efforts to limit increases in the cost of prescription drugs without this incentivizing research and development by major pharmaceutical companies. he responded to questions about his agencies housing more than 2300 migrant children who were separate from their parents after crossing u.s.-mexico border. the senate finance committee hearing ran two hours and 15 minutes. [inaudible conversations] [inaudible conversations] [inaudible conversations]

[inaudible conversations] [inaudible conversations] >> i i like to welcome everyoneo today's hearing on prescription drug affordability and innovation. we are pleased about our secretary here, secretary azar who i think is doing a great job before the committee. today, i know members of both sides that i'llho are eager to hear from him on the trump administrations plan to lower prescription drugs costs. i was in the rose garden when the president announced his plan to put patients first by lowering prescription drug and out-of-pocket costs to consumers. i commend the president and the

secretary for their focus in this area and for releasing this comprehensive blueprint. i also appreciate that hhs is seeking feedback from the public on the policy ideas in the blueprint. the administration is prudent to work through options by properly consulting those affected by these policies first. as we continue to develop policy options, it is imperative to understand the impact on patient access, affordability and innovation before taking any i specific action. to that end, today is a golden opportunity for members to discuss policy proposals and ideas in the blueprint, which contemplates many weighty issues that would seriously change the current way of doing things. and on that note, i believe that those who have criticized the blueprint as insufficient are either responding from a lack of knowledge or purely for political gain. now, i bring to the table

decades of experience of working on drug pricing. that's why we've titled today's hearing in a way that clearly explains the heart of these issues, prescription drug affordability and innovation. this hearing title references a concept that has been very important to me throughout my time in the senate. after all, the goal is to help consumers, and the best way to do that is to balance both affordability and innovation. over three decades ago, i championed the drug price competition and patent term restoration act, what has since become known as hatch-waxman. as i noted in an editorial that ran in roll call yesterday, the hatch-waxman law established a system for regulating drugs that rewards new products while encouraging generic competitors. around that same time, i sponsored the orphan drug act. and i am proud to say that law

has resulted in new treatment options that have enhanced care and drastically improved the quality of life for hundreds of thousands, if not millions, of people that live with rare diseases.dr at the time we thought we're just taking care of some rare diseases but it's become a very important law. those two bills are just the tip of the iceberg though. i have since spearheaded numerous other legislative initiatives to address shortcomings in the system and to capitalize on opportunities for improvement. i brokered the agreement thatt allowed physician-administered biologics to flourish, providing effective treatment for many cancers and other serious medical conditions. more recently, i have successfully advocated for policies that promote development of biosimilars as a way to foster competition and lower costs. i do not bring up this history to boast, but to point out thatt the pursuit of the balance of affordability and innovation has served us well.

now, nearly 90% of prescription drugs dispensed to patients are generics.. yet, we also have realized life-altering breakthroughs in treatment. maintaining this balance must be a part of the conversation here today and as we move forward. and any lasting solution must continue to be market-driven. the medicare part d prescription drug program is built on a system of private entities competing on price and service. this private-sector approach is ingrained in the design of the part d program, which wisely forbids the government from interfering with the negotiations between these private entities. for part b drugs and biologics, medicare pays based on the average price that the manufacturer charges to other payers. this effectively represents a rate negotiated in the private sector. don't take this to mean the way

medicare pays for prescription drugs is perfect. there is certainly room for improvement. but the fact that the united states continues to be a pharmaceutical research and development powerhouse is in e large part because we have long preserved the market-based approach. it is vastly superior to the alternative of direct government involvement and price setting. after all, the private sector has proven time and again that it is far better suited at identifying challenges and turning them into opportunities. one persistent challenge is that certain key drugs and items are in such short supply that hospitals and other providers can't even purchase them in sufficient quantity. these drug shortages, which include generic medications, threaten patient care and demonstrate a weakness in our system. i am proud to say that my home state of utah is taking a

leadership role by creating a market-based response.e. utah-based intermountain healthcare has joined with other like-minded systems across the country to form a generic drug company. this new venture will fill a market need by producing and distributing drugs that are in shortage. this new company will also provide more competition that will improve prices and opportunities for consumers. there are others, too, like some commercial health plans that have responded to market demand by offering prescription drug coverage options that pass along the negotiated discounts and rebates to their enrollees at the point of sale, rather than only through lower premiums. turning back to the president's blueprint, it contains policy ideas related to medicare and medicaid that merit serious consideration. take for example the idea of

paying for a drug based on itsus success in achieving the intended patient benefit holds promise, especially for novel, breakthrough therapies that do not yet have competition. we should explore how these value-based arrangements can work within our federal health programs. we should also assess how we can modernize the popular part d program because it is now more than ten years old. and a review of the part d program should involve action to mitigate the change in the bipartisan budget deal enacted earlier this year that increased the discount that manufacturers are required to provide on drugs in the coverage gap. this misguided change has only dampened some of the competitive forces that have made the program so successful. we will soon hear from secretarm azar on the policy ideas in the blueprint. it will be important to understand how the policies in the blueprint would impact not only the list price but patient

access, beneficiary premiums and other cost-sharing, as well as innovation. as the vast majority of the blueprint's policies are in the jurisdiction of the finance committee, this engagement with the secretary will inform how we move forward. before i conclude my opening remarks, i must say that i suspect that some of my colleagues may want to talk about other pressing issues that touch on hhs's jurisdiction. to head off just one such issues i have made my position on the situation at our southern border known, we must keep families together as we work to avoid illegal border crossings. we also need to ensure that children who have been separatet from their parents are reunited, and i know the secretary is working aggressively to do so. however, my experience tells me that our time at this hearing will be best spent discussing

the issues we all have prepared for weeks to talk about with secretary azar. after all, the cost, innovation and availability of prescription drugs is a deeply important and often life-or-death issue for millions of our constituents each day.ug my hope is that we can all take advantage of the opportunity before us today and stay focused on the agreed upon subject matter of this hearing. with that i'm going to turn to our ranking member, my good friend and partner, senator wyden, for his opening statement. >> thank you very much, mr. cha. thank you, thank you voting district. i'm going to get to rescuing americans are getting mugged by their prescription drug bill as well as the administration guiding safeguards for those with pre-existing conditions. first, the american people are owed an answer about what is

going to be done to protect the thousands of children the trump administration separated from their mothers and fathers, and put in the custody of today's witness. as of this morning, hhs, homeland security and the justice department seem to be doing a lot more to add to the bedlam and deflect blame than they're doing to tell parents where their kids are. according to new reports, the government is ransoming these children by telling their parents they can have their kids back if they agree to leave the country. the president tweeted that the u.s. should forget about due process rights for immigrants, essentially an endorsement of judging people by the color of their skin. the white house chief of staff floated their family-shredding policy in the press more than a year ago. it wasn't conjured out of thin

air this spring. but with news reports that hhs is scrambling to collect resumes of individuals with experience in child care, it's clear the department was woefully unprepared. this committee has oversight of the child welfare system. members have worked hard on bipartisan child welfare policies that keep families together whenever it's possible and safe. that's because unnecessarily ripping children away from their families and putting them in institutions is harmful. it's harmful to their health. it's scarring to their emotional well-being. it's detrimental to their growth.ei that is a fact, and your department knows it. secretary azar, you are certainly going to questions about this today. an administration that has traumatized thousands of child

refugees, dehumanized these kids and their parents, and tried to normalize this behavior through deception has a lot to answer for. now let's shift to discuss americans getting hit with enormous bills when they walk up the pharmacy window. when the president said in early 2017 that drug companies were getting away with murder, he offered his diagnosis of thehe prescription drug cost problem. a year and a half later, it sure looks like he's decided not to treat the problem. the president made prescriptionh drug costs a key part of his pitch to the american people one health care. but the party in power hasn't done any legislating on it. they have put other so called blueprint, essentially a collection of the same questions

people have been asking about this issue for a decade or more. to me, it looks less like a blueprint than it looks like blue smoke and mirrors. a lot of what the president and his team have said ishe head-scratching. for example, the president labeled european countries freeloaders. he said that if drugs got more expensive overseas, fattening big pharma's wallets, prices would fall here at home. that is just fantasy land. i don't know what magic one of the administration plans and using to two-drug prices in otr countries, but i don't know having the power today exists. second, even if drug companies did come into windfall from overseas, it's laughable to expect that theyha take that asa reason to slash prices in america. look at the trump tax law. huge amounts of cash were showered onto these multinational drug companies.

what did they do with it? they put into stock buybacks that benefit shareholders, not consumers. one of the trip to pharmaceutical fantasyland. on may 30th, the president said that in two weeks, drug companies would be announcing, quote, voluntary massive drops in prices.as two weeks went by, then three weeks, and now it's been nearly a month. no massive drops in prices to report. as long as americans are getting mugged at the pharmacy counter, from sea to shining sea, this issue demands serious, by present action. to begin that effort in a serious bipartisan way thisha morning i'm releasing a comprehensive report that looks exactly what makes this industry so complicated, and why those policies do so much to make sure that prices just go up and up and up.

it's not just a look at the drug manufacturers. there are a lot of pieces to the puzzle, middlemen, distributors, misplaced incentives and broken. the company to look under the hood of the entire pharmaceutical industry for the first time. otherwise, when americans get the trump administration and the president in particular, when you look at the record, is talk to the fact is there blueprint has raised issues that have been raised for quite some time. the administration needs to stop pretending that asking the same questions that are already been asked to the equivalent to getting results. the fact is there's a big gap between the triumphant headlines the trump administration tries to grab on prescription drugs, and the lack of serious proposals put forward. so today i hope we will see that gap getting closed.

one last issue. the trump administration said recently it was going to get out of the business of defending protections for americans who have pre-existing conditions. these protections of millions of americans know because it lets them sleep or soundly at night, while the law of the land. it isn't a narrow policy that applies to only a handful of people.o there are more than 150 million americans who get insurance through their employers, and i'd that they will would be very surprised to learn that this trump decision can hurt them, too. if you don't have a pre-existing condition, i guarantee you know somebody who does. and the trump administration decided it isn't going to protect them. we have a lot to do this morning, mr. chairman, and as always as we does often as i look forward to working with you

in a bipartisan manner. >> thank you. thank thank you very much. once again i would like to thank secretary azar for coming here today. we appreciate you, sir. secretary azar was sworn in as secretary of health andnd human services on january 29, 2018. and because there's a lot of ground to cover we all have to come to know, have come to know secretary azar quite well. so i'd like to move right along, as such secretary azar, please proceed with your opening statement. >> thank you, mr. chairman and ranking member wyden and members of the committee. appreciate the opportunity to appear before you today to discuss an important issue, why prescription drug prices are too high, and what we are doing about it. drug prices was on the very first topics i mentioned when i could before this committee during the confirmation process early this year. i know members of this committee are serious about taking p on ts challenge and i appreciate your

efforts in this area. from day one of his administration, president trump has directed hhs to make drug pricing a top priority. earlier this year the presidents toileting budget laid out a range of proposal on the issues including reforms to medicarepr and medicaid. topics that are testified about when presenting the president's budget for this year before this committee. in may building on the budget the the president released a blueprint to put american patients first. this blueprint is a plan for bringing down drug price of keeping our country the world's leader and biopharmaceutical innovation and access. it lays out dozens of possible ways that hhs and congress working together can address this vital issue. we face four significant problems in the pharmaceutical market. high list prices set by manufacturers, seniors and government programs overpaying for drugs due to the lack of the latest negotiation tools, rising out-of-pocket costs, and foreign governments free writing off of

american investment. the president's blueprint lays out four strategies for tacklinn these problems, and we have begun to take action on each of them already. first, we need to create the right incentives for list prices. everybody in today's system makes money as a% of list prices, including pharmacy benefit managers who are supposed to keep prices down.ef everybody wins when list prices rise, except for the patient whose out-of-pocket cost is typically calculated based on that price. one of aged as his initial actions were to record drug companies to include their list price in advertisements. for example, americans deserve to know the price of the wonderful new drug that they hear about on tv before going to ask their doctor about a product they may find unaffordable. but more fundamentally, we may need to move toward a system without rebates, where pbms and drug companies just negotiate fixed-price contracts. such a system's incentives, detached from artificial list

prices, would likely serve patients far better. second, we need better negotiation for drugs within medicare, that is what president trump has promised, and it's what we're going to deliver. in medicare part d, hhs will work to give private plans the market-based tools they need to negotiate better deals with drug companies. part d is a tremendously successful program, but it has just not kept pace with innovations in the private marketplace. while intended patient protections may be preventing plans from a properly managing utilization while everybody agrees on the importance of the trucks that are in the protected classes, manufacturers often use that list as a protection from paying rebates. we also want to bring negotiation to medicare part d physician administered drugs. right now, hhs just gets the bill, and we pay it. this system may actually be

driving doctors to prescribe more expensive drugs, while potentially tempting drug companies to develop drugs that fit into part b rather than d. we are going to look at ways to merge part b drugs into part d, and leverage existing private sector options within part b. we need a more competitive pharmaceutical marketplace. thanks to the reforms congress passed in the 1980s, america has the strongest generic drug market in the world. there are many ways manufacturers still unfounded block competition. since the role of the president blueprint, fdf publicist the names of companies who may be using safety programs to block competition and issued new guidance to help lessen the effects of these action if on generic approvals. since a blueprint rollout, cms reminded part d plan it is unacceptable to have gag clauses barring pharmacies from working

with patients to lower come to identify lower-cost options. more broadly we were to ensure patients patient so how much you drug costs, how much it's going to cost them and whether there are cheaper options, long before they get to the pharmacy counter. these are some of the elements of an aggressive long-term plan to solve this problem we all care deeply about. thank thank you gilda radner tod i look forward to taking questions and discussing how together we can help american patients. >> thank you, mr. secretary. one of the ideas, both mention inde the blueprint and that you discuss publicly since its release is doing away with rebates and medicare part d through changes, to antikickback statute safe harbors. you have stayed the rebates could be replaced withh somethig called a, quote, fixed-price disco,o, unquote. the term fix and price in the

same phrase does make me ame little bit nervous. i'm sure it doesn't mean setting a price, but can you explain what the term means, how would be different fromce a rebate, ad how it would limit list price increases from year-to-year or over a longer period of time? w >> absolutely, mr. chairman. right now the problem is the pharmacy benefit managers make their money often on getting a high list price and negotiating a big rebate offer that, and in keeping a percent of that rebate at the don't necessarily passed to the patient or to the insurance companies that do work for and that'sni just the busins model. it's not saying they're doing anything wrong. what we are thinking about proposing and have been asking for comment out of the request for information that we have is moving to a system where instead of encouraging a very high list price with a rebate thickets administered after the fact, what if our contracts that the

pbms have instead just say here's the price, here's what we'll pay you. you have mt market power in the pharmacy benefit manager, youav control the formulary and you will get this level of discount. here's the price and that gets administered at the point-of-sale. you take list price at of the equation, the pharmacy l benefit manager has no incentive for higher list price. it's administered right there, it's an actual discount, the money flows with it and we just take list price off the table. >> well, states continue to buy with the concept of a close formulary in medicaid with the recent examples of massachusetts and arizona, and other states with a bipartisan mix of governors considering the idea that there's growing interest in the outcomes of imposing a close formulary in medicaid through a demonstration project. how would the medicaid drug rebate program interact with

such a proposal, ndu envision carvin protections for certain drugs or classes of drugs required coverage of medically necessary treatment to which there is no alternative? >> as you mentioned, mr. chairman, the presidents 2019 budget does propose having i hates have the opportunity to see if they can do better than the medicaid statutory rebate program in negotiating. right now the system we have is that all drugs are available in medicaid but in return for that there's a statutory rebate at the drug manufacturers have to pay. .. some suggested they could run their formulated the way medicare part d runs the formulary, and they could get a better deal. we would like to give them that chance and see if they could do so. there's still patient protections a >> there would still be patient protection and medical appeal,

clinical necessity, everything you mentioned would be there just as it is for your insurance, my interest, anyone else's to protect you from unreasonable or non- clinically based formulary. >> i'm pleased they reversed an obama era payment policy that sent the wrong signal to p the nation. under pain which studies estimate will cost 20 or 30% less than the biologics which they appear is not a recipe for a new -- you know, similars. what else can be done to encourage the use of bio similars as a way to increase and -- >> we want to do which is create

a robust highly competitive sector that competes against brand product and that why the payment was change. rothere's adequate incentive to come in to me that change we sat some bio similar enter theut market significantly below what the pricing would have been in part because of a rule change. we believe thatld the fda they could get rid of the abuses by drug companies representing access to their products for the bio similar committees to be able to do the clinical trials needed to product to market. we will -- it would allow the development of the generic g market, as you did. >> thank you so much. senator wyden. >> mr. secretary, your agency plays a crucial role in child

safety so i have a few questions that i think are pretty brief and hope you can give me specific answers. how many kids who were in the custody because of the zero tolerance policy have been reunified with the parent or relative? >> so, i believe we have had a height of over 2300 children that were separated as a result of the enforcement policy and we now have 2040 -- >> how many have been reunified? >> with parents or r other relatives so if the parent remains in detention unfortunately under rules that are set by congress and the court they can be reunified while they are independent. >> the answer is zero spirit no, no, we've had hundreds of children who have been separated for now if for instance if there was a parent in the country -- >> i want to know about the

children in your custody? >> that is what i'm saying. they been placed with a parent or other relative. >> how many? >> several hundred of the 2300 plus that came into our care. >> how many parents have been told where their kids are? >> every parent has access to know whether child is. we want to ensure that -- >> that is -- >> that should be the failsafe and every parent should know where they are. we havee' deployed -- >> let him answer the question. >> mr. chairman, the time is a short in the american people have been getting lots of deception and not many facts. how many parents, have been told where their kids are?

>> that information is available for every parent and we have deployed public health service officers to work with the ice case managers to work with all the parents and we are progressing through them to help temple up for the background check and confirmed parentage as well as to ensure that they may contact in the whether child is and get them onne the phone and get them on the skype if that is available. we want to have every child compareinregular communication. >> i have asked twice how many parents were actually told where their kids are and you said they have access and this is just, in my view, part of the rosy responses that the american people have been getting amateur does not line up with the first-hand account of parents that i hear from the desperately want to know where their kids are. >> there's no reason why they were not know where the child is located. i could at the keystrokes i have sat on the or our portal with basic keystrokes could find any child in our care for any pare

parent. >> mr. secretary, suffice itt te say portals are not part of the daily existence -- >> that is why we have case managers andy the 800 number. >> could you tell me specifically, as of today, how many parents october the kids are? now come on drug prices, not less than 14 days after the president's speech on prescription drugs o they announced the price of two of its cancer drugs going up $1000 a month. that was the second price hike in success. it sure doesn't look like drugmakers are taking your blueprint particularly seriously. we have 42 million americans who get their drugs through part d of medicare and they are getting price hikes every day after a year and a half in office i don't see evidence of this and ministration taking real action f possibly january 1, 2020.

1000 days after the president said john companies were getting away with murder. so, are there any policies in your so-called blueprint that has actually taken affect and h will hold drug prices down? >> patients have already saved a .8 billion and they saved $320 million a year from the change to part b medicare reimbursement and we have already listed the 150 companies hiding behind the program to theirt access for products and we have put the dashboard out that shows the price increases and we have already told the part d plans we ldfind the gag cause to be unacceptable and i am disappointed by this price increases and want to put the drug companies on notice that we aree hitting july 1st and it's a traditional time for drug

price increases and i hope they will exercise restraint, as we come across this. and lower increases than we historically do. >> my time is up and you did not answer the customer. i asked about part d changes and we have not seen for those 42 million americans who get their drugs through part d we have not seen any change and i will hold the record open for this as well as the other matters that you did not respond to. tell us specifically what medicare part d changes are being made and when they will be made they will help those 42 william people. >> senatordioi stamina. >> thank you, mr. chairman. let me first speak to the issue of the children separated at the border as i talk to you this is a appalling what has happened and it is an american tragedy

and ats tragedy for these parens and these children and i want to start by calling you to make sure that the over 2000 children in your custody at hhs are able to get back to the parents as quickly as possible in the makei this a priority. as ilo indicated we have over 10 children in michigan and they are in loving, safe foster homes and that is not the point. as of my last contact with the they did not know were not given any information up to this point about where the parents are and they were not communication going on in terms of what is happening to these children. every single day in a child's k life -- the kids keep growing up matter how long we take or how bureaucratic we are or whatever is happening with this administration that every day these children are growing and changing and experiencing trauma

and pain. i want to go on record as saying that this needs to get fixed and needs to be the top priority for what you are focused on in terms of children and families right now. this is on your watch and we will hold you accountable. let me go on the question at the topic of the day and speak specifically about what is happening with the outrageous prices of the locks own. we have an opioid overdose, opioid crisis, we talked about this before and let me speak again about the history of pricing which is an overdosepa reversal drug and it has saved countless lives, as you know. the drug was first approved by the fda in 1921 and generic versions have been available since 1985 and as of 2005 asi generic vial was available for a

dollar in 2005 but by 2013 now that we have a crisis the generic companies are selling the drug for 15 times as much and an autoinjector now sells for more than $4000, $4000 for and now a two pack for the autoinjector is over $4000 and arcand the nasal spray version is sold for about $150 for a two pack. at your confirmation bring a raise this issue and raise the fact that the president's commission on the crisis, opioid crisis, recommended negotiating the best price and at the time you said quote, i want to look at that and learn more about the

situation but if the government is the purchaser so let's take for a instance if we buy that is part of the opioid crisissu program and we are directly buying that and supplying it then look at the first responders which is what were doing there's nothing wrong with the government negotiating that. we followed up with the letter and with colleagues and with that response that did not include the word negotiation. is naxolone priced association in the drug pricing blueprint? >> the blueprint to address specific drug prices. arcand is the nasal formulation of naxolone which is p a preferd formation for first responders. that is available and i looked into this that is available under the federal supply schedule at $70 a package and are other first responders state and locals have through group purchasing access to that same pricing there.

we are also working at fda to bring over-the-counter naxolone to the market and there are different formulations -- >> in the interest of time so the answer is no, negotiation is not -- >> but the prices at $70. >> it was a dollar and now it 7- >> i don't know if nasal was a dollar. [inaudible conversations] >> with this particular way of administering it $78 and i want to share with you that southwest michigan behavioral health was planning to spend $366,100 year on this particular discounted price that you are talking i about, $366,100 and they could be spending on treatment for people in michigan who have an opioid addiction and instead they are pain even at this discounted rate 78%, 78 times

more than what was available in 2005. i just have to say that if we want to talk about rigged systems there is not a more rig system than the way prescription drugs are priced. >> thank you, senator. senator cornyn. >> thank you, mr. chairman. i appreciate your service and i can't of anyone better qualified to serve in the position you are serving in. we appreciate the expertise and experience you bring to this world. i wanted to raise the issue because in addition to the blueprint that you rolled out to try to control prescription drug cost there are other cost drivers that we see in the healthcare system that the administration has tried to address. one is the department of labor has issued regulations to make p possible for more people to get access to association healthcare

plans so take advantage, not of the individual market, but of the employer provided insurance market and find s their premiums is substantially lower. i would note that people individual market, 9 million people in the individual market, do not haveng subsidies and they have seen their costs rise by 105% since 2013 which is unaffordable by any measure. the second thing that i wanted raise with you i'm sure you are aware of is the good work being done by senator collins and senator alexander and representative walden and representative costello to make sure the people, 250% below, b that access toer lower premiums for their healthcare coverage. again, the problem is the unaffordable obamacare model which has all the mandates and provides spotty subsidies particularly for people below

250% of poverty. that would result if embraced wy congress -- the alexander collins walden stella bill would lower premiums for those in the individual market by 40% and make it more affordable. the tragedy is unfortunately the resistance that never trump approach to for the work here in the congress in washington has resulted in what used to be a bipartisan bill basically being abandoned by her democratic colleagues who refuse to even work with senator alexander and collins to work with. get a solution list premiums under obamacare. in addition to the good work that you are doing on prescription drugs which i applaud. you to continue these are two other areas that i wanted to late. one initiative by the administration to the department

of labor and the other legislative but which has been rejected pending the outcome of the midterm elections by our democratic colleagues.t since i was in brownsville on friday and our colleagues across the aisle to talk about this issue and not prescription drug costs so much i had a chance to visit to facilities in brownsville and was enormously impressed with the quality of care being provided to these young people who have been brought across the border without their parents and some with their parents and isn't it true that 83% of the individual children in care were brought or

were sent without a parent. does that figure some right? >> it is true, senator. was of them came unaccompanied some by the parents or came on their own and they find themselves in a custody. >> i've not heard a word from our democratic colleagues about those 83% of the children who were sent there by the parents voluntarily separated by their parents because of the conditions in the country in which they lived in the hope for better life here in red states which certainly we all understand. it seems to me that what is being advocated here is not zero tolerance when it comes to violating immigration laws but zero enforcement and indeed our friend the senator from california, senator feinstein, worked with a number of occasions has persuaded all the democrats in congress and in the senate, i should say , too sign on a bill that basically

provides a more enforcement zone for violation of immigration laws within miles of the border. indeed, you probably seen were some democrats in the house of introduced bills that would abolish immigration and customs enforcement. if you go on twitter or any of the social media site you will find a # abolish ice which wants to do away with any enforcement action lawsuit. we canee all agree that these children ought toan be treated humanely and compassionately and joined together with the parents where possible and there is legislation that would do that in a week that this week. >> senator, your time is up. senator nelson. >> thank you, mr. chairman. after secretary, i would like to seek some answers respectfully. to have a civil discourse. you are a friend of a n close and i respect that. on saturday i was allowed in the detention facility in, florida.

i wanted to speak with the 70 children that i was told that were there that had been separated from their parents. do you know what to's changed since saturday with those monday? >> senator, we are very happy to arrange visits for senators andy members of congress to these facilities. we do need to do so in a way that is orderly because they are trying to first and foremost the priority is the safety of the children and have been and would have been able to interact with them butth not interview them. note are minor children and there to be deposed or interviewed. want to be careful about that. that is the way not acceptable. we have to protect these children. they are in care and they are in shelter and it's a difficult situation for all a of them and i'm sure you share that desire

the best and most to be respectful of those children. >> mr. secretary, i did not ask that. i asked what has happened since saturday to those 70 children. >> well, i don't know which 70 you met with spirit no, i didll not meet with any of them. i was not allowed to. >> you are allowed to be in the presence but you can't deposed -- >> i understand. my question, please, i'm trying to be respectful but my question is the 70 that i was told were in that facility that had been separated from their parents what has happened to them? >> they would either continue to be in our care oro if they reace a point where a sponsor was in the united states as a parent or relative has been vetted and has been approved for sponsorship they would have been released as

quickly as possible to the sponsors. >> how many of those children been able to be in contact by telephone with their parents from whom they were separated? >> for any of them been separated from their parents at the time of the parents attention by the customer and border patrol within 24 hours of arriving at an oh are our shelter we endeavor to put them in touch and get them on the phone and sometimes that can happen is the parent has been ld for criminal prosecution placed by the bureau of prisons say with a county jail. it may be harder to arrange the medication.mu we are sending deployment health service officers to help facilitate that. we want every child appeared to be a vacation at least twice a week so theyy are talking by skype or phone available and we want this to b happen and so i

can't say to the 70 but also the been within 24 hours of arriving made in touch if possible with a parent if the parent was accessible. >> okay. i asked that question of the lady who is overseeing the facility of getting the children in touch and she said that a handful of the children had not been able to be on the telephone. so, i said what is your plan for reuniting these children and she said there is a lady named barbara floated us who since i was there on saturday she doesn't work except on the weekdays and i said i will try to reach barbara to tell me what is the plan.

i was prevented from speaking with barbara yesterday, monday and can you help arrange that so that i can know what the plan is to reunite the children? >> will be happy to work with you. she's not an employee in my department and she works for it would be their decision if they want to make her available to you. it will continue to work with your staff and facilitate if you wish to speak with her. >> you will not hinder me talking desperate yesterday that occurred so what is the plan to reunite 2300 children? >> absolutely. the first thing we need to do is for any of the parents we have to confirm parentage. that's part of the process with any child in her care we've to ensure there are traffickers and smugglers and bad peoplely occasionally we have to ensure that the parentage is confirmed

and that those parents to ensure there is no violent history on them and as part of the regular process for any placement with an individual. at that point the be ready to reconnect with her parents and this is where our very broken immigration laws come into play. you're not allowed to have a child be with a c parent who isn custody of the department of homeland security for more than 20 days. until we get congress to change the law for the forcible separation of the family units we will hold them or play some with another relative of the united states butid we are workg to get all these kids ready and get that all cleared up as soon as if congress passes a change or if those parents complete their immigration proceedings. we can then reunify so the president does not want any children separated from their parents any longer than absolutely necessary under the law and we want to make that happen. >> senator, your time is up.

senator menendez, senator. >> thank you. you've talked about the goal of lowering drug prices as part of the administration's goal. if they announce a reduction in thee spices would be in ministration consider what that would mean throughout the supply chain in the part d program and particularly of an announcement came midyear how it is such a change impact plans and pbm's and then if we could hold that thought what would the beneficiary experienced in the t way of changes in premiums and co-pays at the pharmacy counter? >> i will answer the second first. if list prices go down to patient benefits. they pay last at the pharmacy. that is white list prices matter

whether most patients whether part b or part d or commercial plans -- to your first question. we've had many major drug companies with major products who want to make substantial and material price decreases and this has shown just how broken our system of drug pricing and drug distribution is in the united states. the pharmacy benefit managers and the wholesalers are all dependent on getting a% of list price and the reaction to some has been if you were to decrease your price you will be harmed in terms of formulary status and patient access versus your competitor who has a higher price. i would encourage the senate and congress to inquire of pharmacy benefit managers as to whether they have received suggestions

or approaches from drug companies for lower list prices and what the reaction has been. i believe still that this will be salt and these are adults and this is so absurd and it will be fixed but this is what is keeping the individual companies so far from moving. the prices are there prices. they set the prices and they are tenable for that but the channel is not making it easier. >> i think the concern in all of this is doesn't get passed on in the form of savings to the ultimate consumer into the beneficiary. how could that reduction and tst prices be sustained over time? >> we are not counting on just a voluntary reduction of prices. it would be nice if that happened based on them seeing that this is the northbound train and this is where it is going or going to lower list prices, better negotiations, ad get on the train and get a

competitive advantage by moving their first and that is the idea but our plan will be reversing the incentives for ever-increasing list prices. i mentioned to senator hatch and it means asking congress to overturn the obamacare gets to the pharma companies of passing rebates in the medicaid program at 1% as they increase their list price it used to be your rebate would keep going up but obamacare cap that at one 100%. that would bring in billions of dollars and create a major goal disincentive to hire list prices is sustained in a lower price that we would see. >> okay. let me switch gears for a minute and i know i've shared with you how important the d plan is in my state and i'm sure it shared by a number of folks on this panel and all across congress but could you talk about what you for see happening in terms of proposed changes to the drug rebate program and the impact and even more broadly what you see happening in terms of the program realizing there are

litigation and regulatory action underway at the moment. >> as we see not expand it has gotten untethered from its purpose of helping those hospitals and uninsured individuals who have trouble affording access and we want to keep working with congress to ensure that is delivering on that promise and not being used for abuse and expanding beyond anything resembling its actual intent. as it expands as more and more drugs go through that and as the flow of money comes out of that it can lead to a cross subsidize asian problem and that's what we mentioned in ourm.m. blueprint e if used or money market paid elsewhere in the system for people in medicare, medicaid, commercial plans might be an incentive to hire list prices we want to work with you to ensure it's there and healthy andor has integrity and it's tied to its

purpose of helping hospitals and patients. >> most of the players ino. the field that i work with aren't familiar are folks who operate those programs and create integrity and support to their bottom lines which is why i think we raise this issue so often to you and other members of her team. we will continue to do that and hope you will continue to work with us and be responsive and try to work with the affected hospitals to come up with a good path forward. thank you. >> senator menendez. >> mr. secretary, thank you for coming today. before i start my questions i want to urge your staff at cms to carefullyly consider the

requests of the entire bipartisan new jersey delegation to extend the imputed rule. it is critical to new jersey hospitals both democratic and republicans administrations have extended it and i hope you will have your staff be critical attention to it. cms predicts prescription drug price growth in 2018 will be double what was in 2017ha county to the president's pronouncement that there would be a quote voluntary massive drop in prices in early june. one of the reasons that we are not seeing reduced risk of drug prices is because some bad actors continue to gain the system to prevent cheaper drugs from coming to market. in fact, the fda recently named and shamed some of the worst actors who were deliberately blocking the development of cheaper generic drugs. congress is working to pass the create act which will be a bipartisan bill that would go after the abuse of some companies that areththip preveng cheaper drugs coming to market. with the administration support the create act? >> we don't have a formal and ministration support on it but what is in the creeds act whatates completely with we have been saying and what fda has been doing to prevent the very abuses you have correctly laid out there.

>> i hope the and ministration to come to a formal position in a bipartisan ha legislation. it does exactly what the president's blueprints said he sought to do by ending bad actors in the pharma world. and so, i would ask -- let me ask after l the fda on may 17 hs there been any behavioral changes by these companies? >> i don't know if there has been a change. let me check with the commissioner and get back to you. we put out to guidances as a follow-up to that making clear that they should not be able to hide behind our regulatory process to protect safety and is part of the follow but if i do get back to you to see -- >> i would appreciate that. would you commit to work with me in a bipartisan way to ensure customer seeout st generics come quickly to the market. >> absolutely. i would love to hear from you as you learn of abuses in the system or entities that are

mutilatingtpr past processes ple consider an open door for any input or point us to those. >> i appreciate that. i familiar with the reducing drug wasteas act, also bipartisn legislation question. >> i am not. >> i like to call to attention this is a including members of this committee who have joined together because the hhs office of inspector general fund millions of dollars in waste due gto drug packaging. >> i'm sorry, he did mention this to me and i'm sorry, but i'm not learned enough of that you onm that. >> this is a bipartisan legislation and the senator from iowa and senator clovis are on a bipartisan basis are looking at this as a way to stop the basically a waste of drugs as a result of drug packaging.

i will ask you to look at that as well and let me turn to the question of the children who are being stripped away from their parents at the border. i have to differ with you. the reason we have a crisis is that the administration has decided that even those who come to a border crossing present themselves as for asylum and they are turned away at a legitimate border crossing. they come back the second day and there turned away. they come back other day and there turned away again. after traveling thousands of miles obviously fling horrific violence they are not about to not have an opportunity for asylum. the administration criminally prosecute them and in doing so separate children. thousands have been miles and i was looking at a map from where these children are and primarily it's in blue states which we are happy to have them but we don't want to have them stripped away from their parents. i heard your response to senator

nelson and let me ask you this -- will both parents that have been deported and his children are here are they going to be reunified and if so, how? secondly, my understanding is there are still 2000 minors that are separated from their parents and not been reunited and what is the timeframe. what is the timeframe that you estimated that will take place? >> as to any parent who supported -- the child has independent rights and we find that when they asked the child to remain separated and remain his country that happens in normal proceedings and i don't know if in the last couple months -- >> if the child is a minor, they can make the case for themselves. >> they had counsel and they decide to remain or they or the parent asks that we have them remain in the country. we keep them in touch as long as a child is in her care. keep them in touch even if the parent is outside the country. in terms of timing, again, we

are working rapidly to confirm parentage and do the vetting and proper criminal by context et cetera on any parents who are in custody so that we are ready to go as soon as either of the parents -- or if asylum was granted and they enter the country we could connect and then or we have alternatives that there are other relatives in the parent who is already in the country we would put them with those parents or other relatives here in the country. we have expeditiously get children out of her care and -- >> you don't have a timeframe. >> i would gladly but these children back with their parents and i legally can't because it's a 20 day mark they have to be sent back and we need congress to change this 20 day limit on parent unification. >> or we need to stoprm criminal prosecuting them. >> the time is up, senator portland. >> let me comment briefly on

this. as you know, we spent a couple years studying the issue of unaccompanied kids, you acs and hhs has, in my view, a difficult job to do which is to help with regard to kids who come without the parents, on the committee kids and we've added to that a separation of kids from families which we think is a bad idea and i commend the president for the executive order which changes that approach and will now deal with the kids in the system. even though you have a tough job to do as you may know in the obama administration in the trump administration i have not felt as though hhs has done a good job in a tough situation because they had not come up with this agreement between thet department of homeland security and hhs and there is a memorandum of understanding and commitment to come up with coming up with agreement and as recently as april we had a

hearing on this and hhs said that they were willing to take a fresh look at the questions of who has responsibility for these kids once they leave hhs and attention facility are placed with a sponsor. my concern is that no one is responsible and i got involved in this initially because of thg eight children that ended up coming from guatemalae and ended up in ohio because they were given to their traffickers in the obama administration rather than to a family. my question to you today is and will get to the drug pricing but you are taking a fresh look at this and you have a july deadline to come up with operation agreement and i don't know if you fall this closely but are you on track on the operation agreement with dhs and who will be accountable or responsible for these children

once they leave a federal government agency custody and go off with a sponsor? >> we do is dance and have a in agreement with the department of homeland security bowl betting with the sponsors and these are relatives, either parents or answer locals or adult relativ relatives. >> at the egg farm they were traffickers. >> obviously, there was a mistake and a things happen. [inaudible conversations] >> once they are placed with a sponsor they are no longer subject to our jurisdiction and we cannot pull a child back from a relative. we don't have the legal authority and they are under the state and local child welfare laws as well as they are subject to immigration proceedings that they may have but we don't have any authority to go out and pull a child back from a sponsor once they are in that sponsors custody because that would be local child welfare authorities and at that point we would.

[inaudible conversations] >> one of the concerns is that this goes back to the obama administration that they did not even tell the states that the kids were in their jurisdiction so it's hard for them to step in. again, there's an issue of getting these kids to their hearing. that is the idea and for that half of them are not showing up for the hearing which is the whole idea to get them with the family pending their hearing on their immigration status. we have work to do i know you are aware of that and i want to make sure that were going back and forth with the team and we have this operation agreement in place by july in our april hearing. >> i know senator stabenow talked about talked about the w upper crisis of the people who need to eight which is a miracle drug but the cost increases $575

for autoinjector in 2014, just four years ago, today it's over $4000 for one of these. you go on your dashboard which i applaud you for you have a -- were now we can see the duck pricing more transparently but it is confusing because it shows an increase from $739 to $4900 with the list price below these and when we push on this we are told this does not include other information like the manufacturer rebates or price concessions which seems to run the other way. we have been pushing on this and get hhs to give us an answer and why can't the information be on dashboard if consumers will have the transparency that you want and we want why can't we include what is going on with regard to the rebates or other price

concessions? >> taking it beyond the naxolone and in that particular drug disclosing publicly negotiated rebate rates are disclosing highly confidential information so let's take any other regular dog and we started publicly disclosing negotiated discounts there could be very serious competitive issues with that as a be walmarts were forced to disclose w their discounts and their competitors would love to hhave that information more thn anything. we have to be careful here. happy to get whatever information we have but an initial reaction on the issue of disclosing whatever the discounted rates would be a particular product -- >> senator, your time is up. >> it's a different issue because titus bought by some taxpayers but not by all and will i think we will end up there we have to figure out how

to get that information better. >> thank you, mr. secretary. you for your service. the lines of senator portman's original question did hhs have a role in participating in the design of the administration's zero-tolerance policy at thebo border? >> we deal with the children once they are given to us and they are unaccompanied. one of the experts on integration. >> so you were involved in planning and meetings? >> it would not be appropriate for meme to discuss interaction. our role is on receiving the children not on setting immigration policy. >> mr. secretary, is the process you described today a special process for reuniting the 2300 kids with their family or is the existing process that oh oh are

uses for unaccompanied minors? >> this is process we use for any child in her care to ensure safe placement because unfortunately it may seem like their parents came acrosss them and they will reunite them but unfortunately these children are often being captured by traffickers, gangs, cartels and that journey through mexico is a horrific journey of rape and violence and deprivation often the individual but we do see traffickers and very evil people claiming to be the parents of children so the same protections we have for any on the company children are vitally important in terms of determining parentage and betting. >> i can appreciate what you can't answer precisely why whenever a child will be reunited but could you give the committee a sense of whether you are talking about days or weeks or months? what direction have you given hhs employees or contractors to

do the work that i'm sure you feel is urgently about as we do? >> getting the children united but i cannot reunite them while the parents are in custody because of the court order that doesn't allow the kids to be with her parents for more than 20 days. i find it hard to imagine but congress needs to fix that. i want the kids ready and want the parents confirmed and vetted so they can place them as soon as it would be either congress changes the laws or parents are through the immigration proceedings and ready to be deported or leased so thator we are ready to reconnect them. in the interim have a separate legal operation to keep working to expedite their other sponsors in the country and different parents or other relatives that i can place them with because i can have them with us any longer than necessary. >> do you imagine thatce this wl

be having this conversation weeks from now or do you think this will be resolved we saw now? >> if congress does not change the 20 day limit on unification then it depends on the process for any individual parent going through immigration proceedings as long as they are in detention they can be together for more than 20 days of certainly but it is the case. >> what is the age of the youngest child? >> we have infants in her care, as senator, as shocking as it sounds we always have infants in our care, just straight unaccompanied infants left on the border. >> what is the youngest? >> we have always had infants from parents or smugglers orr traffickers who leave or have lost a child at the border and there placed in our care so we've always -- the program has always had devastating tragic as it sounds. >> what happens if the transparent is already completed

expedited removal proceedings and has been deported? notified andild how long does a child have tod wait to be reunified under those circumstances? >> the parent wishes to have the children reunified weth will wok because we have to confirm the parentage in the vetting to ensure that even in a foreign country to ensure the parent doesn't have it any information suggesting that we are placing the child in jeopardy and we worked with the home country for the transfer of the if it is the parents wish where a child may assert their own right to pursue asylum or other claims that they have independent t of their part and they seek to remain in the country and remain in our care because of their lawyers. >> there are children from certain countries treated differently than other countries? was everyone treated the same? >> everyone is treated in our

care the same but immigration laws are different. mexico and canada have different provisions and the process there around deportation that i am not the expert in but children in our care we treat all of them the same and we attempt toer reconnect them or get them to sponsorship as quickly as possible. my be dependent on corporation with countries getting those. certificates through confirmation. >> senator carper. >> welcome, thank you for being here today and responding to our questions. i wanted to follow this briefly on the issue of her children at our borders. we are paying a lot of attention and itit needs to be dealt with. i spent part of yesterday with

jay johnson was a previous secretary of health of homeland security talking about the same issues from his perspective. one of the things that we discussed was is important to get right what is going on the border and in the spirit of matthew 25 when i was a stranger in your land you welcomed me and i think it is important for us to focus on that and feeding these kids the way we would want our kids to be treated. the other thing is important for us to focus on the root cause for why these kids and families are coming to our borders. i remind my colleagues 20 years ago in columbia a bunch of gunmen rounded up the colombian supreme court members to come in to a room and shut the death.o shut them to death. you had the druglords and the

leftist guerrillas and almost working to bring down the government of columbia and desperate times from leaders inn the country and said we will not let this happen. those leaders were supported by bill clinton, joe biden, the chairman of the foreign relations committee to come upit with some plan in columbia which is why we can do it [inaudible] we have a similar approach is not but those -- it's a plan for columbia for those countries. it is many of the same things

and we are in our third year on this and we need to continue to fund it continue to oversight on that and the reason why people come to our countries is because they are leaving horrific lives. we are complicit in their t misery. we have a moral publication to help them where trying to do that. i believe that here in my colleagues feet really. i want to talk about value -based pricing we talk about this before and i like to say everything i do i know i can do better that is true of all of us and in the delivery of healthcare and pharmaceuticals. as discussed, reimbursements for drug is a top priority to not just reduce drug prices for seniors and it might be medicare

but for our government and taxpayers and regular ordinary people. what are stakeholders, in your policy experts, telling you about value -based contracting of prescription drugs and how this policy could improve affordability for consumers and our government programs and ultimately for taxpayers? >> senator, thank you for your leadership. we are already moving forward on that and commissioner gottlieb is just recently put guidance out to create a better pathway for sharing of information and discussions between pharmaceutical manufacturers and insurers around economic information in the plan for new product launches so they can collaborate and build those value -based treatments as quickly as possible. we are working on guidancee around reporting and a kickback statute roles that can again create a greater pathway around how we private actors set up the

value -based range was there. it's a feature of how we do pay for drugs and paper outcomes for healthcare and brinkley, i love to see it if theymo can be more incorporated into the overall holistic health of the patient and more of a bundled notion and that is probably long-term in the future rather than a payment on the drug itself. >> what actions do you need from us on the side of the dais tosu enable you to implement these value -based pricing to ensure that spinning for healthcare services and products are in line to overall healthcare cost? >> i believe we have the authority to greatest pathways around value -based reimbursement models directly with through the anti- contract and if i find that revelatory authority is limited i will come back to you and ask for that authority because it is a critical. >> senator, your time is up spirit mr. senator, i want to thank you for holding this hearing. it is terrific. the proposal from the administration, broad proposal, it's like a small team that has a lot of singles and doubles.

i don't know of any home runs but a lot of single and double's and we can work together and score points on the boardrd for taxpayers and citizens and it'ss great that we hear doing this. >> that sounds like a tripleet o me. [laughter] senator cassidy. >> thank you for being here. let me start off with a specific drug and then we will build from that into a line of questioning. in the past we have spoken of a drug that was released in 2001 which used to be probably a couple thousand dollars a year and now i am told that it costs $8800 a year in canada and it costs $144,000 here in the united states. as you and i both know the way that the catastrophic coverage works is that once someone moves into the catastrophic portion the beneficiary is responsible

for 5% of the list price, not that that price. i have a former patient and i'm only former because i'm no longer practicing but she is paying 5% of $144,000 for a drug which is been released since 2001. now, my staff tells me that the company that owns a struggle is extended the ability and the patent protection from if you will, with agreement for the generic in competition. senator stabenow asks will be about this and you responded that we need competition. i would say what we do about this? it's been available since 2001 and canadians spend less than 9000 and. that is -- are 5% of the list price patient cannot afford. what to do about that? >> senator, i may be misinformed here but i do believe that the generic is available.

>> let's say that we are back in 2015 or 16 in which this would apply and again, a drug 15 years after release is 144,000 because there will be another one if there is now a generic. how do we address that? >> one of the items inlt terms f affordability that we have is in the president's budget which i would love the chance to work with would be to create several changes and one of which would be a genuine for the first time ever ranking member widen has a separate piece of legislation to this fact that a genuine out-of-pocket catastrophic -- >> let me pause on that. as we both know for context one of the pernicious effects of the rebate system which we have is that moves people more quickly into the catastrophic but even

if it's protected the taxpayer is on the hook so i'm looking here and a cms report which says the federal taxpayer out lies or outlays to pbm's and then increases from 11 billion in 210,233,000,000,000 in 2015 and so the taxpayer is getting hosed. even if we protect the patient with 5% how do we protect the taxpayer? >> you are absolutely correct. glad you raise that because that is one of the five-point changes to part d that we propose in our budget that we would reverse that in the catastrophic benefit to ensure that the pharmacy benefit manager is very 80% of the cost and taxpayers only 20% so the pbm's have more skin in the game to get that list price control because -- >> would be changed so that it's only been price and as opposed

to the list price? >> it would be total expenditure but that would be because the list would do and that the pbm's would have more incentive to get that list price controlled not just the net because they are curing 80% ofl,'r that. >> i see the proposal is that currently and maybe one proposal would get rid of the rebate structure again altogether but the third is that a third of rebate would be returned to the patient at point-of-sale and why not one 100%? why should the patient forfeit two thirds of that amount? >> that may be where we end up in terms of fixed pricing at the point of sale completely in the budget proposaloi we proposed oe third and honestly there's a significant debate about the issue and we think it's the right thing and the patients should get the benefit -- >> i don't mean to cut you off but i'm have limited time. if the if part b does not come

into d let's imagine another drug in the part b space in which we are paying that and he was taxpayer is painless and were of but overseas they are paying for less. when that reference pricing and let's take our five biggest developed countries like germany, japan, australia, kennedy in canada, britain or france and let's have a multiple price like 1.6 or one point to but it will be 14 times such as wast the case and imagine again within the part b space were not reference pricing? ... statement.

i wanted four things, list price, negotiating tools, cost share and the foreign outlook. on plans for plans for negotiating, one of the best negotiating tools about their is the provision of the basic health plan or essential plan that is now operating in a few states where families can have, basically the state ends up negotiating. they negotiate on behalf of of a large group of individuals. those who may not along to a large employer or employer who doesn't have insurance. those can see as little as a six-dollar co-pay for generics, $15 for bran drugs or three dollars for those off the formulary. in my mind, that's a great model. why? because it's a negotiating tool

by creating margaret leverage for a large group of individuals. they wouldn't have market power, i call it the costco model. if you buy in bulk you should get a distant. that state buys and bolt and is getting a discount. why should we continue to look at that as a model? >> i will learn more about how the basic health plans are doing that and as long as it's done in a competitive framework of competitive insurance as opposed with any preferential scale. those kind of collective aggregations is exactly what we do impart the and that's where we get such good deals through private plans. >> i think you'll find in new york i think there's 13 different insurers that are bidding into that market. what they like is another bidding on 650,000 people so they're willing to give a discount. i'm looking for market power for

individuals who are finding it in other ways. >> and happy to look at that with you. i and you. i know you've had a bunch of water in your face but what beyond confirming the relationship between child and parent and the criminal check background, what else needs to happen for here to be processed? >> in terms of reunifying her with her child, first off i want to ensure she knows where her child is and she has been able to communicate. if that's not happening please let me know and as we do with

all the children and parents, we want to make sure that's happening. >> she is not been able to talk to her child. >> we will make sure that happens. we are working fortor everyone o be in regular communication. i i read. all. if she completes her application and she's admitted she could be reunited reunited. if she's deported she would be reunited at that point. i just don't see why we send a child back to her while she's in a detention order. congress can change that and we hope they will. >> i think what you need to hear is that this problem, in her case didn't exist prior to this administration changing the law. in that case she is seeking asylum to come to our border and

ask for asylum and would have been processed in a way that she was either being able to stay in the community with her child and not seen as a threat. this administration is turning her into a threat. we want due process, we want people to be understood, but people seeking asylum should not be treated the same way as some criminal that the president is now talking about obsessively. we want people of criminal backgrounds to be stopped before they even get into the united states. but, we want those were seeking asylum not to end up in a detention center never to be heard from again or have to be brought up at a hearing as a way to get attention to the case. >> i don't want to speak about her case because i do not know about it but if they present a lawful border crossing as opposed to coming illegally into the country they will not be separated for they will not be arrested but they're not violating the law so the challenge here she came in the country illegally and we have laws and we are enforcing the laws.

>> i will want to find out besides doing that background check, and the heritage, how long will it take her to have that process? one of the other steps you have to take. >> those would be the steps we have to take but she can, she has to receive the child. if she is in custody i cannot reunite her with her child. >> i'm asking you how long it will take to do both of those things. we are going to get back to you. there's no deadline on it but as quickly as possible. >> i think that's what we want. the problem is one have to confirm her heritage. if she's from honduras i have to get a birth certificate from that. >> think there's technology that can help speed up this process. >> we be happy to. >> senator chief casey. >> mr. chairman, secretary, thank you for being here. i wanted to ask you about the issue of conditions, were told this affects 130 million americans so a lot of people are affected by it.

i know when you were here last, when you read the help committee senator hassan asked you a question about it and you said, regarding the issue of pre-existing conditions in the attorney general's legal position, you said we share the view of working to ensure that individuals with pre-existing conditions can have access to affordable health insurance and that you also look forward to working with congress under all circumstances to achieve that. because it does affect that many tens of millions of americans, there is, to say there's an uncertainty with regard to this because of what the administration says in a legal proceeding in a case and what you said here as the secretary, there's a lot of uncertainty and if there is one aspect of our

healthcare policy that needs absolute certainty it is that both parties, both houses with the administration is going to guarantee that no one who has coverage now that has a pre-existing condition will lose it and no one in the future will have that uncertainty. i guess one of the first questions i have for you is what have been your recommendations to the president regarding how you and the administration generally are going to maintain those protections for people with pre-existing conditions. >> so of course my discussions with the president are not something i'm at liberty to discuss but the administration's position is we support rim cassidy, the proposal in the budget in the 2019 budget and as part of that it would provide first states an alternative mechanism to say an individual mandate as a way of protecting pre-existing conditions. in terms of litigation, the litigation in texas versus cesar

that you're referring to, in that litigation that is a legal position, constitutional matter regarding the impact of the removal of the tax provision and the impact on the mandate and following the obama administration views of dutch tory construction the other provisions must fall if that provision falls. we are operating the 2019 program under existing authority of interpretations as if everything is remaining as it is so we are doing everything to keep stability in the program and operate the program as it is. >> mr. secretary, why not take the uncertainty off the table. just say we will support the policy no matter what. you're not forced as a legal matter to take a position. the administration has chosen to take that position. there's no mandate that you take that position in a court of law

or otherwise. why not just say were to make sure, by way of policy, by way of any other action the administration takes that everyone who has a pre-existing condition will have coverage or treatment the matter what, why not just make that the position of the administration. you don't have to tell me what you told the president but it ought to be clear to the american people what the administration policies on pre-existing condition. 130 million people. why not make it clear that that's in essence a broad statement of administration policy or whatever the hell we call it these days. just be clear about it. say that there's no question this administration, hhs, the white house, the department of justice, no one, no institutional entity has a position other than we will guarantee, not have access to coverage, guaranty because

that's what the law provides. why not they were just going to uphold existing law. you can have your debates with us about a lot of other issues but my god, why is there any uncertainty at all? >> of course we are upholding existing law in the position of the attorney general is the position as to what the existing law is in the statute and before the court, but the policy position of the administration is that in whatever framework we have around the individual markets we support solutions to prevent to ensure people with pre-existing conditions have access toh affordable insurance and we workre with congress. the affordable care act, if those provisions are found to be invalid we will work with congress to continue the efforts to find alternative way to provide alternative insurance. >> it sounds like a lot of legal mumbo-jumbo. why not make it clear that the policy. >> we are country of law we follow the law. my policy preferences and become law. >> you can get to the same

outcome by saying we will ensure people have this protection. >> senator mccaskill and i thank you. i will follow-up with the same topic senator casey was on. saturday the president of the united states said in a very public rally, he was being critical ofwa senator mccain who voted no on the republican plan to replace the aca. then he said, i'm quoting, it's all right because we've essentially got it anyway. do you agree with the president statement? >> what the. >> is a simple yes or no. either you agreet with the president. >> without y the individual mandate, individuals are now free, the liberated from having to pay attacks by insurance that they do not want and cannot afford and that's why i believe

what the president was referring to. >> haven't there been other steps they've taken t that have been resulted in much higher premiums on individual markets. >> no. the steps we are taking her to try to provide. affordable options. the 28 million who have been locked out of the insurance in the individual market with continue to try to find affordable options for them in the system. we've tried to work on a bipartisan basis to get congress to appropriate csr's, to stabilize the market. >> you support those. >> we did support what was bipartisan legislation to fund and create reinsurance. at the end of the day, bipartisan support on the alexander collins act and nelson package. >> i think there is bipartisan support. >> if it were it would'vet. pa passed. >> the president personally pushed for its path. >> secretary that bill has even been brought to the floor. mitch mcconnell decided we are not allowed to vote on that

bill. you all are in chargey, of healthcare. you control the white house, you control congress in this bipartisan bill you speak of, first of all the president went back and forthye as to whether r would ever be paid. you know that. so yes we got together in a bipartisan way. i think the term attention chairman will not argue with me. those bills are sitting there and i think that got 60 votes. the republican party, i've not seen the president at a rally thing let's pass the csr. i've not heard him in a rally saying let's stabilize with reinsurance. i've heard them say we've gutted it. >> if i could interrupt for a second, i have to say leader willing to did this but the democrats objected to it. >> mr. chairman i will guarantee you this. if mitch mcconnell will put on the floor the bipartisan pieces of legislation that have been negotiated to stabilize the market, you will pass that bike,

i can imagine there's any democrat that would vote against that. i don't know what the negotiations are these magic rooms but none of us get to see, the same place the tax bill is done in a appropriation bills were done. we don't get to see what's going on. >> i'm not sure what happened mr. chairman because we aren't allowed to be told or we don't see. but i know this, the president isis proud that they have gutted this and i want to offer into the record a very important document which is a document that was received and not made public. it was received back in 2101 house with his investigating the way pre-existing conditions were handled before the aca protection. i would ask unanimous consent to enter into the record the humana agent eligibility and underwriting guide. >> without objection. >> this document goes through.

the ministration upon the court to do away with pre-existing conditions. the attorney general has gone to court to do away with pre-existing conditions, protections in the united states. there were 400 things listed including high blood pressure and what it sayslo in this document, the low conditions are permanent decline unless otherwise indicated. everythings from autism, diabetes, pregnancy, high blood pressureh and denying workers to get insurance for minors and airline workers and others. there were -- they were told not to write insurance for them.

they say do away with all the consumer protections are put in the aca to prevent the people that have the 400 different conditions that said don't write insurance for these people. i understand you can say it's our fault somehow that this legislation is in getting past but i think you might be blogging to make an independent judgment. thank you, mr. chairman. >> thank you senator. senator brown. >> german hatch mentioned that over a month agot president trup hosted many of my colleagues in the rose garden to tout his drug pricing blueprint promising massive cuts to drug prices. weeks later, as the ranking member pointed out he double

down on his commitment to the american people. stillh later we're waiting for these massive cuts the president promise.ee my guess is we'll see dozens more increases before we see cuts. you agree there scenarios where pharmaceutical companies increase the list price of their product and price gouge in order to increase their profit margin. >> of course we've seen examples about. >> the fact there's no repercussion for companies that engage in this is a problem that contributes to her broken drug pricing system. let me read briefly from a letter i received. she wrote my husband takes numerous medications, many that are expensive but one gets my attention. i was preparing our tax returns,

the generic price fluctuated between $1000.3000 for 90 day supply. i started asking why the price was so high but didn't get a satisfactory answer. we recently refilled the prescription for 90 days and it was $6000. generic drugs are costing more than those because medicare can't negotiate drug prices in some unscrupulous companies see that as an open door to gouge the government and the rest of us to. the prices included in the blueprint to lower prices or shift costs along the supply chain are not enough to fix this broken system. there's nothing in your proposal that would prohibit or penalize the actions that areio gouging ohioans. the government

needs tools to prevent companies from jacking up the price of life-saving drugs to make millions off the backs of hard-working americans who lives literally depend on these medication. we need to i hold that actors accountable by imposing penalties on corporations proportionate to the severity of their price gouging to hold bad actors accountable which is something we rarely do around here. we commit to reviewing this legislation on working with me on finding a way to prevent pharmaceutical companies from parties gouging consumers. >> actually. you.appy to work with we agree price gouging, our plan addresses that.

we want to give part d the ability midyear that if there's any price increase to allow the formulary to be reopened immediately. we also want to open up medicaid rebate so there would be uncapped liability based on that, price increase. if there's a part d grade drug we have inflation penalty for drugio increase above the rate f medical inflation. >> that's just part d, not everyone we need to protect so work with us on that last thing. i know many metallic have raised collective concerns to separate children from parents, something that our government, something that's shameful and embarrassed all of us as members of this government. i understand policy that dhs

that remain in flux but the situation can use the troubling to anyone paying attention.. last week facilities were preventing children from comforting one another. i sent a letter concerning the care provided for, type children at hhs facilities. regardless of the topic i had trouble getting written answers to my letters. please commit to getting me a response that letter by the end of this week. >> i haven't seen that particular letter. i will get that response. in terms of comforting, there are no restrictions on comforting of underage children or any other provision other than state child protection la laws. there is no basis for what the individual reported.

these are normal care facility subject to state law. these grantees and charities, i cannot tell you how seriously they take their mission to care for these children. >> i wish the administration your part of the equal care and caring for children. >> your time has expired. >> thank you. i will begin by echoing senator menendez comments about the rural floor problem. that will create a market shifting reimbursement left around rhode island differentiating it from massachusetts and connecticut. it doesn't make any sense to undo what has been the status quo for years and will continue tok work to make sure we don't create that anomaly.

i think we had this conversation before but one can generally divide pharmaceutical market into three cardiac brace. one is where there is a functioning competitive marketplace. the other is where there's a legally approved monopoly protected under patent law and the third is where company enjoys a de facto monopoly and there's not real competition and it's in that sector of the pharmaceutical industry that we have seen the worst misbehavior. my concern is that you get these companies that buy up a drug manufacturer that no value, invest in the research but simply crank up the price for

speculative purposes. you agree with me that these defective monopolies do exist in the prescription drug market. >> i do. we have seen not with these full source generic that senator brown and i were just talking about. if you see a branded company abusing the system for past the expiration of their patent, so the concern i have is that we are not seemingly addressing that problem. i know you've proposed reopening of formulary but if you have a situation in which a drug manufacturer has a de facto

monopoly, they were able to succeed at the original low price that the speculator came in and bought the company and bid up it is always within their capability to drop back to their original price should a competitor emerge, and price of the competitor. you can play the market in that way and the threat that something might reopen a formulary in the very helpful not case because a wise speculator will happily bet that no one will come and that marketplace because they can stop the price in t and drop thm back out. it seems to me we have tools that go back to the age of grain silos and when dealing with monopolistic behavior.

why not use those tools once particular entity has been determined to be a a defect on monopoly in many cases not even a member of the pharmaceutical industry. just a speculator trying to squeeze money out of the system. >> i think that's a fair question looking at policies and competition when there's no circumstances to see if monopoly power is being abused. i will follow up on that. i think that the fair thing to look into. we n do need competition. >> we all agree on that. one of the things we asked about was whether were actually in this country and under reimbursing for generics. we need a stronger genetic market. we may be driving up prices so low that were creating manufacturing anomalies.

we need to be open-minded about whether we've actually made it to low. >> i think in the area of de facto monopoly it would be hard to identify an agency of government that actually has response ability in that area. i don'trn see d.o.j. showing any signs of life so i think that's part of the problem right ther. i will ask you a question for the record related to what i'm hearing about very significant problems getting drugs in emergency rooms. this way when you see the q a fargo mill this was a question i was concerned about. >> thank you. >> senator warner. >> thank you, mr. chairman. it's good to see you again. i know there's a question read drug pricing today but i have some questions about the ongoing crisis about the children of the

border. department of human health services has contracted facilities to house thousands of unaccompanied minors including one in my state the shenandoah valley, the juvenile center near the virginia with her have been very disturbing reports of abuse and lawsuits filed as a result of those accusations. i think the administration, i sent the multiple letters on the need to get information back my hope would be that we can get thosee responses moving to know if they are able or willing to comment on the accusations made about the center and stanton. >> without regard to the particular individuals involved, it's important to know that we get these children into our care they are immediately evaluated for mental health and behavioral evaluation as they are with any childrenen.

we have 12000 children in our care, 60000. year. some will need extra care such as mental health and may present a risk to themselves or others. we have contracted with some facilities including one you mentioned that specialize in juvenile care of a special need for those whoee may be a risk to themselves or others. our children are kept separate from the rest of the juvenile population. the separate grant provision. they fully comply with all state licensure, state laws around medication, et cetera. we oversee that state licensing authorities, honestly we take any allegations racers like, we got proper care for these children. any allegations are quite .isturbing i have seen nothing toot confirm the nature of those allegations but we will certainly respond and work with you on. >> i hope with the reports i have, of minors being kept in solitary confinement for 23 to 24 hours and being strapped to

chairs without any clothing and having bags over their heads, i hope those are all practices that seem inhumane and worthy of a great deal of review. i just wondered, i understand you might not be able to speak to the specifics of what happened and stanton, what level of training do they put her guards in these type of facilities if ineffective place. >> without in any way knowing or being able to confirm the validity of any of those allegations, this would be subject to state requirementss and licensure around the care of.nt and so whatever the state licensure requirements are and oversight in addition to our

oversight, i don't know that we have separate training in addition to state licensure requirements for the juveniles in those detention facilities but i do not knowe the answer. >> we have sent a couple of letters. the sooner you can give me a response on the better present me move to an area senator whitehouse already talked about and that's around the pricing of generic drugs. we saw a great deal of relief 15 years ago but you've indicated in trying to price right below theh price point sometimes margins are so thin that companies would not continue to produce older patented drugs and the ability to keep competition in th generic marketplace to medically declined. what tools have human oppression proposed for you and cmm i to

try to increase more genetic generic competition and build the market where there o might actually be three or four generics to provide that price competition? >> i absolutely agree with you and if youyo have any suggestios i welcome them. we are working, the fda commissioner is working to ensure that if we have any product approaching course status as generic that would make it clear to other manufacturers but that's a market opportunity to make expedited pathways and streamline any process we have to get products to market to compete bring them in. we need to look on the reimbursement side where the request for information. any help youou can provide, it's an open book. >> i do think pricing transparencyci and more knowlede within the marketplace possible opportunities seeking actually see whether the market will

perform or whether we need other things to spur this type of competition. thank you mr. chair. >> thank you senator fred t my partner would like to ask a question and determine. i have one last critical question and then a matter we have to clear up and will do that as part of my closing remarks. mr. secretary, earlier is. asked you what you were doing to help the 42 million seniors of medicare part d with their skyrocketing prescription drug bill. you deflected the question by talking about other matters and after asking you again what you are going to do to help the seniors on part d, i got your exact quote here. you said this morning you hope that the big drug companies will

exercise pricing restraint. as we begin to wrap this up, i justin have to tell you, to get real pricing relief for those millions of seniors i've been asking about on part d, is, take a a whole lot more than your hopes that your former ceo pharmacy colleagues are just going to step in and help those seniors. my last pharmaceutical question deals with another matter will determine whether were actually going to get some results here or just forcing you to make these big promises. press reports indicate you and your office are negotiating directly with drugmakers to lower the price of drugs like insulin for patients who pay cash other drugs. is that correct?

>> that story was a mystery to everyone that i have spoken to at my department. we have node idea what that wasn reference to. >> so it is not correct. >> i am not aware of negotiating that the cms is doing around cash pay on any product. we are having discussions with drug companies that are thinking about decreasing their list prices to see if we can help clear barriers, do anything inn the channel, working to see how that can be facilitated to drive prices down, but that story was a mystery to everyone i asked about. >> and let's make sure we understand what these conversations are all about. need them as negotiating.s >> know. companies are seeking to lower their prices are facing barriers from wholesalers or pharmacy managers, we areen attempting to seek if we can clear any

barriers that we have regulatory or political around not too help facilitate that. anything that we do, you made a statement about my previous answer and i think you sort of cabin did as if it didn't relate part d. anything we do to lower list prices will help our patients in part d because of the cost sharing. our five-point plan in the president's budget would decrease patient out-of-pocket cost sharing by tens of billions of dollars if only congress will pass the five-point plan that we have. we want to fix the star system and protected class to allow genuine negotiation against the drug company in part d were now they're not paying commercial level rebates. we want to empower greater competition. >> you are a smart fella and good at this but that's not what you said. >> lives at it now. >> well great, but earlier you said you hope, i'm just reading it to you. you hope they will exercise

restraint. >> listen. i would love it if drug companies cut their drug companies on their own. it would be great also if there were no price increases. that is not our plan. our plan is that we create the regulatory and financial incentives competition negotiation out-of-pocket. that is our plan. those would simply be ancillary benefits. our plan is to get that to happen actions. >> i just wanna wrap up with one other very disturbing aspect of this hearing that you told me a little bit ago that the department of 2047 kids in its custody. >> thatdy are separated. we got about 12000 unaccompanied in our program. >> so little bit after you made that statement you said the department has 2053 kids and that was the same number that

was reported six days ago. >> that was number in aix press release yesterday. by the evening it was down to 2047.ly the press releasese shows the 22053 but as of last night the last number was 2047. we have them in the system. the public there's a mystery. as we outplace these kids to parents or relatives, that rnumber will change. >> secretary, the point is, in both of these areas we talked about today and with respect to prescription drugs, i don't think you're going to fix the problem sky rocketing prescription drug bill if your former industry colleagues get off the hook by your signaling at a hearing like this but you hope that something might happen and i don't think we are going to solve this calamity of kids being separated from their

parents at this kindpa of pace. no matter for talking about 2053 or 2047, it's going to take you months and months and months to bring these kids back to their parents and back to safety. on both counts, i sure hope, your smart guy, there's no question about that. i hope we are going to see action rather than this continued effort to offer us rosy projections and happy thoughts that for seniors won't help them when they get mugged at the pharmacy window and for the kids it's not can help them get to safety anytime soon. thank you. >> mr. chair and we ask unanimous consent before we conclude. i would like to relating to the

floor issue. i have a letter from the hospital association of rhode islandti expressing concern abot the boundary effect that this will create, also a letter from our governor expressing her concernnd and also a delegation letter from the rhode island on occasion to administrator verma. mr. chairman this is important toto us. >> i will make that all part of the record. >> think you. >> mr. chairman are we going to secondt round. >> no, i think we've got to respect, sure you can ask one question but i'm not going to a second round. i think the secretary has been more gracious and answered every questions and answer them wells far as i'm concerned. >> mr. chairman, thank you.

i know the secretary has been here a while. very briefly, this issue of children at the border in the separation policy, i've said at the policy straight from the pit of hell i think most people agree with that. i know the executive orders in place but the problem is zero tolerance led to the problem of separation and zero tolerance will continue to separate children unless you change and have alternatives. here's my question. you've read all of the statements made by medical professionals all across the country, one from the washington post, doctor charles nelson pediatrics from harvard said the effects on children would be catastrophic. you heard from the academy of pediatrics, we've all read the, statements about the adverse ana long-term permanent damage it does to children. some of those imagers being inflicted even with their parent in detention. what if any of these

organizations that live their lives to give us information about the effect of a policy like this on children, whether at the academy of pediatrics, the american psychiatric association, for folks with children and individuals with disabilities, the university center on disabilities, has hhs or did hhs in the lead up to this policy or once the attorney general announced zero-toleran zero-tolerance, did you or anyone ofnc the hhs or the juste department ever consult with the american academy of pediatrics? >> first i want to share your concern. none of us want impacts on these children. none of us want the separation. we do everything we can to mitigate any impact on these children with mental health care, medical care, dental,

vision, education, activities, athletics, we try to ensure as happy and safe and good as an environment for people who enexercise real compassion on them. i'm not aware of engagement with any of those particular groups and i believe our administrator has been working with or are with her psychiatric expertise. i believe that's the case. certainly our grantees are trained in and have clinician care as every child goes through mental health evaluation and mental health care whether there but it's not a desirable situation have children separated from their parents. the parents didn't bring them across legally this would never happen. we are we are we are in terms of the ones who are separated. we want to reunite them and we will get rid of the 20 day ban and we will work so quickly to

get back children back together with their parents. we want the reunification. we want these kids well cared for. >> and we have to go but i will submit some questions in writing for you to answer as part of the record with regard to kids with disability and down syndrome and how they're being cared for, how many kids you have under your care so i'll be cementing those for the record. >> thank you for the extra time. >> thank you senator. i just want to say, i've only been here 42 years and i've seen a lot of witnesses in my time and certainly a lot of them on healthcare and a lot of witnesses who have been in your position. i've never seen a better witness than you. you are clearly very competent and doing a really good job, you've been saddled with some very tough problems and i have confidence that you will handle

them expeditiously and well. i'm really proud of you and i think everyone in america ought to be proud of you and glad you are in this position. to add further clarity to what occurred on the alexander stability package, i want to note that when senator collins asked for a unanimous consent, senator murray objected. they seem to have no interest in working with us to stabilize the individualal market.

that i want to personally extend my congratulations and complementon you for the efforts you put forth, for the care you've exhibited, for the kindness that i've seen. keep it up. these are tough times. these are tough issues. these families are all suffering. these kids are in danger and i'm just glad you are there. i think people ought to be thanking you rather than criticizing you so i'd like to thank everybody for their attendance here and participation in this - particur hearing and again thank you secretary is our prayer excellent testimony. i asked for any member who wishes to submit question for the record do so by the close of business on tuesday july 10 and with that this hearing is

adjourned. [inaudible conversation] [inaudible conversation] [inaudible conversation] [inaudible conversation]

[inaudible conversation] [inaudible conversation] >> coming up on c-span2 from our weekly program the communicators political reporter carrie bennett discuss how china is gaining access to u.s. technology. and what the u.s. is doing to protect it. then i will republican senator chuck grassley on the role of congressional oversight. later, congressional hearing on

sec oversight. live later today president trump will be in weitzer silver springs west virginia to honor members of the military. this week, but tv is in prime time starting tonight at eastern newt gingrich with his book trumps america the truth about our nation's great comeback. wednesday at 9:00 p.m., in-depth fiction addition with brad thor michelle obama on her upcoming memoir coming in friday at 8:00 p.m. "after words" with barbara and her book natural causes and.

watch tv in prime time on c-span2 sunday night on q&a freelance journalist tom dunkel on his washington post magazine article locked and loaded for the lord. >> what is going on in century church is a co- mingling of a lot of undercurrents in the country of religion, politics and guns. it's a degree we have seen before. it's still small church, there's no question about that. they have a worldwide following, maybe 200 people in the congregation in pennsylvania total and 500,000 worldwide. in these days you can follow church on youtube all the

sermons are webcast and that co- mingling i what is the culture. when you get the genie out of the bottle of mixing guns and religion in almost any society, it's usually been problematic. >> sunday night at eight eastern on c-span q&a. >> is part of our 50 capital to her and with the help of gci cable, the c-span bus visited alaska with anchorage, the final stop on the tour. >> c-span plays a critical role of making sure america's democracy is functional, provide the common understanding of what's going on and also provides a window into washington d.c. but those of us

who are far distance away can see what the current. >> we believe it's important to offer c-span to our customers because we believe in them network mission to be an unfiltered and trusted media source. we proudly support their efforts to educate and inform the world on policy, politics, history and current events. >> join us july 21 and 22nd we will feature our visit to alaska. watch alaska weekend on c-span, c-span.org or listen on the c-span radio app. >> corey bennett of politico is sensitive technology developed here in the u.s. for sale worldwide? >> absolutely. it's for sale in a number of ways. obviously you can straight up purchase technology and sign a contract with company but perhaps one a more