Madam Speaker, I want to thank my colleague, Representative Carter, for his work on this. He was a small pharmacy owner before he got here. Prior to my arrival in Congress, I was actually an insurance broker for many years, a health…
Madam Speaker, I want to thank my colleague, Representative Carter, for his work on this. He was a small pharmacy owner before he got here.
Prior to my arrival in Congress, I was actually an insurance broker for many years, a health insurance broker. And it always amazed me, as pharmacy benefit managers tried to explain their business model, that they actually couldn't explain their business model.
So I rise today in support of our local pharmacies and the unique role that they play in serving patients. I stand here to commend the Centers for Medicare and Medicaid Services and the recently-proposed rule aimed at addressing direct and indirect remuneration, DIR, fees and drug rebates; rebates that don't go to the consumer, but rebates that go to multibillion-dollar corporations.
I frequently make stops at local pharmacies when I am back at my home in Georgia, and I appreciate the services that they provide their customers.
I am from a small town, and local pharmacists are a fixture in the community. They are the first line of defense in preventing and treating a customer's needs. They have known most of their customers in their community for many years.
I will give you one brief example. As an insurance broker, we had written a contract on a business and the cards had not come in yet. And there is a small-town pharmacy, and then there is the big chain pharmacy. One of the employee's children had gotten sick.
Guess which pharmacist was willing to work with the family to get them the medicine before the insurance card came in? And guess which pharmacist was blocked out of the plan by the pharmacy benefit managers? It was the same one, the local, small-town pharmacist.
I am troubled on many of these visits, because I know how these community pharmacies are finding it more and more difficult to serve their neighbors while remaining competitive in the larger healthcare marketplace.
I hear from my constituents regularly about the financial burden they face as drug prices continue to climb. And the price for a drug today, when they go to get it refilled a month from now may be totally different, and rarely is it lower.
Plain and simple, we pay too much for drugs in this country. I would hope that it is something that we could work together in a bipartisan manner. President Trump has already said that he is willing to sign a piece of legislation to reduce the cost of pharmaceuticals in this country, and it is something that we should be able to come together and pass to help the American citizens and reduce the cost of healthcare for the American family.
Most Americans assume that it is probably a pretty simple transaction for the pharmacist when the pharmacist purchases the drugs, even though they know it is a very complex transaction for them, never knowing what the drug is going to cost prior to going into the pharmacy.
But the pharmacy transaction is just as complex; and it is anything but clear and simple, and this is because of the pharmacy benefit managers.
They have used direct and indirect remuneration fees, DIR fees, to claw back money from pharmacies on individual claims, long after those claims are believed to have been resolved.
It means that a pharmacy doesn't know how the final reimbursement amount will be received for a claim for weeks or even months. And anyone who runs any business, healthcare business or any other business, knows you can't operate when you don't know what your reimbursement is.
CMS recently proposed drug pricing rules addressing this issue head- on by requiring all pharmacy price concessions, a subset of DIR, to be included in the negotiated price, which is the price the pharmacy will be reimbursed at the point of sale for dispensing the drug.
This directive would move negotiated drug prices much closer to the cost of the drug for the Part D sponsor, essentially eliminating retroactive pharmacy DIR fees.
Patients win when pharmacy price concessions are included in the negotiated price.
I want to commend the administration for making lowering drug prices a priority; and I want to challenge my colleagues in the Democratic Party to work with the administration and the Republicans in this House to push forward legislation that would continue to reduce the cost of healthcare, specifically pharmaceuticals, for the American citizen.
I, along with many of my colleagues on both sides of this aisle, have advocated for these sorts of reforms that bring transparency and accountability to the system.
Now who could be against transparency and accountability?
These are bipartisan issues on which we share broad agreement. I call on the leadership of this House to put the partisan politics aside; follow the lead of the administration; or walk with the administration to address the lack of transparency in the pharmaceutical industry. Give pharmacies a level playing field to compete, and provide Americans access to affordable prescription drugs.
This is something that we should have done for the American citizens long ago and it is something that we can do right now.
Madam Speaker, I thank my good friend and fellow Georgian, Mr. Carter, for hosting this Special Order this evening. I look forward to continuing to resolve this issue for the American citizens.