Know the Lowest Price Act of 2018

Madam Speaker, unfortunately, there is just no wonder drug that will cure prescription price gouging. And with many prices for drugs rising at 10 times the rate of inflation, and with an unaffordable drug being 100 percent ineffective for the many that cannot afford it, many Americans are really desperate.

In this Congress, we have another lost year of failing to address prescription price gouging. Now, on election eve, we take this miniscule step forward. A few of the many consumers who have been scrimping to get their medications, could at least find out if by paying cash, they can get a particular prescription at a lower price. No longer will gag provisions deny pharmacists the right to counsel about this issue.

After learning about this problem about two years ago, I consulted with experts, with patient advocates, with pharmacists about these clauses, and asked the CMS, the Centers for Medicare and Medicaid Services to prevent this administratively, which they could have done, but they failed to do so.

Finally, months ago this year, I filed two bills as companion legislation to the measures we are considering today by Senators Collins and Stabenow, and was joined by 32 Members of the other house in supporting and sponsoring those measures.

This Patient Right to Know Drug Prices Act, the House version of it, was endorsed back in June by the National Community Pharmacists Association, thereafter, by the National Association of Chain Drug Stores, and by the American Psychiatric Association.

Madam Speaker, I include in the Record their letters of support.

National Community

Pharmacists Association,

June 28, 2018.

Re National Community Pharmacists Association (NCPA) Support

of H.R. 6143 & 6144.

Hon. Lloyd Doggett,

House of Representatives,

Washington, DC.

Dear Representative Doggett: The National Community

Pharmacists Association (NCPA) is writing today in strong

support of the Patient Right to Know Drug Prices Act and the

Know the Lowest Price Act of 2018, H.R. 6143 and 6144, two

bills that would ban provisions in contracts between pharmacy

benefit managers (PBMs) and pharmacies (so called ``gag

clauses'') that prohibit pharmacists from being able to

inform patients of cheaper alternatives for their medication.

NCPA represents the interests of America's community

pharmacists, including the owners of more than 22,000

independent community pharmacies. Together, they represent an

$80 billion health care marketplace and employ more than

250,000 individuals on a full or part-time basis.

``Gag clauses'' refer to contract provisions and/or

requirements embedded in lengthy provider manuals that

include overly broad confidentiality requirements, and non-

disparagement clauses, as well as requirements that

pharmacies charge insured patients what the PBM says at point

of sale, leaving pharmacies with little to no ability to

inform patients of actual drug costs. Such provisions have

the effect of chilling a range of pharmacist communications

with patients and others for fear of retaliation by the PBM.

NCPA strongly supports passage of the Patient Right to Know

Drug Prices Act and the Know the Lowest Price Act of 2018 to

help ensure that patients are not being charged inflated

prices for their drugs. Thank you for your leadership in

addressing this issue, and we look forward to working with

you to advance these pieces of legislation.

Sincerely,

Karry K. La Violette,

Senior Vice President of Government

Affairs & Director of the Advocacy Center.

Madam Speaker, I am pleased that finally our House Republican colleagues have agreed to approve this proposal today. With families nationwide concerned about soaring drug prices, this legislation would end a restrictive, anticompetitive, and anticonsumer provision for those who rely on ObamaCare in the marketplace and for group employer ERISA plans.

I must note, however, that of all the many bills I have either introduced or supported from other colleagues dealing with excessive medication costs, this is the most narrow of the proposals out of all of them.

Instead of really saving lives, some may view this as simply a life preserver for those who have ignored prescription price gouging for the past two years. Approving this modest, narrow bill is not a substitute for tackling the pervasive problem of prescription price gouging.

Pharmacists are not the only ones who are, apparently, gagged. Right here in this Congress, some seem to be unable to find their voice and vote for real reform that would lower drug prices when we are outnumbered by two pharmaceutical lobbyists for every Member of this House of Representatives.

Repeated attempts to pass measures that would lower prices have been blocked. Republicans even blocked my amendment to the opioid legislation to authorize the Trump administration to negotiate the price of naloxone, the lifesaving opioid overdose reversal drug whose prices soared by 700 percent.

During the past week, Big Pharma, with considerable help from the Republican majority leader, sought to hitch a ride on this very same opioid legislation to get an unrelated $4 billion gift. It is enough to make you gag. Hopefully, we have got that stopped.

Passage of this bill today is one modest step that we can take, but so much more is needed. That this bill even counts as progress, demonstrates how far we have to go. And while this bill brings some transparency to the pharmacy counter, the transparency which is most needed is comprehensive legislation like the Transparency Drug Pricing Act that I have introduced, to shed some light on where the prices get set. And that is by the manufacturer who hides the whole process through discounts, rebates, and fees.

Now, we all know that President Trump solved the problem with his Rose Garden press conference early in the summer when he announced that prices are going down. But I have yet to find anybody who has benefited from that announcement. And, in fact, the Associated Press just analyzed drug prices since that announcement and they couldn't find any company that had made any significant reduction on prices.

And when questioning the executives of 24 large drug companies, the AP didn't find a single one committed to cutting prices.

Madam Speaker, the attitude was best captured by one pharmaceutical executive who within

the last month said that he had a, ``moral requirement . . . to sell the product for the highest price.''

Today's two minor prescription drugs bills are being passed in this process that is called ``suspension.'' But let's not create any further suspense for families that are in need on their healthcare costs. Let's approve real, comprehensive prescription drug pricing reform in a new Congress that is not indifferent to the needs of American healthcare consumers.

Madam Speaker, I move to suspend the rules and pass the bill (S. 2554) to ensure that health insurance issuers and group health plans do not prohibit pharmacy providers from providing certain information to enrollees.

Madam Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and insert extraneous materials in the Record on the bill.

Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, as the only pharmacist in Congress and a practicing pharmacist for over 30 years, this issue of an industry forcing the American people at the pharmacy counter hits incredibly close to home for me.

Pharmacy benefit managers, also known as PBMs, have put forth restrictions that debase the drug supply chain in the United States.

PBMs have existed for decades, but they have grown through mergers and acquisitions to be the middlemen for much drug coverage on formularies.

The hope was that PBMs would reduce administrative burdens and be able to negotiate drug prices, yet here we are today voting on two bills to stop them from intentionally defrauding patients. It is unfortunate that we have even reached the point where there needs to be a law passed that prohibits this type of behavior.

I appreciate that we are here today voting to sign these two Senate bills banning gag clauses into law; however, I think these bills could go further.

My bill, the Prescription Transparency Act, which was introduced earlier this year, deemed any contract containing gag clauses null and void. Furthermore, it applied to every single insured patient. And it not only ensured that patients were notified of the lowest price, but also of any less expensive generic equivalents that might be available to the patient.

My other piece of legislation, the Know the Cost Act, not only bans gag clauses in prescription drug plans for Medicare Advantage, Medicare part D, and individual and group insurance plans, but also informs beneficiaries about the consequences of paying out of pocket.

My bill received letters of support from the American Medical Association, the American Psychiatric Association, the Global Healthy Living Foundation, the National Association of Chain Drug Stores, and Rite Aid, a clearly diverse group of stakeholders all hoping to lower the price of prescription drugs.

States around the country have taken action to address gag clauses, with over 20 States having banned them and countless more considering it.

While we have worked through these bills, we have seen the wide- ranging impact it has had. We have even heard in a committee hearing from colleagues like Congresswoman Dingell, who was initially told that her prescription would be $1,300 but then talked to her pharmacist and got an equivalent for $40.

I want to repeat that.

We have even heard in a committee hearing from colleagues like Congresswoman Dingell, who was initially told that her prescription would be $1,300 but then talked to her pharmacist and got an equivalent for $40.

The discrepancy in costs should really be a wake-up call for how formularies are being impacted. Let's get this legislation passed so we can take on the other issues in this space.

While I am pleased that we are taking these important steps toward reining in PBMs and drug costs, I think there is still far more work ahead.

Again, Madam Speaker, I want to thank you for including these bills on the legislative calendar for today. I sincerely hope that you take the resounding national support for banning gag clauses in consideration in the future and allow patients to regain control of their medical decisions back from multibillion-dollar middlemen.

Madam Speaker, I urge all Members to support this important legislation, and I reserve the balance of my time.

Madam Speaker, I yield as much time as he may consume to the gentleman from Oregon (Mr. Walden), the honorable chairman of the full Committee on Energy and Commerce.

Madam Speaker, I yield myself the balance of my time.

Madam Speaker, I want to thank my colleagues on the other side of the aisle, and I want to assure them that this is only the beginning of what we intend to do and what I intend to do to help to lower prescription drug prices here in America.

Madam Speaker, I want to thank also my colleagues on this side of the aisle for all of their help. I ask for support of this legislation, and I yield back the balance of my time.

Madam Speaker, I yield myself such time as I may consume.

Madam Speaker, I rise today in support of the Patient Right to Know Drug Prices Act and the next bill we will be considering, the Know the Lowest Price Act. These two bills are the product of bipartisan efforts in the Energy

and Commerce Committee to ban so-called gag clauses, which prevent pharmacists from providing consumers information about cheaper prescription drug options.

I did want to mention I see that my colleague, Mr. Doggett from Texas, is here, and the Senate bills being considered today are companion legislation to a House bill that Congressman Doggett introduced with 32 colleagues earlier this year.

Specifically, gag clauses are contractual provisions that can limit pharmacists from informing consumers that their prescriptions may be purchased for a lower price if paid out of pocket instead of through their insurance plan. These bills increase consumer transparency and may help some consumers who get their insurance through the private market or through Medicare save money.

Madam Speaker, I would like to thank, again, Congressman Doggett and Mr. Welch, also from our committee, for their long-time leadership on this issue. I see also that Mr. Sarbanes is here, who has also been involved in this legislation in a major way.

I am glad to see we are voting on these policies today.

The Patient Right to Know Drug Prices Act also includes an important provision that ensures biologic and biosimilar drug manufacturers are required to inform the Federal Trade Commission of potentially anticompetitive agreements that may delay lower cost drugs from entering the market in the same manner that brand and generic drug manufacturers do today. This notification will allow the FTC to challenge any ``pay for delay'' agreements in court

Madam Speaker, the language included in this bill is based on legislation introduced by Congressmen Sarbanes and Johnson, and I thank them for their leadership on this important issue.

Now, I must say, Madam Speaker, while I believe both bills are commonsense measures that we should all support, I also strongly believe that this cannot and should not be Congress' only effort to reduce drug prices.

When I am home--and we have been home a lot, as you know, over the last couple of months--one of the number one issues that people are concerned about is the high cost of prescription drugs. We need to address that. I personally believe we should be negotiating the prices of drugs under Medicare, but there are many other measures, including encouraging more generics, that could accomplish the goal of trying to reduce drug prices.

These bills do nothing to address the biggest drivers of high drug costs in this country, namely, the high list prices set by drug companies for branded drugs. So we must address overall drug affordability, which these bills do not, but I continue to urge my colleagues to work together to find solutions that can actually lower drug prices in a meaningful way.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I yield 5 minutes to the gentleman from Texas (Mr. Doggett).

Madam Speaker, I yield an additional 1 minute to the gentleman from Texas.

Madam Speaker, I yield 5 minutes to the gentleman from Maryland (Mr. Sarbanes).

Madam Speaker, I have no additional speakers, and I yield myself the balance of my time.

Madam Speaker, let me just say these are commonsense initiatives that help address the drug pricing issue. As I have said before, we still need to do a lot more, and we haven't this Congress. But I do agree that these bills will be helpful in that regard.

Madam Speaker, I urge support for this legislation, and I yield back the balance of my time.

Madam Speaker, I rise in support of the two bills that will bring some much-needed transparency into the drug supply chain process, and they will help patients afford the medicines that they really need.

The Patient Right to Know Drug Prices Act, sponsored by Senator Susan Collins, and the Know the Lowest Price Act of 2018, sponsored by Senator Debbie Stabenow, will, together, ban gag classes from Medicare and private insurance.

These clauses restrict a pharmacist's ability to inform a patient that their drug would be cheaper if they paid out of pocket than if they paid through their insurance. And while there is already a regulation banning this practice in Medicare part D, this legislation will end the practice across Medicare Advantage prescription drug plans, Medicare part D, and group and individual insurance plans.

These two bills mirror legislation authored by Representative Buddy Carter, who is carrying this legislation for the majority on the floor today. He is a very valuable member of our House Energy and Commerce Committee. And, by the way, he is the only pharmacist in the Congress, so he understands this from a very personal perspective from behind the counter.

He was joined in this effort by Representatives Welch and Cathy McMorris Rodgers, Anna Eshoo, Morgan Griffith, Debbie Dingell, Gene Green, and our chairman of the Subcommittee on Health, Dr. Michael Burgess.

I think all of us on the committee are very supportive of this effort. We, in fact, moved this bill, Madam Speaker, as you know, as an important part of our committee earlier this month, and it did pass unanimously. So I commend Mr. Carter for his good work on this issue.

I first heard about the gag clause issue from a pharmacist in Grants Pass, Oregon, named Michele. That is in my district. She is an independent pharmacist. We were talking about a lot of these issues, about how we get drug prices down for consumers, and she told me that as a pharmacist, she was prevented, precluded under certain insurance contracts, from telling a patient that their cash price would be cheaper than going through their insurance.

Can you imagine such a thing in America?

Michele told me that she once even received a cease and desist letter for trying to help a child with a terminal illness access his medication--simply unacceptable, period.

Madam Speaker, I am glad we are taking concrete action today to address this important issue. And as we have heard already, these bills are coming over from the Senate. We had them in the House, marked them up in committee, and did our work. At the end of the day, I decided the important thing was not who had which bill. It was, how do we help consumers the quickest.

Taking the Senate bills, getting them down to the President's desk with the support of our colleagues who worked so hard in the House seemed like the best path. It is about putting consumers first. That is what we have done on the Energy and Commerce Committee, and I encourage our colleagues in the House to support this legislative effort.

Madam Speaker, I thank the gentleman for yielding.

Madam Speaker, I rise today in support of the Patient Right to Know Drug Prices Act, an important bill that will ensure consumers can get the lowest price for their drugs.

This bill is also aligned with the bipartisan Biosimilars Competition Act, a bill that I introduced that will shine a light on secret agreements called pay-for-delay deals. Pay-for-delay deals are great deals for the drug companies, but they are bad deals for consumers. Pay-for-delay refers to a practice where brand-name drug or biologic manufacturers make agreements with competing manufacturers to keep their lower-cost drugs off the market in exchange for a settlement.

Brand-name drugs often have exorbitant costs compared to their generic counterparts. Although they make up approximately--listen to the statistics--although they make up approximately 10 percent of all drugs dispensed in America, brand-name drugs make up 72 percent of U.S. drug spending. A 2013 FTC report estimates that these pay-for-delay agreements cost consumers $3.5 billion each year.

FTC currently has the authority--and this is good--to review agreements like these between conventional drug manufacturers. But this authority does not extend to the manufacturers of biologic and biosimilar drugs, which are new, cutting-edge drugs that are often extremely expensive.

This means that right now, we have no way of knowing how many of these backroom deals occur between manufacturers of biologic and biosimilar drugs. That is why I introduced the Biosimilars Competition Act, a bipartisan bill, which would combat these agreements that keep drug prices high and have the effect of harming patients.

These provisions would require manufacturers of biologics and biosimilar drugs to report pay-for-delay agreements and file them with the FTC and the Department of Justice for review of antitrust and anticompetitive behavior.

Granting the FTC the authority to monitor these deals and punish bad actors, will deter many of these backroom deals from being made in the first place, and will help crack down on unfair deals that give millions of dollars to big pharmaceutical companies, while forcing American consumers to pay more for lifesaving drugs.

Madam Speaker, I urge my colleagues to support these new requirements because they are good for consumers. They will increase transparency in drug pricing, and add more competition to the drug market, both of which will help lower drug costs at the pharmacy.