as i said, the problem of opioid addiction is not just health. it's also housing. and this legislation will provide a way in which we can help the homeless and deal with the housing issues in order to make people less vulnerable to being left out of the opioid recovery. it does deal with the underlying causes with research and development and nonaddictive painkillers to get c.d.c. grants and to look at mechanisms that control prescription drugs. and it does deal with the killer effect of -- that we have in fentanyl. fentanyl, as you all know is a synthetic drug primarily produced in china but there are other sources that come into this country that are mixed with heroin causing in -- causing in many cases instant death. this will provide a way which customs will have greater enforcement to keep fentanyl out of the united states and provide protection for first responders

so they can protect themselves. because they go on a scene, there may be fentanyl there. they don't know it. they can become afflicted by this synthetic drug. all this is good news, madam president. i only scratched the service on a lot of the provisions that are in this bill. it is a comprehensive bill, it is bipartisan. it represents the work of several our committees, including the senate finance committee, which i proudly serve on. i urge my colleagues to support this legislation and let's increase the federal government's role in partnership to deal with this crisis in all parts of america. with that, madam president, i would yield the floor.

the presiding officer: the democratic leader. mr. schumer: madam president, over the last -- over the past few days, new allegations have come to light about president trump's nominee to the supreme court, brett kavanaugh. these allegations ought to be treated with the utmost graffiti. the allegations are extremely credible. they were made by someone who voluntarily submitted to a lie detector test and had been discussed in the past, long before kavanaugh's nomination to the supreme court with a family

therapist. i believe her. many, many, many americans believe her. many, many women in america who have been taken advantage of certainly believe her. for too long women have made serious allegations of abuse and have been ignored or dragged through the mud. it would be a disgrace if this body and our fellow republicans let that happen. chairman grassley must postpone the vote on judge kavanaugh's nomination until, at a very minimum, these serious and credible allegations are thoroughly investigated. the f.b.i. conducted a background check on judge kavanaugh before these allegations were known. the f.b.i. when they did their background check had no knowledge of what went on here. so it is now the f.b.i.'s responsibility to investigate these claims, update the analysis to judge kavanaugh's

background, and report back to the senate the f.b.i. is the right place for this investigation for two reasons. first, the f.b.i. has the resources, the information, and the legal tools to conduct an investigation the right way, far better than some staffer talking to professor ford on the phone. you cannot lie to the f.b.i. that's a crime. the f.b.i. will get to the truth. they almost always do. second, our republican colleagues have run a transparently partisan conversation process, and then they immediately insinuated that dr. ford is being untruthful. republicans and their staff cannot impartially investigate these allegations. they've already said that they're not true.

republicans and their staff cannot do this in a respected way because they have run such a partisan investigation thus far. there's no bipartisanship here, none. so to have any credibility, this has to be done by an independent , outside body. the f.b.i. is the best one. the vote must be postponed until it is complete. it is an insult -- insult -- to the women of america to rush this through after these serious allegations have been made. it is an insult to the majesty of the supreme court to rush this through. -- when these serious allegations have come forward. now, in addition, dr. ford has said she's willing to testify

before the judiciary committee. does anyone believe it is better for staff to talk to her on the phone, republican staff only -- because no democratic staff will participate in this biased, far-fetched process? does anyone think it's not better for her to come testify? then why can't see? chairman grassley should provide the american people the forum to hear her out. i believe she's credible. a lot of my republican friends don't. what are they afraid of? are they afraid that she might be very persuasive? well, if she is, it is a whole different ballgame, isn't it? so chairman grassley should and must provide the american people the forum to hear her out and decide for themselves whether her testimony reflects on judge kavanaugh's character and fitness for the supreme court.

of course he can have the chance to testify again, too, and both of them have said they would. so why, in the good lord's name, why wouldn't we do that? why? there's no reason. no reason. there is no requirement, rule, or precedent that says the judiciary committee must move forward on judge kavanaugh's nomination this week. none. what's the reason we have to rush it through? when these allegations are hanging out there, when women who are victimized deserve the right to be heard, at the very minimum? and then the gall -- the gall of my dear friend, the republican leader, who delayed justice scalia's seat being filled for nine months to say that we can't take a couple of extra weeks.

unmitigated gall. the seat of justice scalia was held open for a long time, a long time, and now, with no reason, my colleague says we can't do that. chairman grassley has to stop playing games, pretending like the nomination can continue to glide through while at the same time the senate conducts a review of these allegations. hastily arranged private phone calls with committee staff members is not even close to constituting a fair and thorough review. it is not part of any sort of regular order and does not substitute for an f.b.i. background check or a public hearing. again, let me ask my dear friend, the leader, what is the reason now that both judge kavanaugh and professor ford have said they'll come testify,

that we don't do it? give me one good reason, one. it's unrelated to how this -- how we became aware of these allegations. whether you like it or not, there is a right for it to be heard. with allegations as serious as the ones before us, the senate must not, it cannot, the honor of the senate conduct a haphazard, slipshod review of dr. ford's claims or be rushed to a vote. there must be time for the f.b.i. to do its work, for the judiciary committee to properly prepare to hear testimony from dr. ford and judge kavanaugh. and there is he a. another issue here -- and there's another issue here. judge kavanaugh's credibility has already been seriously questioned in the aftermath of his testimony regarding e-mails stolen from the judiciary committee by a republican member, by his involvement in

the nomination of judge william pryor, and other controversies. in all of these cases, judge kavanaugh's credibility was questioned because documents reveal that he was far more involved than he head on to when he testified. -- than he led on to when he testified. and now he has unequivocally denied this. there is an issue of credibility here. you have two people with diametrically opposed views as to what happened. and this is not just an argument for its open sake. it is for nomination to the supreme court, the highest court in the land that terms through their legal rulings the lives of americans, and in many instances is seen as the arbiter of right and wrong. are we going to let this happen, not even hear what someone who

believes she was terribly aggrieved -- and i believe her -- has to say? when the credibility of a supreme court justice is on the line, we're going to just brush it under the rug? and again, after delaying merrick garland for over a year with no explanation as to why we can't wait a short -- a much shorter period of time, the double standard, the twisting of this body into a cruel, nasty partisanship, unprecedented, in a feverish desire to fill the bench with people that the other side agrees with. it's one of the lowest points i have seen in my years here. one of the lowest points. i want to applaud my colleagues on the other side of the aisle who have called for hearings.

i believe one way or another six have said this should be delayed. i hope they'll be strong. i hope they'll tell leader mcconnell he's doing the wrong thing. dr. ford deserves to be heard. to railroad a vote now would be a deep insult to the women of america, a lasting scar on the integrity of the supreme court. now, on another matter, tonight the senate will take up legislation that will help our country fight back against the opioid epidemic. the bill will help people from all backgrounds and all ages and is designed to address the spectrum of opioid addiction. that means medical prevention and law enforcement prevention, reversing overdoses, helping those in treatment, and enabling those in recovery to get back to their lives. on this one we've had real

bipartisanship. democrats and republicans came together to pass major funding increases to fight the opioid crisis. when we considered the labor-h.h.s. appropriations bill this week -- i hope we'll see it signed into law soon by the president -- congress will have appropriated $7 billion over two years to address opioid addiction. and that fund something now making its way to the states. the legislation will consider this week is another side of the same coin -- the funding increases are important. and now this bill will complement those efforts by making important policy changes and creating new programs to help providers, first responders, law enforcement, communities, and families beat back the scourge of addiction. stopping this crisis will be a multifaceted effort. this bill recognizes that fact. so i want to thank members on my side whose legislation is

included in this bill, senators baldwin, donnelly, manchin, mccaskill, nelson, casey, heitkamp, and klobuchar, and many more democratic senators contributed to this bill, as have many republicans, and i thank them for their hard worth addiction -- hard work. addiction, madam president, has held too many americans in its grip for too long. we cannot let up our efforts to fight this courages. in the coming days and weeks, the senate will work on merging the senate bill with the house bill and it is my hope that we will have a new opioid law signed in the future. on one final note, my heart goes out to the people of the carolinas and surrounding states. to see the pictures of houses being flooded breaks your heart. you see the devastation and it's something that minded me of what happened in my state a few years ago with sandy. our hearts go out to these

people and the federal government always pulls together when a part of the nation has a problem. i'm not going to look up the voting record of those on the other side from these states who are no going to -- who are now going to ask for aid when they voted no when my state was so beleaguered. that is not how i believe it the proper way to approach this. they are suffering and we need to be there for them. i yield the floor.

a senator: are we in a quorum call? the presiding officer: we are not in a quorum call. a senator: madam chair. the presiding officer: the senator from hovment. -- ohio. mr. portman: thank you. my colleague spoke earlier about the opioid crisis and the fact that we're about to vote on legislation called the opioid crisis response act and he talked about some of the innovations going on in the state of maryland. we are fortunate in my home state of ohio to have some great work going on as well. the stabilization centers he talked about, we now have in ohio the opportunity for people who are treated for addiction, who are given this miracle drug, narcan, which reverses

the effects of the overdose to be able to not just go to an emergency room where they can be taken care of for this reversal of the overdose, but also get into treatment. the maryhaven addiction stabilization center in columbus, ohio, has become a model not just for ohio but for the country, and one of the early centers where they have taken some of the federal funds we have passed here and using them to come up with innovative ways to get people into treatment. their success rate is over 80% which unfortunately is not true with regard to other instances where someone is given this narcan issued by a first responder or in an emergency room setting and does not go into treatment, rather goes back to the environment and the old community or the gang where the addiction happened in the first place. then in so many instances first responders are called again and sometimes again and again to provide that narcan to the same individual. that's not helping anyone.

it's certainly not helping that individual. and taking this disease of addiction and dealing with it in a serious way. the stabilization centers are a great idea and we're starting to do some of these things back home in an innovative way that's going to help us turn the tide. and this legislation that we're voting on tonight will help in that regard because it provides additional funding and additional help for some of these new approaches that we badly need. sadly, despite some progress, based on legislation we passed here about a year and a half ago, the cara act and cures act which we'll talk about in a moment, things are not getting better. in fact, they are getting worse. in every state in this chamber has been affected by this issue. this chart behind me shows those states who last year had an increase in overdoses from opioids and other drugs. if you had an increase, you're in orange. if you had a decrease, you're in blue. sadly, as you can see, states, including my home state

of ohio and the presiding member's home state of iowa, saw an increase. in fact, overall there was about a 9% increase in deaths. overdoses deaths last year in america, based on the centers for disease control data we got about a month ago, was 72,000 people. think about that. that's of course more individuals than we lost in the vietnam war. 72,000 means that this is the number-one cause of death now in america for those under the age of 50. in my home state of ohio it's the number-one cause of death, period. so we are in a crisis. we are in an epidemic. despite new innovations going on back in our states, we continue to see these grim records year after year. we need to reverse this, and tonight posts legislation will help -- tonight's legislation will help do that. franklin, ohio, which is in the center of ohio near the columbus area, as an example just in the past nine days

recently experienced 29 overdose deaths. you know what the coroner said? the coroner said this spike was caused by a synthetic drug called fentanyl. it is about 50 times more powerful than heroin. fentanyl is the number one killer. we need people to get into treatment and we need to do more to keep this fentanyl, this new scourge out of our communities. this legislation will do both of those things. this is consensus legislation. there are five committees that were able to provide input for this legislation. they had public hearings. they contributed ideas to it. that includes the help committee, judiciary, finance, commerce, banking committees. i want to particularly applaud the help committee chairman lamar alexander, because he pulled together all these ideas from these four or five different committees and helped us come up with this consensus package. i'd like to thank majority leader mcconnell and democratic leader schumer for agreeing to bring this legislation to the floor toont.

it doesn't -- floor tonight. it doesn't include everything all of us want to see but it has important new initiatives and it's a step in the right direction. i know at least one issue we couldn't include in this broader package is the arbitrary cap that's in place in so many treatment centers. they're capped at 16 beds for medicaid reimbursement which is really a vestige of a previous policy to get people out of institutional care mostly mental health focused but it's having an effect now in this opioid crisis we talked about, because people who are ready to get into treatment are told there is no room. this is for residential treatment. we have a solution to it. we introduce election on that -- introduce legislation on that tomorrow. the house has legislation that addresses this. i appreciate senator alexander's willingness to do that. senator cardin who was on the floor earlier, and i talked about this. he's part of a bipartisan group that is putting our ideas out there to allow these good treatment centers to be able to take in more people without an arbitrary cap. this package builds on the two

legislative projects i talked about earlier, the comprehensive addiction recovery act and the twenty first century cures legislation. the cara legislation, the comprehensive addiction recovery act, provides resources directly to evidence-based programs that are working. prevention, treatment, longer-term recovery, helping our first responders. the cures legislation, 21st cures doesn't go straight to the groups, the organizations, the nonprofits. it goes to the states and the states decide how that money is spent. these laws are beginning to make a difference in the people we represent, helping these communities to be able to push back and fight and try new things. even before those bills passed, we got together, some of us here in this chamber, to talk about how do we ensure we have the adequate resources to be able to take on this issue. also in our appropriations bills, these bills are being funded. in fact, above the amount we approved here or authorized. that's good.

in about 2015, so just a few years ago we began to see this fentanyl issue rise up. in my home state of ohio by 2016 it had invaded our state at crisis levels. in 2015 we had over 1,000 deaths. 2,350 detectives last -- 2,350 deaths last year. 2017 numbers are coming in and i'm heerg it will be about two-thirds of the deaths in ohio, as we continue to hear numbers for this year, 2018. so this trend of increasing fentanyl overdoses rings true all around the country. fentanyl overdoses nationally reached nearly 30,000 last year. that means they've increased by 850% just in the four years between 2013 and 2017. between 2013 and 2017 we've seen an 850% increase in overdoses

due to this one drug. the synthetic opioid, fentanyl. here's a chart that talks about this a little bit. it shows that with regard to some drugs, as tragic as the offender rates are -- as the overdose rates are, it's pretty flat going from thimbt 2015 to 2018. this is the new scourge of the opioid epidemic. it is 50 times more potent than heroin. it is relatively inexpensive on the treats, relatively accessible. as a result many traffickers turned to this. in fact, fentanyl is being spread to other drugs. heroin is being laced with fentanyl. cocaine is being laced with fentanyl. even crystal meth. this increases the potency of those drugs, increases the chance of addiction. with the rise of fentanyl of course we're seeing more and more deaths because of its power.

and we are also seeing that no street drug is safe from potential offender and a death. i heard a couple tragic examples during our two teletown hall meetings. the first case was last month, sam from shelby county talked about fentanyl issue. he was talking about it very objectively and policy-wise, and then his voice changed and the emotion was clear. and i asked him if he had any family relationships with this drugs and he acknowledged his son died from a fentanyl overdose. his son died a few weeks before the call. his son didn't know he was taking fentanyl because it had been laced with another drug. last month pauline from zanesville called in and told me her brother passed away. he was a heroin addict but he had no idea he was taking fentanyl. it was laced in the heroin

overdose and died. in both of those cases, they weren't using it knowingly but the autopsy revealed it was fengt. -- fentanyl. this is happening across our country. this growing trend is why a couple years ago we began looking into fentanyls and seeing what can we do about it. we conducted an investigation into this under p.s.i. and said how can this be happening in our country? we found out something shocking which is it is primarily produced in laboratories in china and coming into the united states through the united states mail system, our own government agency, postal agency. our investigators identified how easy it was to get these drugs into the united states. we had an undercover operation where we posed as buyers. based on that, we found out that these overseas sellers essentially guaranteed delivery if the fentanyl was delivered

through the u.s. postal service. if you sent it through a private carrier not guaranteed, like fedex or one of those. if you sent it through the post office, they guaranteed delivery. why is that? well, because the postal service has a weaker screening policy than these private carriers, and that's because of congress. after 9/11 congress said to the private carriers you've got to have a better screening policy including providing advanced electronic information to law enforcement officers on every package that comes into america. if they were doing it for other contraband and explosives more than fentanyls but that is effective now. otherwise it's like finding a needle in a haystack. think about that. you need this data. and law enforcement uses it, and i've seen them do it. i've gone to their distribution centers and seen how they pull things off. they put on protective gear to be able to open these packages because this fentanyl is so deadly. the information tells them where it's from, what's in it, where it's going.

they then use big data to identify suspicious packages and keep some of this deadly drug out of our communities. the law does not require the post office to do that. after 9/11 we said you need to study this issue and get back to us. they've never gotten back to us, so we need to get back to them and say you have to do it too. this is a minimum. we at least have to know that, what's in these packages coming into our country so law enforcement can stop some of this poison that's overtaking our communities and robbing thousands and thousands of americans of their god-given purpose in life. it's not to be an addict. it's not to overdose and die. we can help. the stop act legislation i authored with my colleague amy klobuchar from minnesota is included in this larger opioid package we're going to vote on this evening. the stop act does just that. it closes this loophole to say to these traffickers, you're not going to be able to continue to exploit our u.s. postal system to ship your fentanyls

into america. it's a commonsense solution. it deals with the most deadly aspect of the opioid epidemic. it requires the postal service to get this data 100% from china now, 70% for the rest of the world by the end of this year and by 2020, 100% every package. this is not only going to stop the flow so much of this poison coming into our communities, it will reduce the supply and raise the cost, which is part of the issue with the accessibility of fentanyl. once enacted into law, it will help. tonight is an opportunity for us to vote on this package. the house and the senate package is identical. if we vote on it tonight and get it passed, it will go to the president for his signature and it will help. is it all we need to do? no. we also need to continue to fund cara and cures to deal with the demand side of this. in other words, the prevention side, the treatment, the longer term recovery. this legislation also has a number of initiatives in that area. some were talked about earlier, others were not. it builds on the cara 2.0

legislation that we introduced recently which was the next step after the comprehensive addiction recovery act. one thing it has in this bill from cara 2.0 is a national recovery housing and housing there is too many examples that has housing you wouldn't expect. it ensures people transitioning out of treatment into longer term recovery, they're going to have high quality offingses. the legislation authorizes support for high school and college students to help children recover from substance abuse disorders. the kleeh yacht recovery -- the collegiate recovery community in ohio state is an example. the 2.0 contribution also includes help for the most vulnerable among us, the babies. there is $60 million for a plan of safe care for babies born

dependent on drugs. this provides treatment to babies for something called neonatal abstinence syndrome. their mothers are addicted and they develop dependency in the womb. these babies have to be taken through the process of withdrawal. i've been to neonatal units around our state to see these babies. it is a sad and tragic thing to see. we need more help to ensure these babies get the care they need to be able to get through this withdrawal process, to help the -- the legislation also includes the crib act that will help newborns suffering from addiction recover and provides support for their families. the crib act says they can be reimbursed for providing the love and care that these babies need at this time. it's a veried sad -- very sad situation. i see it across my state. but i also see it across the country. there is a great group called bridges path where they provide

love and care and support for these babies, but they get no reimbursement for it. this is an opportunity to help these children achieve their potential in life. the crib act, the $60 million in funding to help babies addicted to drugs, it will help, it will help these kids in need. there are a number of other important programs that will be reauthorized in this program, including the drug corps, drug-free community acts, the high-intensity drug trafficking areas to help law enforcement push back against the drug traffickers. as we pass this legislation, as we did two years ago with the passage of cara and cures, congress is committing itself to actually putting politics aside, it's not just bipartisan, i think it's nonpartisan, in dealing with the reepidemic out there and helping the -- real epidemic out there and helping the people that need it.

72,000 lives lost last year. these are people with hopes, dreams, and families. need to give law enforcement the tools they need to stop these poisons from infiltrating our country and commit ourselves to additional resources at the federal level that can help our states, local communities and private sectors respond. the comprehensive opioid legislation that we're voting on today, clufg the stop act -- colluding the stop act and -- including the stop act and more will do just that. thank you, madam president. the presiding officer: the senator from louisiana. mr. cassidy: i come to speak as a senator who is also a physician. in my medical practice i learned, if the patient has the power, the patient can make the wisest decisions for their health an pocketbook. i'm here to support the patients right to know drug crisis act

put together by senators collins and mccaskill of which i'm privileged to cosponsor. let me just say right now our health care system is designed just if you will to shake as much money out of the patient and taxpayer, all to the benefit of the others, but not to the patient and not to the taxpayer. and one of the most egregious examples are the pharmacy gag clause. in a pharmacy gag clause, if you go to the pharmacy and it would be cheaper for you to pay cash for the drug as opposed to your insurance deductible, the pharmacist may be restricted by a contract from telling you that. if the pharmacist does tell you that, the pharmacist loses the contract with the pharmacist benefit package. you pay more by paying with your deductible than by paying cash. that money is taken away from you and given to the pharmacy benefit manager. that is wrong.

and what this bill does, the patients right to know the drug prices act, is it gives that power to the pharmacists and to the patient to come up with a solution that is best for their health and for the pocketbook. it does more than that, by the way, it's also requires biologic and biosimilar drug manufacturers to report potential pay to delay agreements to the federal trade commission and department of justice as is currently done with small molecule brands and generic manufacturers. this will allow biosimilars to get to the market sooner, again, save the patient money, saving the taxpayer money. there will be an amendment put forward that will dilute the impact of this bill. but restricting the -- the -- restricting the preventions of this bill to those plans which are self-insured. but i will point out that the three largest pharmacy benefit

managers control 72% of the market for drug distribution. multibillion-dollar corporations operating across all states. it clearly falls within the purview of congress, regulating interstate commerce, to pass a bill such as that. and defeating this bill or watering it down, again, is one more way it take power away from patients and to take money away from patients and from taxpayers to the benefit, not of the patient and her health and her pocketbook, but for the large p.v.p., the patients right to know drug practices act is a key step to lower drug costs for patients. i ask my colleagues to support this bipartisan legislation giving patients the power to save money on their prescriptions and to support the bill as is. thank you, madam president. and i yield the floor.

the presiding officer: the senator from maine. ms. collins: madam president, i rise today in support of the patient right to know drug prices act, legislation that i've introduced with senators mcskill, barrasso, stabenow, and cassidy. our bill is also cosponsored by chairman lamar alexander and 19 other senators from both sides of the aisle. so, madam president, this is one of those rare occasions when we're taking up a bill with widespread bipartisan support that is going to really make a difference. this commonsense bill would ban the use of pharmacy gag clauses, an egregious practice that prevents pharmacists from telling their consumers when they could purchase their prescriptions for less money by

paying out of pocket remember than using their insurance. this legislation is action that we can take right now to help lower the cost of prescription drugs for some consumers. madam president, more than half of americans, as well as more than 90% of seniors, 65 or older, take at least one prescription drug each month. americans have been estimated to spend nearly $45 billion out of pocket each year for copays for prescription drugs. according to a recent poll by the kaiser family foundation, as many as one out of five americans do not fill a needed prescription because they are unable to afford it. i witnessed this struggle firsthand recently at a pharmacy

in bangor, maine, when a couple ahead of me in line received their prescription, they were told by the pharmacist that the copay would be $111. the husband looked to his wife and said, hone honey, we -- said, honey, we just can't afford that. they turned around and walked away leaving the prescription behind. i was so upset when i saw that i asked the pharmacist, how often does this happen? his reply, every day. our bill would ensure that pharmacists could volunteer information to customers on how to lower their costs for prescription drugs. a recent study published in the journal of the american medical association found that 23%,

nearly one-quarter of prescriptions filled through insurance, ended up costing consumers more money than if they had purchased the drug without using their insurance. who would think that using your debit card rather than your insurance card to purchase a prescription drug would be less expensive? it is, of course, so counterintuitive that consumers do not think to ask this question of the pharmacist, yet gag clauses and contracts -- in contracts prohibit pharmacists from volunteering this information to patients from telling them how to obtain the lowest prescription drug price and thus consumers are paying more than they should unless

they ask for specific guidance. americans have the right to know which payment method provides the most savings when purchasing their medications. by prohibiting gag clauses, our legislation takes concrete action to lower the cost of prescription drugs, saving consumers money and improving health care. more than 40 organizations support our bill banning this unfair restriction, including the national community pharmacist association, the american medical association, the alliance for transparent and affordable prescriptions, the erisa industry committee, the pharmaceutical care management association, and america's health insurance plans. our bipartisan bill was approved by the help committee with

unanimous support on july 25, and the administration has already condemned gag clauses and is on record supporting our bill. now, madam president, despite this widespread support for banning this egregious practice which restricts the free speech of pharmacists, senator lee has filed an amendment that would eviscerate our bill. the lee amendment would limit the gag clause prohibition to only self-insured employer plans. that would seclude all of -- exclude all other employer group and individual market plans. under the lee amendment, approximately 85 million americans would be excluded from protection. think about that.

85 million americans who are receiving coverage under employer-sponsored plans or under the individual market would be excluded from this protection. the gag clauses that would be banned under our bill are unconscionable regardless of the time of insurance plan. we know that patients who do not take their medications experience greater complications. one study estimated that medication nonadherence cost, the health care -- cost the health care system some $337 billion, not to mention poorer health outcomes for the individuals affected. the patient right to know drug prices act prohibits gag clauses from being used by health plans sponsored by employers or

offered in the individual market. the federal government's role in regulating these plans and protecting consumers served by these markets is already well established. the employee retirement income security act, better known as erisa was enacted in 1974. employers that sponsor insurance plans for their employees, as defined by erisa, are able to deduct the expenses associated with these plans. these expenses are also not subject to the payroll tax. in 2017, the value of the federal tax benefit for employer-responsed health insurance was estimated at $260 billion. now, madam president, i strongly support our state-based system of insurance regulation, and, indeed, i spent five years

overseeing the main bureau of insurance as maine's commissioner of professional and financial regulation. our bill does not change the longstanding deference to states on this issue, but i would note that even know erisa preserves the authority of the states to impose insurance regulation on fully insured plans, these plans must still comply with a multitude of provisions set by the federal government, and it has been that way for many, many years. for example, regardless of state law, a fully insured health plan must comply with cobra, must cover minimum hospital stays after childbirth, reconstruction after a mass mastectomy, and sts

who take medically necessary leaves of absence. also these plans from prohibited of discriminating based on genetic information. unlike senator lee's amendment, our legislation would prohibit gag clauses in all group health plans so that no matter how the employer decides to provide insurance coverage, employees are able to get the best price for their medications by consulting freely with their pharmacists. our bill would also prohibit the use of gag clauses in individual health insurance plans, protecting consumers who don't have employer-provided insurance and are rather -- and are rather purchasing insurance on their own.

americans who purchase insurance in the individual market may qualify for tax credits to help cover the costs of their policies, or they may be eligible for tax-preferred savings accounts such as health savings accounts established by the medicare modernization act of 2003. but senator lee's amendment would eliminate the protections our bill provides for these individuals, many of whom already face growing out-of- pocket costs. madam president, we need this bill as a complement to another bill that we passed just recently that prohibits these gag clauses for the medicare part d prescription plans. this is a companion bill to that legislation. the bottom line, madam president, is this --

pharmacists should not be restricted from telling customers if there are other ways for them to purchase needed prescription drugs less expensively. the administration has made banning these clauses a top priority, and this important consumer protection should be written into law. i urge my colleagues on both sides of the aisle to oppose senator lee's amendment and to support passage of senate bill 2554. today, madam president, the senate can go on record taking a concrete step to help reduce prescription drug prices for some consumers, and it makes no

sense to exclude 85 million americans from this protection, as senator lee's amendment would do. reducing prescription drug prices must be a national priority. madam president, i'm pleased to yield to the leading cosponsor of this bill, senator mccaskill. mrs. mccaskill: thank you, madam president. the presiding officer: the senator from missouri. mrs. mccaskill: thank you to my friend and colleague, the senator from maine, who it is always a pleasure to work with her on legislation because she is a senator who does her homework. don't ever try to get one by susan collins. she knows what she is talking about. if she is not sure of it, she takes the time she needs to try to find the right way forward.

what we're really trying to do here is reassure the american people that we're on their side. the frustration out there is so high right now with what's going on with the cost of prescription drugs, and when people find out that there is actually a pharmacist that is legally prohibited from telling them you can pay eight bucks if you just want to pay for it, but you will pay 20 bucks if you use your insurance plan. that's real money. that matters to missourians. we know the data shows in 2013 alone, it was like $135 million paid by americans more than they should have. why? where is that money going? who is making that money and why? we need to get a better deal for

people. and we have got so many problems with prescription drugs. i mean, we could -- this is just the tip of the iceberg in terms of the work this body needs to do, in terms of bringing down prescription drug prices, but this is low-hanging fruit. i mean, the notion that we can just say simply pharmacists, you have the right to tell your customers that they can get it cheaper. that's all we're doing. pharmacists, you have the right to tell your customers you can get it more cheaply. and so that's why the lee amendment is so perplexing to me. why would you want to leave 85 million people behind? i mean, i get ideology about regulation, but sometimes common sense needs to scoot all the ideology out of this place, and we need to just look at the bare bones issue of how we save people money on prescription drugs. and that's what this bill will accomplish. today was a big day for me.

i actually -- a bill that i am the democratic cosponsor of, the president of the united states tweeted that he supported it. youzah! that's a big deal for me. i'm thrilled that the president of the united states tweeted this afternoon that he supports this legislation. it shows you that not all is lost in this town. every once in a while, we can get together -- i see my friend, senator barrasso over there, he's a cosponsor on this bill. senator kennedy. it is really exciting to me when we have one of these moments where the administration agrees, secretary azar agrees, republicans agree, democrats agree. if we could do this more often, maybe the people in this country would renew their faith in us as a body. so i am thrilled that we're going to have a chance to get this done. i hope that the body listens to the arguments that my colleague made about the lee amendment and how misguided it is in terms of

leaving so many americans behind in terms of this cost savings. while i'm on the floor today, i would also like to just briefly mention another vote that i think is important. i am really glad that we're expanding grants for first responder training and opioid prevention and all the other important things we're doing in this bill, but i'm really disappointed that it doesn't include a commonsense proposal that i worked with senator casey on that would provide more transparency on those that are lobbying on opioid-related issues. my office did an investigation through the homeland security and government affairs committee where we discovered thrrs all these organizations out there like the american academy of pain management and others that are deriving a lot of their budget from the opioid manufacturers. the opioid manufacturers are giving money to organizations, and in many instances, they are

just fronts for lobbying on behalf of opioids. for an example, we know that over $9 million was given to these organizations with half of that coming from perdue, the biggest manufacturer of oxycontin. and listen, i'm not saying we should prohibit them from doing that, but people ought to know it. we ought to make it transparent, and that's all the bill does. it just makes payments by opioid manufacturers to organizations that are 501-c-3's or c-4's and requires them to just say if the opioid manufacturers are behind their budget. one of these groups actually lobbied c.d.c. about not lowering the recommended dosage of opioids. another one entered a brief in a case arguing that a doctor shouldn't be convicted when he was prescribing thousands of pills a day for moving

controlled substances. transparency is always a good thing. i am really disappointed and frankly confused as to why some of the members on the other side didn't want to include this proposal in this package. i certainly want to thank senator cassidy for his help. we tried very hard to get it in the bill. i hope it's not because big pharma has a vice grip on this thing. i have seen it before and it worries me that that might be it. there is the irony in this. not only does that -- is that provision not included, but guess what is included? there is a provision in the bill that authorizes federal money to one of these advocacy groups. and guess what? it's an advocacy group funded by pharma. so i -- i really think that it's ironic that we're more comfortable giving federal money to one of these groups that can serve as a front organization for the opioid manufacturers

that helped create this crisis than we are in requiring disclosure of the private funding for these groups. i'm really hopeful we can get it in the bill. in conference, i -- that we can either get the bill in conference, more importantly get that other provision out. by the way, if we're going to allow federal grant funding to these organizations, it should be all of them on a competitive basis, on merit. not name one that gets the money. there is something up there. there is something up there when you just name one that gets the money. i have learned that around this place. so i -- i hope the bill passes today. i'm honored to work with senator collins on this important prohibition on the gag rule. it will save missourians money, it matters, and i yield the floor. mr. barrasso: madam president. the presiding officer: the senator from wyoming. mr. barrasso: thank you, madam president. i come also to speak on this important piece of legislation and in favor of this important piece of legislation.

i just visited with senator collins who knows, as so many members of this body that i practiced medicine for a long time before coming to the united states senate. took care of a lot of wyoming families as a practicing physician. as a doctor, i often prescribed medication to help my patients fight their disease, improve their equal of life. i know the importance of prescription medication. i also know the importance pharmacists play in the lives of their patients as well, because the same patient that i'm taking care of, the pharmacist is also caring for and in so many ways, the pharmacist has to be able to speak freely to their patients about information about the medication. pharmacists are often that last line of defense when they give a call to the doctor's office and say mrs. jones is here. by the way, you prescribed this, but don't forget that she is allergic to this other medication, and there might be some interaction. or she is already on this

medicine or this patient is on that medicine. pharmacists provide vital, important roles to the patients on a daily basis. it happens all around the country. so they need to be able to speak freely about those things and they need to be able to speak freely about the things that can save a patient's life but also things that can save a patient money. that's what this whole piece of legislation is about. because i know that many patients fail to take medications that their doctor might prescribe because of the cost involved, the expense of the medicines. that's why i am so glad to see president trump make it a priority to find ways to lower the costs that people pay for their med sin. the administration actually put out a blueprint for ways that we could address drug costs. part of the plan was to eliminate the so-called pharmacy gag clauses. pharmacists should not be gagged. they need to be able to talk with the patients, whether it's about drug interactions, the drug use, how to take it, how to use it properly, and the cost.

these are important things for a pharmacist to be able to discuss, and these gag clauses are clauses that are sometimes included in contracts. not between the patient and the pharmacist. contracts between a drug company and an insurance company. this needs to be stopped. a gag clause says if a patient brings a prescription to a drugstore to be filled, the pharmacist cannot talk about the cash price of the drug. it's not allowed. it's wrong. but maybe someone has an insurance plan where their co-pay for the medicine, let's say it was $10. for the prescription that they are filling, the drug would cost them $5 if they paid in cash, but under the gag clause, the pharmacist is not allowed to say anything about it. pharmacists need to be able to speak up. it's important. it's important for the patient, it's important for the integrity of the process. right now, the pharmacist can't tell the patient, you know you could save a little money if you just paid cash and you didn't bother to use the insurance along the way. so the way things are now, the insurance company would collect

its $10 co-pay from the patient. the insurance company keeps the rest. and the patient doesn't know anything about it. the patient is left in the dark because the pharmacist cannot share this important information with the patient. i believe it's wrong and that's why i cosponsored the legislation that's on the floor right now. well, the trump administration has taken a close look at the situation, and they completely agree. they said people should know if there is a simple way that they can save money. and today i'm hoping that congress agrees as we vote on this legislation. earlier this month, the senate passed legislation that prohibits the gag clauses for medicare plans, and it was the right thing to do. it passed unanimously. i'm so happy to see that. today we're taking the next step. we're going beyond medicare. this legislation that we're about to vote on eliminates the gag clauses in insurance plans that people get through their employer, through their work, plans they buy on their own. it's not just medicare that took

care of it before. this takes it to the next step, to give the pharmacist the freedom to speak. we're saying with a clear voice today that patients should be able to talk with their pharmacists. pharmacists should be able to talk with their patients to know that they are paying the lowest price for the medication. i support this bill. i want to thank the members who led this bipartisan effort. it's a privilege to work with senator collins, senator stabenow, senator cassidy. senator mccaskill was just on this floor to get this done. i appreciate your attention, madam president, to this important piece of legislation. i look forward to voting to support it and getting it passed today and getting it down to the president for his signature. thank thank you, madam president. i yield the floor. i suggest the absence of a quorum. the presiding officer: the clerk will call the roll.

quorum call:

a senator: madam president, i ask the quorum call be dispensed with. the presiding officer: the senator from washington. without objection. well -- ms. cantwell: i thank my colleagues for working so hard to pass this legislation dealing with the opioid. from port angeles to spokane, i guarantee i've heard about this problem, seen how the communities are struggling and this is the very help they've been asking for. they want new tools, better

solutions ndz they want us for join the fight against drug manufacturers who push this out to communities when they should be -- should be following a process and reporting so that our law enforcement can cut down on the huge amounts of opioids streaming into our community. ms. cantwell: this legislation does many things and i'm glad that it does. it stops the -- basically with the stop act trks will help -- act, it will help crack down on shipments of fentanyl into the united states from mail, something very important that we do and i thank my colleague from ohio on that. authorizes funding for a new grant program to help train law enforcement and protect them against the deadly opioids like fentanyl because their exposure to it has been so unbelievable and it is a risk to them every day they're out there doing their job. it reauthorizes the drug courts which many people in the state of washington have told mes that been beneficial to how they deal with this crisis as it relates to the individuals in their

states, helping nonviolent offenders recovery and help them move forward. it reauthorizes the high intensity drug trafficking area program which uses federal resources to help local law enforcement crack down on illicit drug rings. we need to help our law enforcement who are dealing with this problem every single day have the tools to do this job and the fact that it reauthorizes this program on a high intensity drug trafficking areas is just the kind of tool that they need. it also makes permanent the ability for doctors to treat up to 275,000 patients with the kind of treatment that is necessary for them which also helps us get to people faster and get them into a recovery situation faster. but, madam chair, the one thing i really want to draw attention to is this issue of hearing over and over again about how opioid

manufacturers have flooded our communities with a product when in reality current law had said they are supposed to monitor and track the distribution of this drug. well, in too many cases, those safeguards were not followed. and throughout their process, they weren't reporting on suspicious orders of opioids, preventing them from ending up in the wrong hand, or in some instances the fact that they ended up in the hands of a black market who then continued to flood communities with the product. in one example, a physician in everett, washington, wrote more than 10,000 prescriptions of opioids. this number of prescriptions was 26 times higher than the average prescriber in everett, washington. so he wrote 26 times more opioid prescriptions than the average prescriber and however the drug manufacturer failed to report this suspicious activity.

whether we authorize this drug, we said this is what has to happen because of its highly addictive nature. it has to be tracked. law enforcement has to keep and be advised of anything that looks like suspicious activity. this abnormal high number was a clear red flag that should have been reported. instead the opioid manufacturer turned a blind eye to the negligent distribution. in response to those, people in my state and many other states have been critical and have filed lawsuits because they have been so concerned about this issue. what is clear, though, is that we need to do something now to make sure that opioid manufacturers follow the law that's already on the books about reporting of suspicious distribution or volumes of distribution that are suspicious. well, today this legislation takes a major step forward on that by including for negligent

distribution strong enough to serve as a deterrent to those manufacturers, the action we've seen in the past. the bipartisan opioid crisis response act includes provisions from legislation that myself and senator harris from california authored. our provisions increase the civil and criminal penalties on companies that fail to take responsible measures to prevent their drugs from entering the black market. our legislation increases the civil penalties by ten times from 10,000 to 100,000 per violation. so that adds up very quickly to what we think has been transactions that have been very suspicious. in addition, the bill increases the maximum criminal penalty to 500,000 to companies that willfully disregard or knowingly fail to keep proper reporting on these distribution activities. again, this is what we put into the law because of the highly

addictive nature of these drugs. we said that they have to be monitored. their distribution has to be monitored but because prior to today the slap on the wrist was not enough of a deterrent, most of those requirements were ignored. today we're putting a much more stringent requirement and to say that they will get serious fines if they don't follow the law. this is such an important issue that a bipartisan group of 39 u.s. attorney generals sent a letter to the senate judiciary committee in support of these efforts. our own attorney general bob ferguson helped in getting that and i want to thank him. the attorney generals wrote, quote, diversion of prescription opioids has devastated communities in our states. the consequences of turning a blind eye to suspicious opioid orders cannot merely be a cost of doing business.

we urge you to support the cares act to ensure that the penalties effectively hold manufacturers accountable and help stem diversion. end quote. so i agree with those attorney generals and i'm so glad this part is in this legislation. creating a more serious attitude towards the illegal distribution of this product falling into the hands of black markets is so serious. i urge my colleagues to support this legislation. i thank the president. i yield the floor. ms. collins: mr. president? the presiding officer: the senator from maine. ms. collins: i suggest the absence of a quorum. the presiding officer: the

clerk will call the roll. quorum call:

a senator: mr. president? the presiding officer: the senator from tennessee. mr. alexander: mr. president, are we in a quorum call? the presiding officer: we are lex i ask the quorum call be vish -- i -- mr. alexander: i ask the quorum call be vitiated. the presiding officer: without objection. mr. alexander: this morning, in nashville, as i got on the plane, the headlines were not about tweets or conclusion with russia or even the supreme court nomination. the headline was senate set to okay bill on opioids. because within a few minutes, we are about to vote in the senate on legislation that senator mcconnell, the majority leader, has called landmark legislation. this legislation that 72 of the 100 members of this body have

made a contribution to. they're not just cosponsoring it. they have a piece of this bill. this legislation has come through five different committees of the senate, and we've been working ton for several -- on it for several months. the reason it's on the front page of the newspapers in tennessee and the newspapers in kansas and the newspapers in wyoming and the newspapers in maine is because opioids is our most serious public health epidemic, and the opioid crisis response act that we'll be voting on in a few minutes is the senate's response to that. before we vote on that, i want to the mention that we'll be voting on another important piece of legislation that the senator from maine, senator collins, who is here, has talked about, senator mccaskill is a

cosponsor. it is the patient's right to know act. it basically does something that i think almost every american would think is a good idea. it says that your pharmacist, when you go into a drugstore, must be allowed to tell you that if you can buy medicine, your prescription, for $5 by paying out of your own pocket, you should do that, rather than use your insurance, which might require a $100 co-pay out of your pocket. right out in there are contracts between pharmacy benefit organizations and pharmacists that prohibit your pharmacist from telling you that. and senator collins deserves a lot of credit for her leadership in this area, as she does in so many other areas, and i fully support what she is proposing. it passed unanimously out of our health, education, labor, and pensions committee. now back, mr. president, for a

moment to the opioids crisis response act, which we'll be voting on within a few minutes. i mentioned it's on the front pages of the newspapers today, despite a lot of competition for other news. i mentioned that senator mcconnell, the senate majority leader, had called it landmark legislation. and i mentioned that it's because the opioids crisis is the most serious public health epidemic in our country. it is ravaging virtually every community. we all have stories that we have heard that we know that we've told, stories like the story becky savage who testified at one of the seven hearings before our health committee that her sons had a graduation party in their basement. she was happy about that. they weren't out running around town doing other things. so they were in the basement, but, unfortunately, someone going to the party brought

opioids pills to the party. that got mixed with alcohol and she found both her sons dead the next morning. they were not drug addicts. they were not alcoholics. they were good boys. but somehow they made a mistake because they and their friends didn't know the consequences of this opioid epidemic. that is why five different committees in this body have reported bills that have made a contribution to the opioid response crisis act that we're about to vote on. that is why 72 different senators have provisions in this bill. that is why last june the house of representatives passed its own version of the bill, also involving several committees in the house. and our staffs and our senators have been working for the last -- mr. president, could we have quiet on the floor, please.

the presiding officer: the senate will be in order. mr. alexander: thank you, mr. president. the senator's time has expired. -- the presiding officer: the senator's time has expired. mr. alexander: i ask unanimous consent for another five minutes. the presiding officer: is there objection? without objection, the senator is recognized. mr. alexander: thank you, mr. president. that is why we've had so much support for this amendment. the bill is so large that some people have had trouble seeing the significance of it. let me mention quickly two aspects of it. one is money. one is moonshot. some people say, where is the money? this is not a money bill. this is an authorization bill. the money bills are in the appropriations committee. and they have been generous. d. and they have been generous. in march the congress addressed $4.0 million for the appropriations bill.

in the bill we will address tomorrow for the next fiscal year, there will be another $3.8 billion. that's $8 billion within a few months toward the opioids crisis. the second is moonshot. some people say this needs a moon shot. it does need the energy and resources of a moonshot. unfortunately this isn't a crisis that we can assign to a federal agency in walking and say, let's -- in washington and say let's fix it in ten years. what we can do is everything you can think of to do to create a an environment an that doctors, nurses, judges, patients, parents, everybody this communities who are affected by the opioid crisis can deal with it. we do our best to do that. for example, with senator portman's stop act, which addresses the fentanyl and other synthetic, illegal drugs for being mailed into this country through our postal service from china. fentanyl is 50 times more powerful than an opioid pill, 50 times more dangerous.

there is a 70% increase in deaths from overdose by fentanyl in our state of tennessee. or what i think is the holy grail of this crisis, that is finding a nonaddictive pain medicine or treatment. 100 million americans live with pain. 25 million americans have chronic pain. they need help. they need something other than an addictive pain medicine, something that works. dr. frances collins at the national institutes of health, scott gottlieb at the food and drug administration have advanced research and have created fast tracks and we have provides hundreds of millions of dollars to find that holy grail. a third is to reduce the prescriptions of opioids. -- that can be diverted so that you can reduce the chance that you might get a 60-pill bottle of opioids, use 12, take it home, put in your medicine cabinet and then your teenager takes it to a party and somebody

overdoses. we authorize the food and drug administration to require manufacturers to sell these opioid pills in blighter packs of -- in blister packs of, say, three or seven. already two dozen states that established harder own limits. in ten it is a limit of three. -- in tennessee, it is a limit of three. what are the next steps for this piece of legislation, the opioids response act. i appreciate the leadership of senator mcconnell and senator schumer in creating an environment where we can move this bill rapidly. we're working with congressman waldon and congressman brady in the house, and with the democrats on both sides of five committees -- or seven committees in the senate on this phase and several in the house of representatives. our goal is to have all of our language in a combined bill

ready by friday of this week, along with congressional budget office numbers, so that the house of representatives can vote on the bill next week before they go home. then we can vote on it the following week or whenever senator mcconnell can put it on the floor, and send it to the president forages there are too many senators for me to thank very moment for their leadership as chairman and ranking member of the committee or for their agreeing to show some restraint anyone sissing on provisions -- in insisting on provisions. senator portman, senator rubio, senator paul provisions, senator lee d but they all said, let's go ahead and vote on this today and work out the remaining differences we have over the next few days with the house and hope that the final version of the bill which comes back from the house is even stronger. mr. president, i am convinced that this piece of legislation,

the opioid response crisis -- crisis response act of 2018, will help deal with the worst public health epidemic that we have. we have a sense of bipartisan urgency about finishing our work in the senate, combining our efforts with the house. their bill is a good bill. i think combining it with ours will help make it stronger. it will get our bill to the president and we may have the same amount of money and the same amount of energy that we had in a moonshot in the 1960's. but the real work is going to be done on the front lines because the only way to deal with the opioid crisis most of the time is through community by community by community. i thank the president, and i yield the floor. mr. blumenthal: mr. president? the presiding officer: the senator from connecticut. mr. blumenthal: thank you, mr. president. i want to thank my colleague

from tennessee, as well as the leaders on both sides. this effort has been truly bipartisan. it is a profoundly significant beginning, but only a first step. it needs to be followed by others because we know that this epidemic truly is national. and i want to thank especially my colleague from west virginia, who will follow me, senator manchin, for his tireless, relentless efforts on this issue. i have been very proud to work with him and to begin working on it when i was attorney general of the state of the connecticut in suing the painkiller manufacturers and taking action against the sellers of prescription opioids, to make sure that they are held accountable. the communities need our help. we've promised action, and we are now delivering, in part, on

this issue, which has been so devastating and deadly for so many families, communities, states, and towns throughout connecticut and our nation. the calls for action tonight are answered in this beginning step with money that will go to treatment and prevention and law enforcement. that money is a good first step. but it must be followed by additional investments and commitments. this measure, in addition, increases the in my judgment of drug takeback programs. i have visited communities most recently east hartford, in greenwich, where these takeback programs have provided an anonymous, secure way for people to rid their medicine cabinets of drugs that all too often can be a menace. medicine cabinets are a

modern-day menace when they provide accessible painkillers to teenagers and others who begin lifetimes of addiction. this measure is important in setting standards and guidelines for sober houses, a very important resource but one that requires some sense of regularity and guidelines. there are many sober homes in connecticut. for example, in forrenton, that good -- in torenton, that do good work. this provision is a step in the right direction. i'm very proud of a bill that i've led with senators grassley and brown to enhance transparency and opioid prescribing. this bill requires drug companies to allow prescribers to ensure that they are not no

being inappropriately influenced by these manufacturers. it is already required for doctors. it ought to be required for everyone who may be involved in prescribing these powerful medicines. the bill will also fight back against deadly drug trafficking when it involves use of the postal system. just a few weeks ago in new haven, there was a mass overdose caused by trafficked synthetic drugs, more than 100 people overdosed on k-2, brought into this country from china and mexico through the mails. these new law enforcement tools are critically important, as is the reauthorization of the office of national drug control policy, and its high-intensity drug trafficking areas program. this bill will help protect our

citizens. i want to thank all my colleagues for supporting it. i'm looking forward to a positive, affirmative vote that will help communities throughout the country and spare families the heartbreaking and gut gutwrenching problem that so infects so many healthy communities. everyone is affected and touched by this problem. i thank my colleagues for supporting this bill. a senator: mr. president? the presiding officer: the senator from tennessee. mr. alexander: i ask unanimous consent that when the senate proceeds to s. 254, amendment 4011 be made pending. the presiding officer: is there objection? without objection. mr. alexander: mr. president? the presiding officer: the senator from west virginia. mr. manchin: first of all, i want to thank my good friend from tennessee, senator lamar alexander, for shepherding this through and washing working in a bipartisan way. it is the most important piece of legislation. also to all the colleagues.

this is a way -- this is the way legislation should work. it is something that was worked on for a long time. senator blumenthal from connecticut, everyone who worked so hard on t the american people are drowning under the weight of prescription drug epidemic. my state o -- my state of west virginia has been hit the hardest. more than 1,000 died of drug overdoses in 2017. this is a record number of oil spill related deaths -- opioid related deaths in 2016 which was a record that year as well. let's put this in perspective. if those of us who are old enough to remember watching the vietnam war on television and the outrage, rightfully so, that came of that, the protests and how we were able to bring that to an end, during that entire vietnam war period of close to ten years, 58,200 young americans' lives were taken. this last year alone, one year, last year alone, we lost

more than 72,000 people to a drug overdose. 7 it 2,000 in one -- 72,000 in one year. 49,000 of those people were killed by opiates, heroin and fentanyl in 2017. that's an average of 134 people dying of an opiate overdose every day. it's a silent killer. if we had these types numbers and we were losing them, they were on television, they were in every neighborhood, almost in every family's home one way or another that's affected, the country would rise up in outrage as they did with the vietnam war, watching the carnage. that's why i'm glad to support this bill today because it will take a number of critical steps to help us stop that devastating epidemic, many of which i have pushed for. it would reauthorize critical state grant funding to address the crisis and ensure that this funding is going to the hardest hit states such as my state of west virginia. it would put jesse's laws to

develop hospital standards to flag a patient's opiate addiction. so simple. you would go into a hospital. they would ask you what you're allergic and mark it all the way through. jesse's law is such a commonsense piece of legislation that it could have saved this beautiful young lady and hopefully it will save thousands of others. while this language was included in the fiscal year 2018 appropriations bill, h.h.s. has not yet acted. this bill will force them to do so. it would also strengthen our federal agencies. f.d.a. and n.i.h. will be pushed to encourage the development of nonopiate pain treatments. f.d.a. will be given the authority to do more work with the c.p.b. to stop the flow of illicit opiates like fentanyl which has driven up deaths substantially. it will be required to review detectives when determining quotas, something i have been pushing for for years.

it would allow states to use federal funding for programs like the handle with care program in west virginia, which helps connect traumatized children with the resources that they need. and it would make it easier for medicare and medicaid beneficiaries to access the treatment that they need. these are critical steps. but so much more has thob done. it must be done. i'm particularly disappointed that the package does not include the jesse jesse grubb's legacy act which makes commonsense changes to the legislation for substance abuse disorder known as part 2. we lost jesse because one of her physicians did not know she was in recovery from opioid addiction and sent her home from the hospital with 350 oxycodone. this could have been prevented easily. while i'm pleased the bill includes jesse's law also included in the f.y. 2018 appropriations bill and would help hospitals develop systems to flag patients with opioid

addiction, it does not include the legacy act which would solve the larger, more systematic problem that is keeping those in recovery from getting the coordinated care that they need. the legacy act is needed because the part 2 regulations are simply not compatible with the way that we want health care to be delivered, in a coordinated manner that takes into account the whole patient and all of their medical needs. access to a patient's entire medical record, including addiction records, ensures that providers and organizations have all the information necessary for safe, effective, high-quality treatment and care coordination that addresses all of patient's health needs. it also helps prevent devastating situations like the one that took jesse grubs' life by helping to ensure health care providers can offer medical care for those in recovery. we need to appreciate people's privacy. the regulations were put into place in the 1970's at a time we

did not adequately protect people's necessary records. but in the 1990's we passed hipaa. and while it isn't perfect it successfully protects the privacy of millions of americans' medical records every day. we simply should not treat substance use disorder treatment records differently than ever other single type of medical record. it doesn't make any sense and it harms patients. the house passed their companion to the legacy act with a strong bipartisan vote, 357-57 because they recognize this is a critical and very critical for stopping the opioid epidemic. the legacy act makes commonsense changes that will save lives and have strong bipartisan support. i urge my colleagues to join me in fighting to include these changes in any final opioid package. i thank the good senator from tennessee. we have to stop this epidemic in tennessee and in west virginia. the people in our states are dying. families and communities are being torn apart. so i look forward to supporting

this bill today but will never stop fighting for the people of my great state of west virginia. thank you, mr. president. a senator: mr. president. the presiding officer: the senator from utah. mr. lee: i ask unanimous consent to complete my brief remarks preceding the vote on my objection. the presiding officer: is there objection? without objection. mr. lee: americans know all too well the crippling cost of health care in our country today. on top of the daily struggles that ordinary families have to put food on the table, skyrocketing costs of prescription drugs are getting harder and harder to meet. pharmacists gag rules are only making matters worse for the american people. much, much worse. these contract clauses between pharmacies on the one hand and insurers and pharmacy benefit managers on the other prevent pharmacists from telling customers they can save money on prescriptions by paying with cash instead of using their insurance. pharmacists are actually prohibited under these clauses from helping their customers to

get their best price for their medications. this is absurd and it's harmful. according to a recent study, about 23% of all drug claims in 2013 involved overpayments, amounting to more than $135 million. who pockets those extra dollars? it's not ordinary americans. it's of course the insurers and the benefit managers. in other words, the pharma middle men you might say. we all agree this is a problem, only further evidence of our drug pricing system that is unnecessarily hurting the american people. we all agree that this is a problem that needs to be fixed. what we must consider is how best to address the problem, who is best equipped to do so and whether and to what extent some of it has already been fixed. senator collins' bill mandates that gag clauses be prohibited under all health insurance plans, including individual and group plans that are currently

administered by the states pursuant to state law. the federal government can and should prohibit gag clauses within the plans that it administers, within those plans that it oversees. but it cannot and should not intervene in plans that it does not. many states already have made some significant progress on this issue. 26 states have already passed laws banning gag rules and another 1 1 states are currently in the process of trying to pass them. i applaud them and we ought to leave space for them to do that very thing. some have suggested that this state action and increased attention to the cost of prescription drugs has more or less solved this problem and greatly limited the use of gag clauses already. bear in mind the study that i previously referenced looked at practices from five years ago. the states were more directly involved because they had more directly witnessed this problem

and they were able to nimbly and quite capably address it. however, even if gag clauses are still in use, where they are, we must recognize that it's not always the role of the federal government to regulate everything. it's not the role of the federal government to regulate entities under the jurisdiction of the states. however well intentioned, when congress oversteps its authority like this, we can end up doing more harm than good and end up undermining the oath we took to uphold the constitution which has as a structural foundation the principle that not all power is invested in congress, only those powers given to the congress are vested here. those that are not vested under the constitution and the federal government are reserved to states or to the people. so the amendment i'm offering would narrow this bill to what i believe would be its proper scope. instead of the bill applying to all health plans my amendment would limit application to

self-insured group plans exempt from state regulation. this would close a loophole where states are unable to reacs additional transparency surrounding the cost of their prescription drugs. and again, while i very much support the overall goal of the underlying bill and applaud my friend and colleague from maine, senator collins, we have to remember that it's neither the role nor the duty nor within the power of the federal government to regulate all aspects of commercial activity within the united states, or all aspects of the lives of the american people. the way to help ordinary american citizens with high drug costs is not to further concentrate power within washington, d.c. the federal government's intervention in health care has already caused huge distortions in the market for which americans pay a steeper price every single year. if we truly want to protect the american people from abuses like

gag rules, we should fight to preserve federalism and our vision of our constitution so that states are empowered to directly and efficiently protect their citizens from the injustices they face. thank you, mr. president. i yield the floor. ms. collins: mr. president. the presiding officer: the senator from maine. ms. collins: mr. president, i ask unanimous consent that i have one minute to respond to my friend and colleague. the presiding officer: is there objection? without objection. ms. collins: thank you, mr. president. mr. president, it seems very arbitrary to me to exclude potentially 85 million americans from the protections that this bill would provide when there is such a clear federal nexus to act in this area. according to the kaiser family foundation, 58% of workers insured in self-insured plans are actually in partially insured plans. the reason this matters is that some states may attempt to

regulate these plans, believing that they can, and then had their state laws challenged in the courts and preempted. why not take the commonsense approach that our bill does and simply ban the use of pharmacy gag clauses, an egregious practice that prevents pharmacists from telling their customers that they could purchase their prescriptions with less money by paying out of pocket rather than using their insurance. we have the support of 40 medical and consumer groups for this bill, and this legislation is action that we can take right now to help lower the cost of prescription drugs for some consumers. it has widespread bipartisan support. it came out of the help committee unanimously, and it

is supported by the administration. i urge a no vote on the amendment offered by the senator from utah and a yes vote on the underlying bill. thank you, mr. president. the presiding officer: under the previous order, the senate will proceed to consideration of s. 2554 which the clerk will report. the clerk: calendar number 549, s. 2554, a bill to ensure that health insurance insurers and group health plans do not prohibit pharmacy providers from providing certain information to enrollees. the presiding officer: under the previous order, the clerk will report the lee amendment. the clerk: mr. alexander for mr0 11. the presiding officer: the question now occurs on the amendment. the yeas and nays are requested. is there a sufficient second? there appears to be. the clerk will call the roll.

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