. The government negate the impact of substantial price increases to renegotiate a lower price as they did during the covid19 pandemic. To further prevent these prices from continuously rising year after year as a habit of vaccines, the government should call for feeling price to be upheld. Similarly to what they have been able to negotiate in a few contracts, the government could insure many manufacturers give them the best price compared to other in the country. The federal government must not sacrifice access in compliance of safeguards with the thinnest contract are the guys of flexibility and speed. Using a contract mechanism like other Transactions Authority inhibits the ability of the federal government to remove unfair axis barriers, to tackle things like affordable pricing. Instead, allocation of funds should be tied to provisions to support the medicare visual is effective. During the ongoing covid health emergency, it may be helpful for 30 products to remain. But the federal government must condition taxpayer money to intend that they work as intended in to answer other country questions. Understanding how different treatments and vaccines, compared to one another, where across cooperation could better determine how many doses pure cure of each product and at what price. Covid19 demonstrated how effective government can be and spread the rapid medical measures. The success of these should not only be measured by what the medical products do when they reach the market. This excess is redefined. As an government acting as a steward of pecks peer funds and answering equitable assets are effective. Thank you very much. Our next witness is mr. Reisman who is president of public citizen. He is an expert on Public Policy and insuring equitable access to drugs. Thank you very much chairman sanders and more for being here today. It is fair to say operation warp speed was a Great Success in speeding the validation of the barda investment model. To an extent. It was a great failure and we need to learn the lesson more. It was a failure in that although the u. S. Government was responsible for funding the Covid Vaccine from before covid even emerged, through the isolation of the key spike protein, through Clinical Trials and up through the development and production of the back the vaccine. Barda impose effectively no restraint restraint on how moderna and other partners would operate. The result was that while moderna executive became billionaires, taxpayers were price gouged. Hundreds of thousands or millions of people lost their lives because we had a global shortage of a vaccine that could have been avoided if we have shared technology. Now moderna announced it plans to quadruple cut prices, further limiting access, further gouging consumers, further gathering the taxpayer. If everyone agrees, we need to learn lessons from the pandemic period and do better going forward. We need poppa, barda, and need to do better. First, more transparency in the contracting process. Taxpayers should know who theyre providing games too, who are they making acquisitions from, and on what terms . Vaccine makers are making coinvestment in products. Tax clickers taxpayers should know how much is being done on the private side along with the public side. Second, reasonable pricing for products that we, the taxpayers, pay for it. If we pay for it, we may not be able to pay with unreasonable prices. The start should be that the u. S. Did not pay more from like more than any other country and, as they should do. You should tailor a reasonable price to the amount of private sectors for investment and risk taken. For the government pays for the development of a drug all the way through. The price should be lower than when they took on that and had to make a lot of earlystage investments. We need to guarantee international access. We know this means everyone around the world knows the products we are talking about. Drug manufacturer vaccine makers may not have capacities and often does not have interest in solving the global properties. We should have a requirement for announcing to the world the Health Agencies of crucial information and share into the algae and knowing how to make sure other manufacturers can produce products everyone needs. Last, we should consider, as well as the traditional model for support search and development, prime models. Such as those who have supported in the past legislation. We know in the case of barda, the monopoly model supported information and does not work. If that is why they are making the investment because the private sector model in these cases, as commissioner califf said earlier does not work. It is at least insufficient. We have to think creatively about how we can get better. Prices can be recalibrated to provide special incentives. As our resources into this space, while also ensuring affordability and access on the back end. We could also do other things to promote inflammation to promote innovation like giving everywhere the people do not a product that contributions along the way. These are some lessons that have come out of the pandemic and that we must incorporate going forward. Senator cassidy, did you want to introduce yours . We are joined by dr. Marty mccarley, a researcher for the Johns Hopkins school of medicine and from John Hopkins Carey business school. Dr. Makar broke his research on health care and other issues ranging from health care to covid19 and previously worked for the World Health Organization where he helped his surgery checklist which help reduce surgery related death around the world. He completed his medical training at georgetown in Johns Hopkins and is the coauthor of over 250 period papers. That i get that right . Pretty impressive. Thank you for joining us. Thank you. Center standards and member cassidy and senator markey. It is a privilege to present. I speak on behalf of myself, not john hopkins or the National Academy of medicine. Congress should avoid the false narrative that insufficient federal findings were to blame for our pathetic covid response. Take, for example, one Johns Hopkins to dent rated a covid tracker the world used. It was not created by the 21,000 employees of the cdc. When hhs met with the cdc, they said it would create that take months to create such a tracker. Then the cdc need 25,000 employees or 50,000 employees . We just had the assistant secretary of preparedness and response say she needs more hiring power. How about firing power for incompetence . Or both. 21,000 employees cannot come up with a covid tracker . We are tragically the nih has 42 billion. Barda, which is a part of the poppa act has another billion dollars. They could not do the most basic Clinical Research we needed done to answer the basic questions to enter the controversies in the conspiracy theories. To finally get at the questions americans were asking, which is how does it spread . From touching surfaces . Do i need to import 20 gallons of alcohol on my groceries . Dr. Fauci was telling teachers in july to where gloves and goggles. Or was that spread airborne . That could have been answered in 24 hours. One week of Clinical Research to answer where sea peak of viral shedding, how long do you need to quarantine for, do masks work . We could have ansell this with definitive basic research early. They did not. I think it is fair to ask how did they do in preparing us for the pandemic . We spent over 20 billion over the last 20 years. What has that done for us . How many lives were saved during the covid pandemic because of investors by poppa pahpa or barda. They have done good work. Regardless of one political affiliation, they need to acknowledge that we doctors were flying blind. We had opinion ruling the day on what we should do. He could have been governed by evidence, policy driven by good placing basic Clinical Research. We did not have that so we had a void of Clinical Research. Over half a year, one year, two years. Filled the void were political opinions. The controversies couldve ended early. We have the money. As a result, the covid pandemic became the most politicized pandemic in u. S. History. Much of it was avoidable. I Research Team at Johns Hopkins did a study of where the nih spent their money in 2020. They spent 2. 3 times more research on aging than they did with covid. I am all for aging research especially as i get older, but not during a global candidate when 3000 americans are dying day. Much of this research was misguided and our study published in the bmj that i included in the packet showed it to the nih after they decided to fund a research study, five bus to get the money to the researchers. That does not work during a health emergency. The mia got an of the reauthorization of barda is. The public has a right to ask what has barda and poppa done for them in preparing for covid . How many lives were saved because of the investment . What is the single best investment barda made with roughly 20 million before the pandemic . That saved lives. It is fair to ask those questions. How many beds are available today . We track the Number Available . We are going to have more catastrophe. Not just viral pandemics but mass shootings, floods, and other natural disasters. We spend a lot of money at barda , making hospitals a lot of money. Contractors making a lot of money. The question is, where was the basic Clinical Research . We have to invite his hunting internationally, sitting teams to get exotic viruses and bringing them into populated areas. I look forward to your questions . Let me start with an issue that has bothered me for a long time. If i have a product that can save his life, and i say, bill, you can have it but it will cost you 100,000. And you say, i do not have that and i say, sorry, bill, my Business Model is that price. Sorry you are going to die. You were talking about maybe millions of people around the world, for people dying because they did not have the vaccines. We have it and i think the vaccine, as i understand it, it costs a couple dollars to reduce produce. What is the morality and i want all three of you to respond to it of us having a product that costs a few dollars to produce, but not making it available to people around the world who are dying and in our own country as well but poor people around the world . Dr. Ramachandran what you are describing, the hypothetical is the reality i see every time i have a clinic where patients come to me and say that cannot afford what i am prescribing them and the fact that this can happen to a fun delete federally funded vaccine is frightening. It should be unconscionable and should not be allowed for that to happen. No one should be poor because they are safe and no one should be sick because they are poor. Sen. Sanders if i have a product that can save your lies the cost that costs me a few dollars to produce, when we look at it globally, what is worth understory underscoring is that there is no market in low and middle Income Countries for big pharma. They are not holding out to see if someone can pay more. They just wont say so there at cell there at all. In those markets, we just have to figure out ways to get the technology to someone who is there and when it comes to lifesaving Technology Like a vaccine. If they dont want to make it to sell there, find, fine, but required them to shut the technology to other manufacturers and give them to the knowhow so they can make it on their own. Sen. Sanders should people die because they cannot afford a vaccine that affords a couple the cost a couple dollars . Mr. Weissman thank you for your work sen. Sanders we are going to have them next week and they will be sitting where you are sitting along with the three major insulin manufacturers in the world. I was that . How is that . Mr. Weissman great. The fda commissioner was asked about shortages and what he is doing and he said we need enter data. How about these mass monopoly powers . We have three suppliers that supply 80 of u. S. Hospitals and they enter into these contracts. The manufacturer gives eight flimsy supply chain for Something Like insulin sen. Sanders all of your points you are raising our good points. I will get back to you. Tell me about the moral issue. Is that our moral Business Model we should sustain . Dr. Makary it is an unacceptable barrier but the best way to lower drug prices in america is stopped taking drugs we dont need and cut the waste of the system. Thank you for being here. Dr. Makary, what do you really think that man . The theoretical given is an absurd theoretical because moderna has pledged they will make it available. I speak with some authority between Medicaid Expansion state, drug should be available for those i can give you a heretical. Theoretical. What if we sell and this incentivize the and this incentivize think we have to have a note of reality as we give theoreticals. Had a productive conversation before the last hearing. One concern i had, either way by the way, the federal agencies that we refer, generally conceded that they did not do well. They are making major efforts to reform so lets acknowledge that. One of the production conversations we should have is how you have production sharing that would not be saddled or quarantined by a federal agency but with sufficient protection of privacy that there will be accessed by under other researchers that may have a different idea then the than the fcc. Cdc. The cdc may maintain it but good researcher at Johns Hopkins who wants to test the thesis can do so with appropriate safeguards. What are your thoughts . Public Health Officials downplayed in silenced this sense many levels. Why has won the vaccine never been approved to be u. S. , being given to one billion people . What is it with the cozy relationship between regulators go back to the information sharing. Is there a way we can have more, a Group Outsourcing and Group Sourcing the data to allow us to have better public houses Health Decisions . We didnt get it. Probably it doesnt support the narrative. Science should not be censored i have limited time. Mr. Weissman, you heard one concern that if you go to that that would be a d isincentive companies to make large scale investments. Your thoughts . Here is that dr. Is mistaken. You are talking about countermeasures countermeasures where the government is the sole purchaser. It is not about charging the most for private individuals. All that gives the all that does it gives the company the u. S. Funded more Bargaining Power when we purchase from them. I think the original premise was that if youre trying to get companies to commit significant resources to develop. Them a traditional electoralm etc. Traditional intellectual, etc. . Mr. Weissman i would reverse what you said. One model is the winner take all. The one who gets the patent, that is the winner and we dont know the value because you dont know what the market will be. You have more certainty with the price because you know the value of it but you can calibrate the price prize even if they are not the winner so you may give an award to someone who drove the Research Forward but did not get the final thing. That is nice that is a nice approach to it. I can of vision the lawsuits over it is my share. That is a minefield that has been treaded. Thank you for your good work. Let me finish by saying this. I have a graph showing that there is a regional pricing loss in the cooperative research and Development Agreement which stopped in 1995 and prior to that point, you have this kind of level of commercialization of research. After that, removal, it took off. It is it suggests that the conclusion of this is the primary stimulus for the increase in the cooperative research and Development Agreement after 1995 was the removal of reasonable icing clauses pricing clauses. Would you disagree with that . Dr. Ramachandran during covid19, we did see the use of regional pricing clauses, which companies, including major manufacturers accepted. Pfizer was one of them with paxlovid. Within that contract, there was a favorite nation because, clauses that pfizer accepted. We are seeing this outside of the medical countermeasures space. One university announced regional pricing provisions for their products so even for products where there is a large commercial market, these protections could be included especially like an agency like nih that has leverage the companys one have want to have . Sen. Sanders let me follow up on senator cassies point cassidys point. You called my question an absurd hypothetical. I suggested people die and get sick when people cannot afford medicine. You think that is absurd . 100,000. Cancer drugs are 100,000 right now. So we have two doctors an expert, is it an absurd hypothesis to suggest that people are dying or suffering are going bankrupt im having their lives disrupted because they cannot afford the prices of Prescription Drugs . Dr. Ramachandran it is not a hypothetical at all. It is the reality of so many americans. Sen. Sanders you see it in your practice . Dr. Ramachandran all the time. Mr. Weissman viewpoints a few points. In the global context, it is commonplace. Sen. Sanders how many people do we think died because they did not have access to the vaccine . Mr. Weissman there are estimates between hundreds of thousands and millions. Most of us who got vaccinated did not get the Higher Quality vaccines. In the u. S. , as you said, 25 or 30 of americans rationed their Prescription Drugs because of price. Now all of them not all of them are dying but some are. The launch price of new drugs are 182,000. 100,000 is not far out sen. Sanders i think many cancer drugs out there are over 100,000. Is that correct. Mr. Weissman yes. The question you asked about to senator kennedy cassidy, in 1995, the point that nih stopped using the regional pricing provisions, they added a new category so the original category was standard those stayed roughly consistent after the removal of the regional pricing clause. They added a new category of material. The numbers that show the seeming just position reflected change in seeming juxtaposition regarding change dr. Makary it happens. The American Cancer Society said that 48 of Cancer Patients say they avoided or delayed future care for fear of the bill. With the promise of the Affordable Care act lowering costs not pending after, we have created new deductibles. Sen. Sanders i dont think senator cassidy, my hypothesis was absurd. We could talk about vaccines, like lack of availability worldwide and that is different than pahpa. Theoretically Medicare Part b providers coverage for most of the cancer drugs. Sen. Sanders occasionally . Judith sen. Cassidy im not if the Affordable Care act was successful sen. Sanders i am not here to defend the Affordable Care act. We are having an intellectual exercise. I think we will have to catch planes. I want to thank you for the work you are doing and thank you for being with us and heres my your credit think my bureaucratic thing. For any senators who wish to ask additional questions for the record, we have a this is day on may 18 at 5 p. M. I have as for consent for these records the midi the committee stands adjourned. Thank you very much. Sen. Sanders thank you very much. Appreciate it. Oh, i did not know that. [captions Copyright National cable satellite corp. 2022] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org]