Looked at his agents role in improving the process. Held by the hill, this is two hours. Welcome to this mornings briefing, Prescription Drug system, ensuring access. Id like to thank our sponsor, the coalition, for affordable Prescription Drugs for making this possible. This is the first in a series of two events sponsored by the coalition to explore some of the most pressing issues facing the u. S. Health care industry. This morning we are focused on the cost of medicine. In the United States, expenditures on Prescription Drugs are rising faster than Overall Health care spending. Reacting to the concern over rising prices, the white house is expected to unveil an executive order examining ways to reign in drug costs. Even as we wait for direction from the government, how can every entity within the Prescription DrugDelivery System help manage costs and keep medicines accessible for all americans, and what innovative marketbased solutions are being ex morning drive oh plord and what role can government play . We hear from stakeholders as they explore a landscape where patients can get the medicine they need at a price they can afford. A few notes of housekeeping. In addition to those of you here in the studio, we are Live Streaming on thehill. Com. We ask that you keep your phones on silent but we encourage you to join the conversation on social media. Follow us on twitter thehill events and comment using the hashtag whats next. Please keep an eye out for members of the team who have hand held mics. Finally theres a very short survey on your chairs. We would love your feedback. Feel free to give those to a member of the staff on your way out. Id like to invite meghan scott, executive director of the coalition to make some brief remarks. Meghan . Good morning, everyone. Thank you, johanna, and thanks to the hill for hosting this very important conversation today. We appreciate the distinguished speakers and panelists and all of you here in the room and those of you watching online. We know that this is a pretty slow time in washington for health care and theres nothing else that you could possibly be focused on, so thanks for being here. All kidding aside, a serious solutionsorient solutionsoriented conversation about the issue of rising drug prices and the effect they have couldnt be more timely. Were pleased to have representatives from across the drug supply chain as well as a representative of the patients who rely on those drugs. Addressing the ongoing challenge is one that deserves a substantive dialogue and cooperation across the entire Health System. To that end id like to share with you just a little bit about who the coalition for affordable Prescription Drugs is, who our members are and why weve come together now. We bring together employers, unions, public sectors retirees and other stakeholders. These organizations know first hand the real value that these partnerships allow them to provide to their members through sustainable, affordable Prescription Drug coverage for their employees and members. The issue is front and center for Many Employers and unions because about half of all americans get their coverage through the employer system, far more than any other source of coverage. Amid these rising drug prices, employers and unions have had to find ways to ensure that their employees, members and their families are able to access the medicines they need. Thats why more and more sophisticated purchasers have been choosing to partner with pbn. Kormd to a survey in 2009 of more than 250 employers, 2009 only 47 of employers were partnering with pbn to manage these benefits. As drug prices continued to rise, four years later you saw that number hit about 61 so these organizations are really working to find ways to ensure that their employees and members have access. While the average list price grew by nearly 10 , the average net growth was held to around 3 . Thats real savings that are being driven through negotiations with manufacturers. Pbns are also essential to the affordability and sustainability of government programs. A recent study found that theyll save Medicare Part d 896 billion over the next ten years and without it seniors would be looking at premiums that are about 66 higher. Beyond the savings generated by negotiations with manufacturers, pbns deliver value to the Health System by building high quality Pharmacy Networks and reducing point of sale prices through negotiations with pharmacies, use their deep clinical expertise to encourage the use of the safest, most effective medicines including generic and alternatives that can achieve the same Health Outcomes often at lower cost and provide patient focused programs and tools aimed at improving Health Outcomes and avoiding unnecessary costs such as hospitalization. Its very appropriate, as johanna said, that the hashtag for todays event is whats next rx because its time to find solutions. Sound approaches that will ensure access and improved clinical outcomes within an affordable and sustainable framework. We believe that solutions should build on what is already working for the government programs, employers, unions and other organizations that most americans rely on for their health coverage. Theres an immense opportunity to encourage the most efficient and effective use of medicines to both improve Health Outcomes and to significantly reduce Unnecessary Health care spending in both the public and private sectors. Finally, we need to do things that will increase competition for Prescription Drugs by facilitating use of generics, by identifying off patent drugs with little or no competition and by taking a closer look at anticompetitive practices. When theres greater competition, patients, employers and taxpayers all benefit. So again, a big thank you to the hill for hosting this important conversation today. With that, im going to turn it back over to johanna and we will get things started. Thank you all. [ applause ] we begin this morning with a conversation featuring two democratic members of congress from the committee that oversees matters related to health care. Congressman gene green of texas is the Ranking Member of the house energy and commerce subcommittee on health, and congresswoman Diana Degette is the Ranking Member of the submity an oversight and investigation. Joining them is my colleague, the Hills National correspondent reid wilson. Reid . Grandmothood morning. Thank you all for being here this morning. Were going to chat a little bit about the cost and transparency of Prescription Drug prices and then open it up to your questions as well, so if youve got questions there will be people with microphones all around looking for you with your hand up. But i want to start with you, congresswoman degette, what role does Congress Play in increasing transparency for drug prices . Particularly our committee, the energy and commerce committee, we have jurisdiction over all of the issues of patent exclusivity and availability of drugs and Medicare Part d. We basically have jurisdiction. So people like gene and i think that what we should be doing is really having some in depth investigations and hearings to figure out why all of a sudden high prices of Prescription Drugs seem to be pervasive everywhere, and weve been urging our colleagues on our majority colleagues on the other side of the aisle to have a robust investigation in hearings. Its not just a simple issue of Prescription Drugs are going up, lets reduce the prices. Its a as we just heard, its a very complex system that seems to be growing more complex and also more opaque by the day. So, we think that Congress Needs to take a very active role. Mr. Green . I agree, and of course were democrats so they dont let us call hearings, but i would have an aggressive hearing schedule of our Health Subcommittee on a number of issues. Id like us to work with cms more and make sure we dont create another issue but also drug prices to see where we could get some of the really things is venture capitalists coming in and then raising the price astronomically. Not a dime of that goes into research but again we dont want to dry up investment in research because thats how were going to discover these new cures. Since diaane and chairman upton with the sponsors, we want to continue that over the next number of years, that intensity with fda funding, obviously nih fund funding. The first two years, appropriations give us 2 billion. Our goal is 10 billion over five years of new research at nih. You bring up this interesting balance between profit for the company that then go into research and transparency and lower costs for the consumers. How do you strike that balance . I dont think weve figured out how to strike that balance. Otherwise we would have the green degette solution which we frequently do, but this morning we dont have that to present. But it seems that as the system has grown more complex, your previous speaker talked about the very complex system where you have patients. Obviously you have employers. You have unions. You have Insurance Companies. You have pbms. You have pharmacies and then of course the pharmaceutical companies themselves. You have this very complex system and each step it seems that theres negotiation and theres rebates, and then overlaid over all of that is the drug research, the patent exclusivity and the development of new and exciting drugs, biologics and other drugs that are really presenting new and innovative cures for people. So its really difficult, especially when we havent had any investigations or hearings to determine exactly what that causes or what the solution would be. Congressman tom reid from new york and i are the cochairs of the congressional diabetes caucus, and of course one of the drugs that has just sort of inexplicably skyrocketed in price is insulin. So weve sort of undertaken a little mini investigation of our own at using insulin as a case study to try to figure out how is it insulin which obviously every type one diabetic and many type two diabetics rely on, how is it that its suddenly spiked up in price. So what weve been doing, weve been systematically talking to representatives from every one of these Interest Groups that i just mentioned and of course its always someone elses fa t fault. What were trying to do is get a full picture and as i say, were trying to convince the chairman, greg walden of the full committee and also our respective subcommittee chairs to have a series of investigations and hearings, and we could use insulin pricing as an example, but its not so clear exactly what you do at this point. I think gene would probably agree. Yeah. Insulin is a good example of it but when you see some of the Market Forces that happen and i think we can agree on a bipartisan basis that we need to make sure that we dont see that kind of jump in price just because someone can go buy the patent. Again, that doesnt help the system. It just raises the price for the consumers. So as congress now appears to be moving towards a bipartisan fix of the Affordable Care act or at least some kind of bipartisan negotiation, what role does what role would you like to see pharmaceutical pricing play in some kind of next version of the aca . Is that something you address in that kind of legislation . I would hope thats where were going to go to. I know theres been a push in the senate for a bipartisanship. I did a one minute yesterday morning on the floor saying we dont have a democrat or republican solution but we need to sit down across the aisle and have an american solution for health care. That would be all encompassing. Obviously access is important. Where i come from, i want my folks to be able to go to some of the great medical facilities at the Texas Medical Center in houston, but they have to have some type of vehicle, whether it be through their employer, through the exchange or through medicaid. Again, one of my sticking points is that we shouldnt have allowed states not to take the whole medicaid. I know the Supreme Court decision. That wasnt in our bill. It was actually the senate bill, but in my district, 46,000 of my constituents would get medicaid if the state had expanded, 100 reimbursement for three years, 90 . Typically in texas our medicaid reimbursement is twothirds fed and onethird state. So 98 to 10 is really a good deal to serve that many more people. So access, but then we want to make sure they can get to those great facilities that we have. So maybe you have some information we dont have about bipartisan negotiations on the Affordable Care act, but i will say as gene mentioned, i worked with fred upton, the former chairman of energy and commerce, for three years to develop 21st century cures and gene and i both believe that the best legislation is bipartisan legislation. Weve been trying to convince our colleagues in the house to work in a bipartisan way on Health Care Reforms because we realize that the Affordable Care act, while its provided opportunities to millions of americans, it also needs improvement. And i identified ten areas where i think we could research it on a bipartisan way. One of them was Prescription Drug pricing. So far though, despite our many approaches, we have not seen any appetite on the part of the republicans in the house to work in a bipartisan way, which i think is unfortunate because i think all of these solutions will have to be bipartisan. And probably the best example, we can do it. 21st century cures in the house is overwhelmingly bipartisan. All of us work like diane works on diabetes with tom reid. John and i work on the next generation of antibiotics that we wanted to gain. In fact, with the legislation going to the senate, we were trying to see how we could jump start that medical research into that new antibioticresistant illnesses. Chairman burgess and i worked together on trauma care, so we can do it. We just need to look at it. We did it really great on cures but now with whats happened in the senate and i would hope we would do that really bipartisanly on how were going to provide health care to americans. Gotcha. Someone proposed requiring pharmaceutical companies to explain their drug pricing models. Is that something that would help the market . I think transparency is important, although we also know anyone who has a patent or they may not want to share some of it so they could have a knockoff coming on. But i think transparency and drug pricing so people will know and even the physicians will know that when theyre if they have an array of drugs for a certain illness, they would know this is, you know, the cost. But the goal should be you need to prescribe the most effective for your patient, and thats what doctors should do. But i think the transparency would help both on the end result but also for employers and unions who have plans. A couple of things i think we need to investigate in pursuit of this transparency is we need to investigate the current exclusivity rules and if theyre appropriate, because as gene says, we really want to encourage development of new therapies and new drugs. Some of those take years to develop and many, many hundreds of millions of dollars to develop. So we need to recognize that on the one hand, but on the other hand, we need to see if there are adequate generic drugs being developed that will give price competition, and we also need to have the transparency to see if the pricing really is in line with what these drugs cost to both research and to produce. Finding a legislative solution to that is not easy and you cant just take your magic wand and develop a formula or Something Like that. When we dont even have the information yet because we havent had it all goes back to the investigation and the hearings. I would be really loathe to start slating before we actually have that. Call me crazy but i think we should have the information before we actually legislate. Surprise surprise. I know, its crazy. Thats where i think it would really benefit. And its not a partisan issue because we all support the development of new drugs and therapies and we all support access for patients for those drugs and therapies. But from the insulin end, i know we have some new and very targeted and excellent insulins, but those arent going to do any good if the formulary doesnt offer those insulins and parents of diabetic children have to decide whether theyre going to spend hundreds or thousands of dollars a month because their Insurance Plan wont cover that insulin. The white house is reportedly working on an executive order to deal with drug prices. What would you like to see them do . I can hardly wait to see that. And what do you think theyll do . They dont call us first, believe it or not. I would like to see leadership out of the white house. But again, you cant jump from one issue every day to Something Else so you have to have some continuity. I think that would help us if we got that kind of leadership out of the white house to sit down and say, okay, lets see what we can do to get accomplish some of these goals. Again, its not going to be done in one session of congress. The cures took three years. Three years. And so its something we have to get started on and have buyin from everybody. Weve heard as well proposals to cut various regulations to speed generics or new drugs