taking a break at the atlanta church court hearing on conduct allegations gaston county district attorney fani willis. she is leading the georgian election in a fierce case against former president trump and others. we expect hearing to resume shortly. you're watching live coverage here on c-span2. >> joining us this morning is gerard anderson, johns hopkins louisburg school of public health aic professor there. here too talk about the rising cost of prescription drugs. so how much have prescription drugs cost got up in recent years? >> they're gone up about three e to four times faster than inflation and they just keep rising and we don't seem to have any way to slow it down. >> why do they keep rising? >> there's a number of reasons, but essentially the brand-name drugs which is a once you are

about all the time represent about 80% of the spending and they have a patent and of market exclusivity. so they essentially have a government run monopoly so they can charge whatever they want. if a for-profit company can charge whatever they want, they will charge whatever they want and they do. also there's a whole group of people that are trying to buy drugs, and everybody has a different system. so unlike other countries which have one systemou to buy drugs,e have a myriad of systems. the medicare has a system. medicaid has a different system. private insurers have many different systems. there's many pbms that are buying so it's very complicated for somebody to try to buy drugs. >> host: hugest to in a washington alphabet soup, pbm, explain cricket pharmacy benefit managers, the ones that buy drugs on your behalf. they're the ones who established

the formularies that are used to actually buy drugs for you if you have medicare or if you medicaid, if you have private insurance. >> host: what role playing in the rising cost? >> guest: they make it harder for you to pay for the drugs. and this will a little wonky but i'll try to make it simple. so the pbms, the pharmacy benefit managers, want to show the medicare program, the want to show the private insurance that they are doing a a good . so they say, we are going to give you a big discount over what the list price is, okay? so list price is a price that the drug company sets. and then the pdmps a much bigger discount on that. but the larger the list price, the greater the discount appears to be.

so each time the drug company raises its list price, you as the consumer pay a higher price because your cost-sharing, your amount that you had to pay when you go to the pharmacy is dependent on the list price. so every time the drug company raises the list price, you end up paying more and there are some drugs where you actually pay more than the pharmacy gets for the drug because the way the cost-sharinghe works. >> host: explained that a little bit more. so they're trying to make up with a losing with the pbms? >> no. no. they are trying to show off to the pbms that essentially that they raise the price and, therefore, everybody else is going to get -- they the pbms are getting a deal. if you look at what you get from the pbm or from your insurer, they say the list price is here

and you paid only this and you think hey, i got a great deal. the problem is the list price determines what you actually paid. >> host: so what is congress doing about were thinking about doing about these middlemen? >> guest: i middlemen this number different kinds ofth mide man's, pbms or pharmacy benefit managers, one group purchasing organization or another. an they are trying to rein in those costs and really the most important thing is so they don't keep raising the list price, the price the determines what you are i have to pay. >> host: how will they do that? >> guest: essentially they are going to say to them something like, and isin not clear exactly how it will work in the final bill, but they're going to say something like you can't take all these discounts. you have to have a price. .. to raise the list price. host: you said that in other

countries there is one system. explain the system and how it is different. guest: it varies a little bit from country to country. but what happens is that the government says we are willing to pay a certain amount of money for a drug. the drug company then says do i want to sell it for that price or not? and if they are willing to sell it for that price then everybody in that country gets it. if they are not willing to sell it for that price, sometimes that drug is not available in that country. in almost every almost every case it is available because the cost of manufacturing of the drug is really small so you will make money even though the united states drug costs $10000, and would probably cost a few hundred thousand in manufacturing so you can sell it in france for $1000 and still make a lot of money.

>> what happened to the cost of the same drug in the united states? okay, we will sell it for 1000 here, what happens to the price in the united states? anything? >> probably not much because in every country of all people from kaiser or merck or whatever try to maximize the amount of money. you have a representative for pfizer and you said to your ceo, make so much money in the united states so you basically have to manufacture, settle as much as you can for each drug in each country. in every single country.

>> 10000 in united states. >> we did a journal in the health affairs, the average amount is about four times but some drugs are 100 times more extensive than the united states and some are 40% less. because everybody is doing their own thing so medicare is doing one thing, medicaid doing something separate. privatera insurance a third thig and the drug companies know that andan patents what they are able to charge whatever they want to charge. >> we are taking questions and comments about the cost of prescription drugs, here's how you join the conversation.

strength center part of the country, 2-027-488-0000. pacific (212)748-8001. text us and include your first name and city.. facebook.com/cspan. you serve on the drug affordability, is that a way to control the cost of prescription drugs, how you do your job? >> are fivee members of the drug affordability, i'm appointed by attorney general but by the senate or the governor and our response ability is to work for marylanders and the price they pay and for certain drugs they sent was called other payment limits, maximum amount is somebody in maryland should pay so we run through the process starting in our march meeting, we be sending rates for a specific so starting the

process. >> how will that help maryland residents? lacey a big difference in what they pay? we hope so. until we do it and figure out how to work to the system, ie can't completely but we know many drugs are overpriced in the united states is of benefit management can't negotiate. they can negotiate relatively effectively a physical drugs on the market that do the same thing what often against another. if there is only one drug other and they can't play off against another they pay whatever the drug company wants to pay, who want to look at that will other countries charge for these kinds of drugs and figuree out, is there in the value of the drug we had to figure out whether or

not we can charge and they can pay a lot less. >> how long. >> the first state to do it, a number of other states so colorado and vermont and a number of states summer rates and underwent are only able to advise others what to do. a wide range of responsibilities but we are able to set rates. >> compared to the "wall street journal" by the ftc district players, the agency is exploring whether -- [inaudible]