Patient Right to Know Drug Prices Act

Madam President, I rise in support of the Patient Right to Know Drug Prices Act, which is legislation that I have introduced with Senators McCaskill, Barrasso, Stabenow, and Cassidy. Our bill has also been cosponsored by Chairman Lamar Alexander and 19 other Senators from both sides of the aisle. This is one of those rare occasions on which we are

taking up a bill that has widespread bipartisan support and that is going to really make a difference.

This commonsense bill would ban the use of pharmacy gag clauses--an egregious practice that prevents pharmacists from telling their consumers when they can purchase those prescriptions for less money by paying out-of-pocket rather than by using their insurance. This legislation is action that we can take right now to help lower the costs of prescription drugs for some consumers.

More than half of Americans, as well as more than 90 percent of seniors who are, say, 65 or older, take at least one prescription drug each month. Americans have been estimated to spend nearly $45 billion out-of-pocket each year for prescription drugs. According to a recent poll by the Kaiser Family Foundation, as many as one out of five Americans does not fill a needed prescription because they are unable to afford it.

I witnessed this struggle firsthand recently at a pharmacy in Bangor, ME. When a couple ahead of me in line received their prescription, they were told by the pharmacist that the copay would be $111.

The husband looked to his wife and said: Honey, we just can't afford that.

They turned around and walked away, leaving the prescription behind.

I was so upset when I saw that that I asked the pharmacist: How often does this happen?

His reply: Every day.

Our bill would ensure that pharmacists could volunteer information to customers on how to lower their costs for prescription drugs.

A recent study that was published in the Journal of the American Medical Association found that 23 percent--nearly one-quarter of prescriptions filled through insurance--ended up costing consumers more money than if they had purchased the drugs without using their insurance. Who would think that using your debit card rather than your insurance card to purchase a prescription drug would be less expensive? It is, of course, so counterintuitive that consumers do not think to ask this question of the pharmacists, and gag clauses in contracts prohibit pharmacists from volunteering this information to patients. They prohibit them from telling patients how to obtain the lowest prescription drug prices. Thus, consumers are paying more than they should unless they ask for specific guidance. Americans have the right to know which payment method provides the most savings when purchasing their medications.

By prohibiting gag clauses, our legislation takes concrete action to lower the cost of prescription drugs, saving consumers money and improving healthcare.

More than 40 organizations support our bill that will ban this unfair restriction, including the National Community Pharmacists Association, the American Medical Association, the Alliance for Transparent & Affordable Prescriptions, the ERISA Industry Committee, the Pharmaceutical Care Management Association, and America's Health Insurance Plans. Our bipartisan bill was approved by the HELP Committee, with unanimous support, on July 25. The administration has also condemned gag clauses and is on record as supporting our bill.

Despite this widespread support for banning this egregious practice that restricts the free speech of pharmacists, Senator Lee has filed an amendment that would eviscerate our bill. The Lee amendment would limit the gag clause prohibition to only self-insured employer plans. That would exclude all other employer group and individual market plans. Under the Lee amendment, approximately 85 million Americans would be excluded from protection. Think about that. There are 85 million Americans who are receiving coverage under employer-sponsored plans or in the individual market who would be excluded from this protection. The gag clauses that would be banned in our bill are unconscionable regardless of the type of insurance plan.

We know that patients who do not take their medications experience greater complications. One study has estimated that medication nonadherence costs the healthcare system some $337 billion, not to mention there being poorer health outcomes for the individuals affected.

The Patient Right to Know Drug Prices Act prohibits gag clauses from being used by health plans that are sponsored by employers or offered in the individual market.

The Federal Government's role in regulating these plans and protecting consumers who are served by these markets is already well established. The Employee Retirement Income Security Act--better known as ERISA--was enacted in 1974. Employers who sponsor insurance plans for their employees, as defined by ERISA, are able to deduct the expenses associated with these plans. These expenses are also not subject to the payroll tax. In 2017, the value of the Federal tax benefit for employer-sponsored health insurance was estimated at $260 billion.

I strongly support our State-based system of insurance regulation. Indeed, I spent 5 years overseeing the Maine Bureau of Insurance as Maine's commissioner of professional and financial regulation. Our bill does not change the longstanding deference to States on this issue. Yet I would note that even though ERISA preserves the authority of the States to impose insurance regulations on fully insured plans, these plans must still comply with a multitude of provisions that have been set by the Federal Government, and it has been that way for many, many years. For example, regardless of State law, a fully insured health plan must comply with COBRA and must cover minimum hospital stays after childbirth, reconstruction after a mastectomy, and students who take medically necessary leaves of absence. Also, these plans are prohibited from discriminating based on genetic information.

Unlike Senator Lee's amendment, our legislation would prohibit gag clauses in all group health plans so that no matter how the employer decides to provide insurance coverage, the employees are able to get the best prices for their medications by consulting freely with their pharmacists.

Our bill will also prohibit the use of gag clauses in individual health insurance plans, protecting consumers who don't have employer- provided insurance and who are, rather, purchasing insurance on their own.

Americans who purchase insurance in the individual market may qualify for tax credits to help cover the cost of their policies or they may be eligible for tax-preferred savings accounts, such as health savings accounts established by the Medicare Modernization Act of 2003. Senator Lee's amendment will eliminate the protections our bill provides for these individuals, many of whom already face growing out-of-pocket costs.

We need this bill as a complement to another bill we passed just recently that prohibits these gag clauses for the Medicare Part D prescription plans. This is a companion bill to that legislation.

The bottom line is this: Pharmacists should not be restricted from telling customers if there are other ways for them to purchase needed prescription drugs less expensively. The administration has made banning these clauses a top priority, and this important consumer protection should be written into law.

I urge my colleagues on both sides of the aisle to oppose Senator Lee's amendment and to support passage of S. 2554. Today the Senate can go on record taking a concrete step to help reduce prescription drug prices for some consumers. It makes no sense to exclude 85 million Americans from this protection, as Senator Lee's amendment would do. Reducing prescription drug prices must be a national priority.

I am pleased to yield to the leading cosponsor of this bill, Senator McCaskill.

Mr. President, I suggest the absence of a quorum.

Mr. President, I ask unanimous consent that I have one minute to respond to my friend and colleague.

Mr. President, it seems very arbitrary to me to exclude potentially 85 million Americans from the protections this bill would provide when there is such a clear Federal nexus to act in this area.

According to the Kaiser Family Foundation, 58 percent of workers insured in self-insured plans are actually in ``partially insured'' plans. The reason this matters is that some States may attempt to regulate these plans, believing they can, and then have their State laws challenged in the courts and preempted.

Why not take the commonsense approach our bill does and simply ban the use of pharmacy gag clauses--an egregious practice that prevents pharmacists from telling their customers

they could purchase their prescriptions with less money by paying out of pocket rather than using their insurance.

We have the support of 40 medical and consumer groups for this bill, and this legislation is action we can take right now to help lower the cost of prescription drugs for some consumers. It has widespread bipartisan support. It came out of the HELP Committee unanimously, and it is supported by the administration. I urge a ``no'' vote on the amendment offered by the Senator from Utah and a ``yes'' vote on the underlying bill.

Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, this morning, in Nashville, as I got on the plane, the headlines were not about tweets or collusion with Russia or even the Supreme Court nomination. The headline was this: Senate set to OK bill on opioids.

Within a few minutes, we are about to vote in the Senate on legislation that Senator McConnell, the majority leader, has called ``landmark legislation.'' It is legislation that 72 of the 100 Members of this body have made a contribution to. They are not just cosponsoring it. They have a piece of this bill. This legislation has come through five different committees of the Senate, and we have been working on it for several months.

The reason it is on the front page of the newspapers in Tennessee and the newspapers in Kansas and the newspapers in Wyoming and the newspapers in Maine is because opioids are our most serious public health epidemic, and the Opioid Crisis Response Act that we will be voting on in a few minutes is the Senate's response to this crisis.

We will be voting on another important piece of legislation that the Senator from Maine, Ms. Collins, who is here, has talked about, and Senator McCaskill is a cosponsor. It is the Patient Right to Know Act. It basically does something that I think almost every American would think is a good idea. It says that when you go into a drugstore, your pharmacist must be allowed to tell you that if you can buy your prescription for $5 by paying out of your own pocket, you should do that, rather than using your insurance, which might require a $100 copay out of your pocket. Right now, there are contracts between pharmacy benefit organizations and pharmacists that prohibit your pharmacist from telling you. Senator Collins deserves a lot of credit for her leadership in this area, as she does in so many other areas, and I fully support what she is proposing. It passed unanimously out of our Health, Education, Labor, and Pensions Committee.

Let's go back for a moment to the Opioid Crisis Response Act, which we will be voting on within a few minutes. I mentioned that it is on the front pages of the newspapers today, despite a lot of competition for other news. I mentioned that Senator McConnell, the Senate majority leader, had called it ``landmark legislation,'' and I mentioned that it is because the opioid crisis is the most serious public health epidemic in our country. It is ravaging virtually every community.

We all have stories that we have heard, that we know, that we have told--stories like the story of Becky Savage, who testified at one of the seven hearings before our HELP Committee that her sons had a graduation party in her basement. She was happy about that. They were not running around town doing other things; they were in the basement. Unfortunately, someone had brought opioid pills to the party that got mixed with alcohol, and she found both her sons dead the next morning. They were not drug addicts. They were not alcoholics. They were good boys, but somehow they made a mistake because they and their friends didn't know the consequences of this opioid epidemic.

That is why five different committees in this body have reported bills that have made a contribution to the Opioid Crisis Response Act, which we are about to vote on. That is why 72 different Senators have provisions in this bill. That is why, last June, the House of Representatives passed its own version of the bill, also involving several committees in the House.

Mr. President, I ask unanimous consent for another 5 minutes.

Mr. President, that is why we have had so much support for this amendment.

The bill is so large, some people have had trouble seeing the significance of it. Let me quickly mention two aspects of it: One is money, one is moonshot.

Some people say: Where is the money? This is not a money bill. This is an authorization bill. The money bills are in the Appropriations Committee, and they have been generous.

In March, the Congress addressed $4.7 billion in the omnibus appropriations bill toward opioids. In the bill--which we should approve tomorrow for the next fiscal year--there will be another $3.8 billion. So that is $8 billion within a few months for the opioids crisis.

The second is moonshot. Some people say this needs a moonshot. It does need the energy and resources of a moonshot, but, unfortunately, this isn't a crisis that we can assign to a Federal agency in Washington and say: Let's fix it in 10 years. What we can do is everything we can think of to do to create an environment so that doctors, nurses, judges, patients, parents, and everybody in communities that are affected by the opioid crisis can deal with it there, and we do our best to do that.

For example, Senator Portman's STOP Act addresses fentanyl and other synthetic, illegal drugs being mailed into this country through our Postal Service from China. Fentanyl is 50 times more powerful than an opioid pill, 50 times more dangerous. There is a 70-percent increase in deaths from overdose by fentanyl in our State of Tennessee.

Here is what I think is the Holy Grail of this crisis; that is, finding a non-addictive pain medicine or treatment. One hundred million Americans live with pain; 25 million Americans have chronic pain. They need help. They need something other than an addictive pain medicine-- something that works. Dr. Francis Collins at the National Institutes of Health and Scott Gottlieb at the Food and Drug Administration have advanced research and created fast tracks, and we have provided hundreds of millions of dollars to find that Holy Grail.

A third is to reduce the prescriptions of opioids that can be diverted, so you can reduce the chance that you might get a 60-pill bottle of opioids, use 12, take it home, put it in your medicine cabinet; then your teenager picks it up and takes it to a party, and someone is hurt or overdoses. We authorize the Food and Drug Administration to require manufacturers to sell opioid pills in blister packs of, say, three or seven. Already, two dozen States have established their own limits. In Tennessee, it is a limit of three days.

What are the next steps for this piece of legislation, the Opioid Crisis Response Act with 72 provisions? We are already working with the House of Representatives. We are working very well with them. I appreciate the leadership of Senator McConnell and Senator Schumer in creating an environment where we can move this bill rapidly. We are working with Congressman Walden and Congressman Brady in the House and with Democrats on both sides of seven committees in the Senate on this phase and several in the House of Representatives.

Our goal is to have all of our language in a combined bill ready by Friday of this week, along with Congressional Budget Office numbers, so that the House of Representatives can vote on the bill next week before they go home. Then we can vote on it the following week--or whenever Senator McConnell can put it on the floor--and send it to the President for action.

There are too many Senators for me to thank at the moment for their leadership as chairmen and ranking members of committees or for their agreeing to show some restraint in insisting on provisions. Senator Portman had provisions, Senator Rubio did, Senator Paul did, and Senator Lee did, but they all said: Let's go ahead and vote on this today, work out the remaining differences we have over the next few days with the House, and hope that the

final version of the bill that comes back from the House is even stronger.

I am convinced that this piece of legislation, the Opioid Crisis Response Act of 2018, will help deal with the worst public health epidemic we have had. We have a sense of bipartisan urgency about finishing our work in the Senate and combining our efforts with the House. Their bill is a good bill. I think combining it with ours will help make it stronger, and we will get our bill to the President.

We may have the same amount of money and the same amount of energy that we had for the moonshot in the 1960s, but the real work is going to be done on the frontlines because the only way to deal with the opioid crisis is community by community by community.

I thank the President.

I yield the floor.

Mr. President, I ask unanimous consent that when the Senate proceeds to S. 2554, amendment No. 4011 be made pending.

Mr. President, I thank my colleagues Senator King and Senator Markey for their remarks and their work as we all come together to battle this terrible opioid epidemic.

I rise as the Senate considers bipartisan legislation that marks a critical step forward in the fight against the fentanyl, heroin, and opioid crisis.

In New Hampshire, and all across our Nation, entire communities are being ravaged by this epidemic. In order to turn the tide, we need to combat the challenges communities are experiencing from all angles; we need to collaborate across traditional boundaries; we need to take a truly all-hands-on-deck approach because the magnitude of this crisis demands it.

This crisis does not discriminate. I have spoken to so many individuals and families from all walks of life who are heartbroken and reeling. Their loved ones were professionals--students, athletes, parents--and then they fell victim to this illness, and their lives and the lives of those who loved them were never the same.

Just this morning, I met with a number of grandparents who are now the primary caregivers for their grandchildren--a situation that many of us at first considered a phenomenon and now realize has become commonplace because the children's parents have died or they are in prison or they are simply absent or unable to be a caregiver due to their substance use disorder.

I spoke this morning with this group of grandparents, two of whom have been raising their grandson for nearly 9 years now, one of whom has seen two grandchildren returned to their parents after their parents recovered from their addiction. In one case, the grandparent whose grandchildren have gone

back to their parents is, at age 57, starting life completely anew. She had given up her job and gone through her entire retirement savings to keep her children safe while their parents battled their addiction.

Another set of grandparents, who again have given up everything to keep their grandson safe, are scared of going to court to get permanent custody and adopt their grandchild because they are concerned the child's father will reappear and contest the custody, and the cost of that custody battle will mean they have no money left to care for their grandchild.

Most heartbreakingly, both sets of grandparents said to me they were worried about what will happen to their grandchildren should they die since the children's parents might not be able to be there for them.

I was also reminded today that at one of our largest treatment centers in New Hampshire, the providers estimate that 40 percent of those in treatment have children, which means there will be more and more children in our communities who need their grandparents or other caregivers to step forward.

This crisis is also taking a particular toll on first responders who respond to overdose after overdose, sometimes reviving the same people on the same day.

This crisis also impacts our workforce and our economy. I have met with a number of employers who can't fill jobs because they can't find workers who can pass a drug test. There are people now in recovery, some with convictions on their record, who wonder if anyone will ever give them a second chance.

There is a lot of collateral damage from this crisis. The good news is, just as the ripple effect of this epidemic touches all parts of our communities, people from all corners of New Hampshire and our country are responding--as communities, as friends and neighbors, and as first responders and healthcare providers--in a collaborative manner. This is a multifaceted problem, and it requires a multifaceted approach, but for too long we haven't seen a Federal response that matches the urgency on the ground.

I am hopeful that by passing this bipartisan legislation, we can move forward. We have given communities and families some of the support they need and that they have been waiting for, aching for.

This comprehensive legislation we are considering today includes many priorities the people of New Hampshire, particularly those on the frontlines, have been urging us to fight for.

This bill reauthorizes and improves State-targeted response grants to ensure that States hardest hit by this crisis--States like New Hampshire--continue to get the resources they need.

This legislation also includes the bipartisan Comprehensive Opioid Recovery Centers Act, which I partnered on with Senator Capito, to offer grants to expand existing centers of care to provide comprehensive coordinated care and support services like housing and employment reintegration for those who are in recovery.

We have also heard loudly and clearly from our healthcare providers that we need a more integrated approach in order to combat this complex disease on all fronts. So this bill includes legislation Senator Portman and I worked on together aimed at the next generation of doctors, encouraging medical schools and residency programs to integrate addiction medicine and treatment into their curriculum, as well as ensuring that doctors who get this training can apply right away to prescribe medication-assisted treatment as soon as they are licensed and have a DEA number.

Members of law enforcement have made clear that they need additional tools to crack down on bad actors in the pharmaceutical industry whose behavior has greatly contributed to this crisis. So Senator Grassley, Senator Cruz, and I worked on a provision to make those tools available and to help hold industry bad actors accountable.

This legislation also curbs the importation of deadly fentanyl and other synthetic drugs being shipped through the borders to drug traffickers in the United States.

These are just a number of the key provisions included in this bill. As the Senate moves forward and moves into negotiations with the House of Representatives, I will work with Members of both parties to make important improvements.

For example, we should keep working in a bipartisan way to include a provision making permanent prescribing authority for nurse practitioners and physician assistants, which were some of the measures that Senators Markey and King were just talking about. Nurses and physician assistants are vital parts of our care workforce, including and especially in rural and underserved areas, and their prescribing authority should be made permanent, and we should allow additional advanced practice nurses to prescribe.

I am pleased that we are taking this step forward today, and I am grateful for the Senate's bipartisan work that has brought us to this point--the consideration of the bill on the Senate floor. I am particularly grateful for the work of Senator Alexander and Senator Murray.

This legislation is a vital next step in our efforts to combat this crisis. The biggest mistake anyone could make is thinking that our efforts are anywhere close to being done. As the families I met with this morning made clear, we have a lot more work to do.

I am encouraged by the progress of this bill, and I believe its implementation will help us mount a much more informed and comprehensive response to this devastating epidemic. I also remain encouraged that we have secured a significant increase in Federal funding to combat this crisis through our budget negotiations.

Let there be no mistake. We will need to continue to work together. In particular, we will need to learn about which treatment and recovery practices will be successful in the long run, and we will need further research to establish best practices for supporting a newly at-risk cohort--the children of those with this disorder. We have been responding to and learning about this disease as the epidemic unfolded, and there is much we do not know and much we still need to tackle.

I am encouraged that Members of both parties have come together, demonstrating that we can put partisanship aside and work together to address some of the most dire challenges our communities face. We owe it to all of the many stakeholders in this fight to keep listening to them, to keep collaborating together, and to keep working on solutions so that we can truly make progress and get better. This is a good start, but it is and must be only a start.

I yield the floor.

Recognition of the Majority Leader

Mr. President, since the Senate last convened, Hurricane Florence made landfall on our Nation's eastern seaboard. According to the latest estimates, this terrible storm has already claimed more than 20 lives in North Carolina, South Carolina, and Florida. With more than 1 million Americans subjected to mandatory evacuations, many families have been displaced, and the storm surge and historic rainfall have brought communities to their knees with crippling flooding.

The Senate stands with all of those affected, and we stand ready to ensure that communities in the storm's path have the resources they need to recover and rebuild, once the time comes. For now, we stand in solidarity with the Americans who are battling this storm and with first responders, who bravely risk their own safety to care for their communities.

Patient Right to Know Drug Prices Act

Mr. President, on another matter, today, the Senate will take two important actions to help vulnerable Americans. First, we will pass the Patient Right to Know Drug Prices Act, spearheaded by Senator Collins.

This legislation would ban so-called pharmacy gag clauses, which prohibit pharmacists from sharing drug pricing information that would save consumers money. In circumstances when the out-of-pocket retail cost of a medication is actually cheaper than the price through insurance, it will allow customers with access to the information they need to choose the more affordable route.

After that, we will vote on major, landmark legislation to address the

opioid crisis that continues to weigh on our country. My fellow Kentuckians and I are all too aware of how drug abuse and addiction attack families and communities. Overdoses killed 1,500 Kentuckians last year alone. That is more than four fatalities per day. Nationwide, it is more than 115 fatalities per day.

The effects of this emergency compound themselves. The crisis can eat away at family ties, at community institutions, at economic opportunities--precisely the things that are necessary to lift Americans out of addiction and into recovery.

On the one hand, research suggests that opioid use rose the most in the very communities where employment fell the most. On the other hand, experts blame opioids themselves for a major share of falling workforce participation, to the tune of roughly 1 million missing workers.

A comprehensive crisis demands a comprehensive solution. That is exactly what this landmark legislation is. It combines work from 5 committees and input from 70 Senators.

First, this legislation will help cut off the opioid crisis at its roots. It will stop more drugs at the border, improve interstate monitoring, and encourage reform of prescription dosing. It will encourage recovery through more resources for State and local responders, better access to care for patients, and more support for the families and caregivers of those affected. This legislation looks to the future by surrounding long-term medical research and economic solutions to get our county past this vicious cycle.

I am pleased that two of my provisions are included--the CAREER Act, which expands grants and targets funding for transitional housing and job opportunities to help recovering individuals find their footing and stay sober, and my Protecting Moms and Infants Act, which will refine our Federal efforts to combat the effects of opioids on expecting mothers and their unborn children.

The situation facing Americans and communities is urgent. With this landmark legislation, the Senate has risen to the moment. It is no wonder that experts and advocates representing 200 organizations on the frontlines of the opioid crisis have publicly called on the Senate to act. That is exactly what we will do when we pass this landmark legislation later today.

Nomination of Brett Kavanaugh

Mr. President, on a final matter, it has been 70 days since the President nominated Judge Brett Kavanaugh to fill the current vacancy on the Supreme Court. For more than 2 months, the Senate has pored over Judge Kavanaugh's professional record.

We have reviewed the 300-plus opinions he has authored while serving on the DC Circuit, more pages of documents than have ever been produced for a Supreme Court nomination--more than for the past five nominations combined--and testimony from prominent legal scholars and top litigators who have praised the nominee's intellect and his exemplary performance on the Federal bench.

We have also considered a wealth of evidence that pertains to Judge Kavanaugh's character and his personal integrity. We have heard testimony or received open letters from literally hundreds of men and women who know Brett Kavanaugh, who have worked alongside him, who have clerked for him as a judge, or who have known him and his family personally over the years. This is what the Senate has considered for the past 70 days. In the Senate and around the country, almost everyone who went into this process with an open mind and who was prepared to give Judge Kavanaugh a fair hearing has come away impressed.

But now an accusation of 36-year-old misconduct, dating back to high school, has been brought forward at the last minute, in an irregular manner. It is an accusation that Judge Kavanaugh has completely and unequivocally denied. This is what he said:

This is a completely false allegation. I have never done

anything like what the accuser describes--to her or to

anyone.

It is an accusation that the ranking member on the committee of jurisdiction has known about for at least 6 weeks--known about for 6 weeks--yet chose to keep secret until the 11th hour. Neither she nor any of her Democratic colleagues chose to raise this allegation during the committee staff's bipartisan background calls with the nominee.

They did not raise it, even with the name redacted, in the 65 meetings--65 meetings--that Judge Kavanaugh held with Senators before his confirmation hearings, including his private meeting with the ranking member. They did not raise it, even with the name redacted, in 4 days of exhaustive public hearings while Judge Kavanaugh testified under oath, even though they chose to raise myriad other matters at the hearing, including sometimes bizarre innuendo. They did not raise it in the closed session, the proper forum where such an allegation could have been addressed with discretion and sensitivity. They did not raise it in the thousand-plus followup questions Senators sent to Judge Kavanaugh in writing.

At the 11th hour, with committee votes on the schedule, after Democrats have spent weeks and weeks searching for any possible reason the nomination should be delayed, now they choose to introduce this allegation--not through the standard bipartisan process, not by advising the Judiciary Committee colleagues and committee staff through proper channels but by leaking it to the press, because the chain of custody of this letter runs through the Democratic side of the Judiciary Committee. That is the chain of custody.

I can't explain the situation any better than the senior Senator from Maine put it yesterday evening when she said this:

If they believed [Judge Kavanaugh's accuser], why didn't

they surface this information earlier so that he could be

questioned about it? And if they didn't believe her and chose

to withhold the information, why did they decide at the 11th

hour to release it? It is really not fair to either of them

the way it was handled.

As the senior Senator from Texas said earlier today, ``that Democrats have so egregiously mishandled this up until now, is no excuse for us to do the same.'' Just because the Democrats have egregiously mishandled this, said Senator Cornyn, is no excuse for us to do the same thing.

I am glad that Chairman Grassley is following standard practice and regular order. As he has stated, he plans to pursue this matter by the book, with bipartisan interviews of both Judge Kavanaugh and Dr. Ford. I have great confidence in Chairman Grassley and his ability to proceed through this process.

Mr. President, I rise today in support of legislation I have introduced with several of my colleagues--Senators Murkowski, Barrasso, Stabenow, and Cassidy--that would remove a barrier that prevents patients from getting the most affordable prescription drug prices at the pharmacy counter.

Mr. President, Americans have the right to know which payment method--whether it is using insurance or paying with cash out of pocket--would provide the most savings when they are purchasing prescription drugs. The two bills we have introduced would establish some clarity in this incredibly opaque drug pricing system.

Nearly 60 percent of Americans, including roughly 90 percent of seniors, take at least one prescription drug. In 2016, Americans spent more than $330 billion, including a staggering $45 billion out of pocket, on retail prescription drugs. The Federal Government picked up another $139 billion through Medicare, Medicaid, and other programs.

Prescription drugs amount to nearly 18 percent of all healthcare expenditures and are the second fastest growing expenditure within healthcare. Moreover, two-thirds of personal bankruptcies in our country have been attributed to the cost of medical care, including prescription drugs. To make informed decisions, at the very least, we should have the right to know how much our prescription drugs cost.

At a series of hearings held by the Senate HELP Committee, I have questioned repeatedly one particularly egregious practice that conceals prices from patients at the pharmacy counter. This practice is the result of what are known as ``pharmacy gag clauses.'' These are contract terms

that prohibit pharmacists from proactively telling consumers if their prescription would actually cost less if they paid for it themselves rather than using their insurance plan. In other words, if the consumer is using insurance, pharmacists can actually be prohibited from disclosing whether the consumer is paying the lowest possible price. In fact, the pharmacist is prohibited from sharing this vital information unless the consumer explicitly asks.

Most consumers would never guess that it would be cheaper for them to pay out of pocket than to use their insurance plan to purchase the medicine they need. Insurance is intended to save consumers money in this situation, but that is not always the case. Gag clauses in contracts that prohibit pharmacists from telling patients how to obtain best prices obscure what the true cost of the drug could be and the fact that it could be lower than what the patient is paying. Several recent investigations, including by the New York Times and NBC News, have highlighted this unacceptable practice. For example, a consumer paid a copay of $43 for a cholesterol drug; however, had that same consumer paid cash rather than using his insurance, the cost would have been only $19. Another investigation told the story of a consumer who used insurance to pay $129 for a drug when the cost would have been just $18 had he paid out of pocket.

From Maine to California, the stories are endless. And this practice is not an outlier issue. According to a survey by the National Community Pharmacists Association, more than 50 percent of community pharmacists reported that gag clause restrictions prevented them from telling patients about other less expensive options, such as paying in cash, at least 10 times in the past month.

Recently, I was at the pharmacy counter at a grocery store in Maine, and the couple in front of me decided not to take the prescription they needed because the copay of $111 was more than they could afford. I could not help but wonder: If they hadn't used their insurance, would they have been able to purchase that drug at a lower price? It is so counterintuitive that very few consumers are going to think to ask the pharmacist that question.

I first learned about these gag clauses from pharmacists in Maine who were frustrated that they were prohibited from providing their patients with information on the most cost-effective way for them to purchase the medication they had been prescribed. Pharmacists are barred from speaking up, and those who do face penalties for doing so. Pharmacists are on the frontlines in helping patients manage multiple medications, and they would also like to help ensure that their patients are getting the best, most affordable price.

The first bill we have introduced, the Patient Right to Know Drug Prices Act, which is S. 2554--which I have cosponsored with the four Senators I mentioned, Senators McCaskill, Barrasso, Stabenow, and Cassidy--would prohibit pharmacy gag clauses in healthcare plans that are sold on the exchange and in group plans as well. The second bill, the Know the Lowest Price Act, which is S. 2553--which I am a lead cosponsor on with Senator Stabenow--would ban these clauses in Medicare Part D and Medicare Advantage plans.

Specifically, both bills would prohibit health insurance plans and any pharmacy benefit managers with whom they contract from restricting the ability of a pharmacist to provide a plan enrollee with information about any price difference that may exist between the price of the drug under the insurance plan and the price of the drug purchased out of pocket. Our bills would also prohibit penalties from being imposed on any pharmacist who shares such vital and valuable information.

Some States have already taken action to combat this problem. For example, the State of Maine enacted a law last year that prohibits charging an insurance enrollee a copayment or other charge that is higher than the cost of the drug to the pharmacy provider. The Maine law also protects pharmacists who disclose information related to out- of-pocket costs from being penalized by insurance companies or PPMs under gag clauses. These are commonsense solutions.

In announcing his drug pricing plan last week, the President, I am pleased to say, stated his intent to ban any gag clauses that would apply to pharmacies. While the administration can take some steps administratively to curb this practice, the enactment of our two bills would ensure that this protection for pharmacists and for patients is required under law.

As consumers continue to face skyrocketing prescription drug prices, we ought to do all we can to ensure that Americans are getting the best prices possible. As Congress looks at innovative ways to bring down prices and to increase transparency throughout the healthcare system, our bills tackle an overlooked issue that directly affects consumers and pharmacies across our country.

Our legislation has already received strong endorsements from more than a dozen organizations, including Patients for Affordable Drugs, the American Pharmacists Association, the Pharmaceutical Care Management Association, and other groups, ranging from the Arthritis Foundation to the AIDS Institute.

I ask unanimous consent that these letters and statements be printed in the Record at the conclusion of my remarks.

It is only logical that pharmacists want to be able to provide their customers with information that will help them afford the medications they have been prescribed. It is absolutely unacceptable for pharmacists in this country to be banned, under gag clauses, from providing that invaluable information to patients, particularly those who may be struggling with the cost of prescription drugs.

I urge my colleagues to support banning pharmacy gag clauses and the passage of both S. 2554 and S. 2553.

I yield the floor.

Madam President, eight Americans die of a drug overdose every hour.

In 2016, more Americans died from drug overdoses than during the entire Vietnam war.

The 2017 figures are even worse. Preliminary estimates from the Centers for Disease Control and Prevention indicate that over 71,000 individuals lost their lives to drugs. More than 5,000 of those individuals were Californians. Addiction has never had such a profound impact on our country.

On October 26, 2017, the Trump administration declared the opioid epidemic a public health emergency. However, this has done little to stem the tide of overdose deaths or to effect this public health crisis that has a stronghold on our communities.

Our government can and must do more. It is not enough to declare the obvious, that this epidemic is an emergency.

As with any emergency, triage must begin immediately. That means swiftly executing and implementing whole-of-government strategy to end the devastation. That also means rapidly infusing funds to support this strategy and prevent more deaths.

The Opioid Crisis Response Act of 2018 does just this. It provides a roadmap for action and authorizes the necessary funds to allow the government to better triage care for those in need while simultaneously providing resources necessary to keep these drugs off the street.

This legislation recognizes that there is no one size fits all approach when it comes to effectively addressing addiction. That is why it consolidates bills that span five committees, including six from the Judiciary Committee.

The bipartisan Opioid Crisis Response Act establishes a number of new drug prevention and treatment programs. It also extends other critical agencies and programs, including the Office of National Drug Control Policy and the Drug-Free Communities, the High Intensity Drug Trafficking Areas, and drug court programs.

Moreover, the bill provides the Justice Department with new legal authority to hold opioid manufacturers and distributors accountable if they fail to identify, report, and stop suspicious orders of opioids.

The bill also preserves legitimate access to pain medications, while allowing the Drug Enforcement Administration to consider, for the first time, factors like drug abuse and overdose deaths when setting annual production quotas for certain opioids.

The Opioid Crisis Response Act effectively balances prevention, treatment, recovery, and law enforcement.

This legislation bolsters the efforts of our public health experts, gives law enforcement and first responders the authority and resources they need to combat illicit narcotics, and will help spur the development of alternative therapies and drugs to help decrease our nation's reliance on opioids.

The fact that this bill includes proposals that were sponsored or cosponsored by more than half of the members of this body illustrates that virtually no State, no community, and no family is left untouched by addiction. It is also indicative of the fact that we must act, and we must act urgently.

We must treat this public health crisis like the emergency that it is. We must stop the devastation.

I look forward to continuing to work with my colleagues on both sides of the aisle to see that this important piece of legislation, which is supported by more than 200 organizations nationwide, is enacted into law.

Thank you.

Madam President, as the Senate debates the Patient Right to Know Drug Prices Act, S. 2554, I rise to offer my views on the need for transparency in drug prices and to offer my strong endorsement of this bill. This legislation that we are voting on today represents a serious, bipartisan effort to lift barriers that prevent pharmacists from informing consumers about how much prescription drugs cost. I am proud to be a cosponsor of this legislation.

Every day, Americans buy prescription drugs without a true idea of how much those drugs cost. Pharmacists should be able to tell you if there is a cheaper way to buy prescription drugs, and yet they are unable to do so. Due to so-called gag orders, pharmacists can be prevented from providing this information proactively to patients. With prescription drug costs rising, Americans should have access to transparent pricing information, especially when it can lower their costs.

Today, the Senate takes a significant step toward improving drug price transparency. With the passage of the Patient Right to Know Drug Prices Act, S. 2554, pharmacists would be able to fully inform patients of the cost of the medications they are purchasing. It is ridiculous for a patient to not be told that their copay is actually more than the full cost of the medicine they need. By banning gag clauses, this bill ensures that customers have a right to know the lowest possible price available for a drug at the pharmacy. This is an important first step in advancing drug cost transparency.

In addition to price transparency, the actual cost of medicine continues to be a major issue. Pharmaceutical companies often price drugs as high as they believe the market will allow and have no other constraints on how much they charge. We see this happening not only in branded drugs but in price spikes among generics as well. For example, the recent announcement that major hospital systems and philanthropy organizations have banded together to create their own nonprofit generic drug manufacturing company, Civica Rx, shows just how concerning the problem of reasonably priced drugs, as well as drug shortages, has become. I'll watch with great interest as this endeavor moves forward to produce 14 common drugs used by hospitals--with the first due out next year.

The bill we are voting on today solves just one piece of a very large puzzle, and we must do more. In this distinguished body, we should advance legislation that would direct the Secretary of Health and Human Services to negotiate drug prices in Medicare. I am a cosponsor of the Choose Medicare Act, which includes this provision. We should also move legislation that provides real financial protection for consumers and limits their monthly copays for prescriptions. I am a cosponsor of the Consumer Health Insurance Protection Act, which includes a copay cap of $250 per month on prescription drugs.

Let's dig in to the real cost of prescription drugs and look for creative solutions that support innovation but ensure that lifesaving drugs can reach patients. A cure doesn't matter if it costs too much to reach those who need it.

The problem of prescription drug costs is real, and it impacts American families across our country. This problem forces seniors to choose between food and medicine. This problem prevents families from being able to care for their loved ones due to the high cost of expensive drugs. In fact, according to a report by the Kaiser Family Foundation, 24 percent of people reported that they or a member of their family either did not fill a prescription, skipped doses, or cut pills in half due to the cost of the drug. And 44 percent of those surveyed said they worried about not being able to afford the medications they needed. This is

wrong, and it must be fixed. Today, we start to right that wrong by voting to pass the Patient Right to Know Drug Prices Act. But more is expected and more must be done. Let's build on the bipartisan work that helped us pass the Patient Right to Know Drug Prices Act tonight and make a real difference for American families.

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Madam President, I come to the floor to thank my colleagues for working so hard on this very important legislation we are going to pass tonight to deal with the opioid crisis.

From Port Angeles to Spokane, I guarantee my colleagues that I have heard about this problem, I have seen how our communities are struggling, and this is the very help that they have been asking for. They want new tools, they want better solutions, and they want us to join the fight against drug manufacturers who push these drugs out to communities when they should be following a process and reporting so that our law enforcement can cut down on the huge amounts of opioids streaming into our communities.

This legislation does many things, and I am glad that it does. The STOP Act will help crack down on shipments of fentanyl into the United States via the U.S. mail, which is something that is very important that we do, and I thank my colleague from Ohio for that.

It authorizes funding for a new grant program to help train law enforcement and protect them against the deadliest opioids, like fentanyl, because their exposure to it has been so unbelievable and it is a risk to them every day they are out there doing their job.

This bill reauthorizes the drug courts program, which many people in the State of Washington have told me has been beneficial to how they deal with this crisis as it relates to the individuals in their States, helping nonviolent offenders recover and helping them move forward.

It reauthorizes the High Intensity Drug Trafficking Area Program, which uses Federal resources to help local law enforcement crack down on illicit drug rings. We need to help law enforcement, which is dealing with this problem every single day, to have the tools to do this job. The fact that it reauthorizes the High Intensity Drug Trafficking Area Program is just the kind of tool they need.

This bill also makes permanent the ability for doctors to treat up to 275 patients with the kind of treatment that is necessary for them, which also helps us to get to people faster and to get them into a recovery situation faster.

One thing I really want to draw attention to is this issue of hearing over and over about how opioid manufacturers have flooded our communities with a product when, in reality, current law says they are supposed to monitor and track the distribution of this drug. Well, in too many cases, those safeguards have not been followed. Throughout their process, they weren't reporting on suspicious orders of opioids that prevents them from ending up in the wrong hands, and in some instances, they ended up in the hands of a black market, which then continued to flood communities with the product.

In one example, a physician in Everett, Washington, wrote more than 10,000 prescriptions of opioids. This number of prescriptions was 26 times higher than the average prescriber in Everett, Washington. So he wrote 26 times more opioid prescriptions than the average provider. However, the drug manufacturer failed to report this suspicious activity.

When we authorized this drug, we said this process is what has to happen. Because of its highly addictive nature, it has to be tracked. Law enforcement has to keep track of and be advised of anything that looks like suspicious activity. This abnormally high number was a clear red flag that should have been reported. Instead, the opioid manufacturer turned a blind eye to the negligent distribution.

In response to those abuses, people in my State and in many other States have been critical and have filed lawsuits because they have been so concerned about this issue. What is clear, though, is that we need to do something now to make sure that opioid manufacturers follow the law that is already on the books about the reporting of suspicious distribution or volumes of distributions that are suspicious. Today, this legislation takes a major step forward on that front by including penalties for negligent opioid distribution strong enough to serve as a deterrent to those manufacturers against the actions we have seen in the past.

The bipartisan Opioid Crisis Response Act includes provisions from legislation that I and Senator Harris from California authored. Our provisions increase the civil and criminal penalties on companies that fail to take responsible measures to prevent their drugs from entering the black market.

Our legislation increases the civil penalties by 10 times, from $10,000 to $100,000 per violation. That adds up very quickly in what we think have been transactions that have been very suspicious. In addition, the bill increases the maximum criminal penalty to $500,000 for companies that willfully disregard and/or knowingly fail to keep proper reporting on these distribution activities.

Again, this is what we put into the law because of the highly addictive nature of these drugs. We said that they have to be monitored and their distribution has to be monitored because prior to today the slap on the wrist was not enough of a deterrent, and most of those requirements were ignored. Today, we are putting a much more stringent requirement in the law to say that they will get serious fines if they don't follow the law.

This is such an important issue that a bipartisan group of 39 U.S. state attorneys general sent a letter to the Senate Judiciary Committee in support of this effort. Our own attorney general, Bob Ferguson, helped in promoting that effort, and I want to thank him. The state attorneys general said:

Diversion of prescription opioids has devastated

communities in our states. The consequences for turning a

blind eye to suspicious opioid orders cannot merely be a cost

of doing business. We urge you to support . . . the CARES Act

to ensure that penalties

effectively hold manufacturers accountable and help stem

diversion.

So I agree with those state attorneys general, and I am so glad this is included in this legislation. Creating a more serious attitude toward the illegal distribution of this product and its falling into the hands of black markets is so serious. I urge my colleagues to support this legislation.

I yield the floor.