why pay more to wait longer for worse care? instead let's give patients the care that they need from a doctor they choose at lower costs. mr. president, that is our goal. that is our objective. and that is what we are going to accomplish. thank you, mr. president. i yield the floor.

mr. durbin: mr. president. the presiding officer: the democratic whip. mr. durbin: i ask consent the quorum call be suspended. the presiding officer: we're not in a quorum call. mr. durbin: thank you, mr. president. i ask consent to be recognized as if in morning business. the presiding officer: without objection. mr. durbin: just a few minutes ago, i had a visit to my office of four young people from the state of illinois. they were of a variety of different ages, from 10 years of age to the age of 17. they all came because they had a similar life experience, and they wanted to share it with me. each one of them have been diagnosed with type one

diabetes. and little owen, 10-year-old owen from deerfield, told a story. the cutest little kid. great reader. read me a presentation which he put together. and the young women who were with him all talked about how their lives changed when they learned at the age of 7 or 8 that they had type 1 diabetes. and for each one of them from that point forward, insulin became the lifeline. they had to have access to insulin and they had to have it sometimes many times a day, in the middle of the night, and reached a point where through technology they had continuous glucose monitoring devices and pumps that were keeping them alive. but every minute of every day was a test to them as to whether or not they were going to get sick and need help. it was a great presentation by these young people whose lives were transformed, and the

parents who were hanging on every word as they told me their life stories. and they brought up two points which i want to share on the floor this morning. the first is the importance of medical research. as one young woman said -- she is about 17 now -- she has lived with this for eight or nine years, and she said she is a twin, and her brother told her when she was diagnosed that he hated the thought that as an old woman she would still be worried about her insulin every single day. and she said i told my brother we're going to find a cure before i'm an old woman. well, i certainly hope that that young girl is right, but she is only right ifaway do our part here on the floor of the united states senate and not just give speeches. what we have to do is appropriate money to the national institutes of health. it's the premier medical research agency in the world. and we have had good luck in the last four years. i want to salute two of my republican colleagues and one of my democratic colleagues for

their special efforts. for the last four years, senator roy blunt, republican of missouri, senator lamar alexander, republican of tennessee, and senator patty murray, democrat of washington, joined forces -- i have been part of that team, too -- to encourage an increase in medical research funding every single year, and we've done it. the increase that dr. collins and n.f.c. central asked for -- and n.h.s. asked for was 5% growth over a year. 5% inflation. do you know what we have done in four years? the amount at n.i.h. has gone from $30 billion to $39 billion. dramatic, 30% increase in n.i.h. research funding. and we're going to have a tough time with this coming budget, as we have in the past, but i hope that we really reach a bottom line as democrats and republicans that we are committed to 5% real growth in medical research every single

year. so that we could answer these young people who come in dealing with diabetes, those who are suffering from cancer, heart disease, alzheimer's, parkinson's, the business goes on and on, that we are doing our part here in the senate, that despite all the political battles and differences, there are things that bring us together, and that should be one. the second thing they raised, point they raised, one of the young girls there, morgan of jerseyville, started telling me the story about the cost of insulin, the cost of insulin. and as she was telling the story and the sacrifices being made by her family to keep her alive, she broke down crying. what she was telling me was her personal experience, her family experience was something that every family with diabetes knows. the cost of insulin charged by the pharmaceutical companies has gone up dramatically, without

justification, without justification over the last 20 years. in 1999, one of the major insulin drugs called humalog made by eli lilly was selling for $21 a vial. that's 20 years ago. 1999, $21 a vial. the price today, $329 a vial. what has caused this dramatic increase? there is nothing that's happened with this drug. it's the same drug. and, i might add, eli lilly of indianapolis, indiana, is selling this same insulin product, humalog, in canada for $39. $329 in the united states, $39 in canada. and these families told me they were lucky to have health insurance that covered prescription drugs -- sounds

good -- except that they each had large co-pays. $8,000 a year. and what it meant was that for this young girl, this beautiful little girl who was in my office with juvenile diabetes, they would spend $8,000 a year at the beginning, the first three months of the year for her three months of insulin before the health insurance kicked in and started paying for it. and of course there are families that aren't so lucky. they don't have health insurance to pay for their drugs. so what are we going to do about it? it happens to be something the united states senate is supposed to take up. we're supposed to debate these things and decide the policy for this country. we'll see. very soon we'll have a chance. the bills coming out of the health committee, health, education, labor, pensions committee, and we'll have a chance to amend it on the floor to deal with the cost of prescription drugs. i will have an amendment ready. if my colleagues want to join mn

the cost of insulin, and we'll have a chance, if senator mcconnell, the republican leader, will allow us. it's his decision, we'll have a chance to decide whether these kids and their families are going to get ripped off by these pharmaceutical companies for years to come. it isn't just insulin. it's so many other products. it's time for us to stand up for these families and their kids, to put the money into medical research, and to tell pharma once and for all enough is enough. insulin was discovered almost a hundred years ago. what you're doing in terms of increasing the cost of it for these families is unacceptable and unconscionable. mr. president, i'd like to have consent to speak in a separate part of the record for my next statement. the presiding officer: without objection. mr. durbin: thank you, mr. president. for the last two and a half years of this administration, we have seen incredible situation when it comes to immigration and our border. we have seen unfortunately some

of the saddest and most heartbreaking scenes involving children at the border of the united states with mexico. the pattern started with the president's announcement shortly after he was sworn in that he was imposing a travel ban on muslim countries. that created chaos at our airports and continues to separate thousands of american families. then the president stepped up and repealed daca, the executive order program created by president obama which allowed almost 800,000 young immigrants to stay in this country without fear of deportation. and to make a life in the only country many of them had ever known. then the president announced the termination of the temporary protected status program, a program which we offer and have throughout our history, modern history, for those who are facing oppression or natural disaster in their countries.

president trump announced he was going to terminate it affecting the lives of 300,000 immigrants. then came the disastrous separation of thousands of families at the border. 2,880 infants, toddler, and children separated from their parents by the government of the united states. this zero tolerance policy finally was reversed by president trump after the public outcry against it. then what followed was the longest government shutdown in history over the president's demand that he was going to build a border wall even at the cost of shutting down the government of the united states for five weeks. but followed with the tragic deaths of six children apprehended at the border and 24 people in detention facilities of the united states. the president then announced that he was going to block all assistance to the northern

triangle countries el salvador, guatemala, and honduras, the source of most of the immigrants that come to our border and that he would shut down avenues for legal migration, driving even more refugees to our border. now on president trump's watch we have an unprecedented humanitarian crisis. we have seen that crisis exemplified by the horrifying image of oscar alberto martinez ramirez and his 23-month-old daughter valeria who fled el salvador and drowned as they tried to cross the rio grande two weeks ago. we've seen this crisis play out in the overcrowded and inhumane conditions at detention centers at the border. in april i visited el paso, texas. what i saw on the border patrol's overcrowded facilities was heartbreaking. in may i led 24 senators in calling for the international committee of the red cross and the inspector general of the department of homeland security

to investigate our border control facilities. mr. president, i never dreamed that i would be asking the international red cross to investigate detention facilities in the united states. they do that, but usually you're asking them to look into some third world country where inhumane conditions are being alleged. after being in el paso and after seeing what's going on at our border, i join with 23 other senators asking the international red cross to investigate the united states detention facilities. later that same month, the inspector general of the department of homeland security released a report detailing the inhumane and dangerous overcrowding of migrants at the el paso port of entry. the inspector general's office found the overcrowding was, quote, an immediate risk to the health and safety of detainees and d.h.s. employees. one week ago the inspector general's office issued another

scathing report this time about multiple border patrol facilities in the rio grande valley. the inspector general's office asked the department of homeland security to take immediate steps to alleviate dangerous overcrowding and poe longed detention, and they stated, quote, we are concerned that overcrowding and prolonged detention represent an immediate risk to the health and safety of d.h.s. agents and officers and to those detained. congress recently passed legislation two weeks ago which included $793 million in funding to alleviate overvowedding at the c.v.p. facilities and other funding to provide food, supply, medical care to migrants. the bill also includes critical funding for the office of refugee resettlement to care for migrant children. we must now make sure that this money is spent effectively by the trump administration. we gave them over $400 million

in february and they came back to us within 90 days and said we're out of money. i would like to know how they're spending this money and i want to make sure it's being spent where it's needed. there is a gaping leadership vacuum at the trump administration's department of homeland security. think of this. in to and a half years -- in two and a half years, there have already been four different people serving as head of that department. every position in the department of homeland security with responsibility for immigration or border security is now being held by a temporary appointee and the white house refuses to even submit nominations to fill these positions. two weeks ago i met with mark morgan, one of these temporary appointees. in may president trump named him acting director of u.s. immigration, customs enforcement. mr. morgan was asked at that time to carry out the mass arrests and mass deportations of millions of immigrants that the

president had threatened by his infamous tweets. shortly before i met with mr. morgan to ask him about the mass arrest and mass deportations, there was a change. they took -- they named him as acting director of u.s. customs and border protection. we went from internal enforcement to border enforcement. so now he's in charge of solving the humanitarian crisis that president trump has created at our border. the trump administration can shuffle the deck chairs on this titanic, but we must acknowledge the obvious. president trump's immigration and border security policies have failed. tough talk isn't enough. we need to do better. this morning i had dr. goza, she is the president of the american academy of pediatrics. she came to give me a report about her visit to several border facilities that's been well documented and reported in the press.

it was hard for her, she said, to see these things as a doctor for children and realize they were happening in the united states. yes, children are being held in caged facilities with wire fences and tires around them. some of them very young children. she told me as a pediatrician those things have an impact on a child, how that child looks at the world, how that child looks at himself. she said she took a lot of notes as she went through these facilities but it wasn't until she got on the airplane on the way home and read through them, she said, then i started crying. i'm supposed to be a professional who can take this, but i couldn't imagine what we were doing to these children at the border. and there aren't just enough medical professionals there, not nearly enough. the united states is better than that. we can do better than that. we can have a secure border and

respect our international obligations to provide a safe haven to those who are fleeing persecution as we've done on a bipartisan basis, democrats and republicans, for decades. i stand ready and i believe my party stands ready to work with republicans on smart, effective, and humane solutions to the crisis at our border. i would suggest the following be included. crack down on traffickers that are exploiting immigrants. that's unacceptable. assistance to stabilize the northern triangle countries. that's long overdue. in-country processing and third-country resettlement so migrants can seek safe haven under our laws without making the dangerous and expensive trek to our border. eliminate the immigration court backlog so that asylum claims can be processed more quickly. mr. president, you know we authorized a hundred more immigration court judges in this administration -- and this

administration can't find people to fill them. they want more judges. they've got -- they've been unable to do it. we need to make sure the children of families are treated humanely when they're in the custody of the united states government. eventually the history of this period will be written and there will be accountability, not just for the officials in government but for all of us, those of us in the senate and the house and those in journalism, other places. we're going to have to answer for the way that these people have been treated. whether or not they qualify for legal status in the united states, i hope we can hold our heads up high and say at least from this point in forward we're going to show them that we are a hugh pain and caring people. no matter where you come from, no matter how poor you may be, we will care -- take care the children are treated in a merciful way and a compassionate way, that the adults are given appropriate opportunities to

exercise whatever rights they have under the laws of our country, and that at the end of the day we can hold our heads high that we've done this consistent with the values of the united states of america. we haven't seen that yet. it's time for the president to acknowledge that the get tough, bizarre teets just aren't enough. we've got to have a policy that makes sense to bring stability to our border. mr. president, i yield the floor. ms. ernst: mr. president? the presiding officer: the senator from iowa. ms. ernst: mr. president, i

recently received a letter from a gentleman living in cedar falls, iowa, who suffers from parkinson's disease. as i speak, he is going without his $1,450 per month lyrica prescription in order to keep a roof over his head. that's right, folks, he must choose between making a mortgage payment and getting his prescription. here's another story, a woman from davenport, iowa, shared with me. last october she was able to get a three-month supply of blood pressure medication for $17. but when she went to the pharmacy for her refill in late december, she was told the price had nearly tripled to $55.

she wrote me and said, thinking this was a mistake, i refused the refill and checked online about the change in price and found i couldn't get it cheaper anywhere else. so i went back in in ten days and thought i would just have to pay the new cost, which was that $55. in that time the prescription had gone up to $130. mr. president, whether i'm talking to folks back home in my town halls and other events on my 99-county tour or in meetings right here in washington, d.c., the cost of prescription drugs is the number one issue i hear about from iowans. every day i hear stories just like these about the outrageous costs associated with their

prescription medications. for too long hardworking iowans have borne the brunt of skyrocketing prescription drug prices. stories like the man from cedar falls and the woman from davenport have become the norm. we've got to change that. and that's exactly what we're doing here in the senate. we've been hard at work advancing bills to drive down those drug prices, to increase competition, and to close costly loopholes being exploited by those bad actors. i'm proud to lead on three such bills that were recently approved in committee. first i've teamed up with senator cotton on a bill that aims to eliminate an egregious loophole in the patenting process. this loophole allows drug companies to take advantage of the well intentioned concept of

sovereign immunity for native american tribes. in order to dismiss patent challenges and unfairly stifle competition. our legislation would put an end to this practice and actually provide ayatollahians with access to cheaper options for their prescription drugs. that's not all we're doing here in the? the to make more low-cost generic drugs available to folks in iowa. we have also been working across the aisle on a bipartisan bill that would put a powerful check on drug companies seeking to keep generics off of the market. the bill would empower the makers of generic drugs to file lawsuits against brand-name manufacturers if they fail to provide required resources such as drug samples needed for generics to clear the regulatory process and, in turn, we'd see

cheaper alternatives available for my folks in iowa. i'm also working with my fellow iowan senator grassley, on a bill that focuses on the middlemen behindke n mistake, fe rising cost of prescription drugs is an issue that significantly impacts hardworking iowans. we here in congress have a responsibility to take action to give folks a voice and to make sure no family is ever forced to

choose between making a mortgage payment and purchasing their medications. and that's just what we're doing. we've got some great bills here in the senate, bills from both republicans and democrats, that can help lower those drug prices, increase competition, and close loopholes. let's build on this effort and continue working together in a bipartisan way to get these bills and others across the finish line and signed into law. iowans are counting on us. thank you, mr. president. i yield the floor. mr. scott: mr. president? the presiding officer: the senator from florida. mr. scott: obamacare made health care even more expensive. premiums are up, co-pays are up, deductibles are way up.

obamacare has been a disaster, and even the democrats are admitting it. let's all remember. obamacare was sold and based on a bunch of lies. you didn't get to keep your doctor, your health plan, and your premiums didn't go down. the democrats want medicare for all, which will absolutely ruin the medicare system and throw 150 million people off the employer-sponsored health insurance they like. that would be a disaster. but there's something we can do and must do right now to help american families. we must lower prescription drug costs. this is very personal to me. i grew up in a family without health care. my mom struggled to find care for my brother, who had a serious disease. eventually she found a charitable hospital four hours away. i remember asking my mom how much lower drug costs would have to be for her to consider changing policies. without missing a beat, she

said, a dollar. this story is not uncommon. all over my state, i hear the amendment is thing. drug prices are rising and we're having trouble affording the lifesaving medication we need. i recently met sabine ravera, a 12-year-old from naples, florida, who was diagnosed with type one diabetes. she's already 0 worried about how she will afford the rising cost of insulin. patients want to shop for better coverage and lower cost, but too often they can't or don't know how. at the same time, pharmaceutical companies are charging prices for prescription drug lower in can d.a.p. for too long politicians have done nothing. american consumers are subsidizing the cost of prescription drugs in europe and canada and all over the world.

why should we being doing that? that's certainly not putting america first, and it's not putting american families first. that's why i'm working with president trump and republicans and democrats in congress to fix this problem. i recently introduced the america first drug pricing plan with senator josh hawley to take real steps to lower costs for patients and put the consumer back in charge of their health care decisions. part one focuses on transparency. first, pharmacies must inform patients what it will cost to purchase drugs out of pocket instead of using their insurance and co-pay. if patients colludes to pay out of pocket, which is sometimes cheaper, the total cost would be applied to their deductible. second, insurance companies, they should and must inform patients of the total cost of the prescription drugs 60 days prior to open enrollment. that a how patients to be consumers and shop around for the best deal. and final i will my bull would simply require that drug

companies cannot charge american consumers more for prescription drugs than the lowest price they charge consumers in other industrialized nations. i found that provision to be controversial in washington. you know where it is not controversial? everywhere else, in tampa, florida, miami, all over florida, this just makes sense. i don't spend a lot of time outside florida, but i would wager in states across the country, my bill would make a lot of accepts, too. why would we, as american consumers, who make up 40% of the market for prescription drugs, may two to six times more than consumers in europe, canada or japan? that needs to change. my bill takes steps to change it and i believe this should be bipartisan support. also with seven on $and my colleagues i wrote a letter asking for pharmaceutical as much as to work with us. we're still waiting to hear back. american consumers are facing a

crisis of rising drug costs and we can't wait any longer. i will not and cannot accept the status quo of rising drug costs. we need to get something done this year and i'm fighting every day to make sure we do. mr. president, i yield the floor. the presiding officer: the senator from west virginia. mrs. capito: [inaudible] -- just a few weeks ago on june 27 it west virginia celebrated. unfortunately, west virginia has its challenges, too, including

health challenges. we have some of the highest rates in the nation for heart disease, diabetes, cardiovascular disease, cancer, and arthritis, and while there are many non-pharmaceutical steps people are taking to prevent, for many their prescription med spin is the ditches between we willness and illness or even between life and death. that's why it's so important that west virginians are able to secure their medications. and that we as a congress make sure that they are not paying too much for those medications. of all the issues that my constituents come to, whether it is a phone call, a casual running into them at the grocery store who are a letter, this is the issue i hear most about. because it's something that affects so much the west virginian way of life, and it is something that equity if as them every day. if it doesn't affect them, it affects someone in their family.

that's why it has become one of our nation's top priorities, one shared by republicans and democrats, and one that is the significant bipartisan focus of this administration and this congress. this is a far-reaching problem with many different factors contributing to it and that's why we have to address it on many different fronts. the chairman of the help committee is here today. he has worked through his committee diligently and, and i applaud him for his efforts and look forward to joining him on the floor in support of those efforts. as we all know, the path of medication -- the path a commission takes from the manufacturer to the consumer is very complex. while making changes to this pathway is very important, my constituents really don't care about the pathway. they're more concerned with the total on their bill that their pharmacist is ringing up. and that is why i have focus add lot of my efforts on the important role that our

pharmacists play in lowering drug costs. in many small towns and rural communities, which is my entire state, pharmacists are the health care providers that people go to quite regularly and they are often some of the most trusted and friendliest and welcoming. and so it is essential that patients, especially seniors, are able to access their local pharmacy. west virginians and americans across the country should be able to trust that their pharmacist is not being restricted about telling them how to get the best prescription drug prices. they need to know they aren't facing higher cost-sharing for drugs. and being accelerated into the coverage gap or the doughnut hole phase of medicare d due to an overly complicated system of fees and price concessions, which nobody really understands, certainly at the pharmacist detection. in order to ensure seniors have access to the pharmacy of their choice, we introduced a bill for

access to local pharmacies our last congress. we will be reintroducing this bill, which will require that community pharmacists in medically underserved areas be allowed to participate in the medicare part d preferred pharmacy networks. why is this important? if a local pharmacy is not included in a preferred network, a senior must either switch to a preferred pharmacy, which will could be father away or less convenient, or may paying co-pays. subsidies in towns, you can find a pharmacy on nearly every corner. but in rural areas that is not the case. accessings a preferred pharmacy could require significant time and difficult travel. additionally, many seniors rely on their local pharmacies to not only access prescription drugs but also to receive those needed services like preventive screenings and medication therapy management. as important as access to a local pharmacy is, it is also

essential that patients can trust their pharmacist to let them know which payment meth odd price the most savings when purchasing their prescription drugs. i was proud to join senator collins last year as a cosponsor of the patient right to know drug prices act. this commonsense bill which the president signed into law in october bans the use of the pharmacy gag clause -- it was really kind of hard to believe it still existed. these clauses were put in place and prevented our pharmacists from proactively telling consumers that their prescriptions could cost less -- less -- if they paid out of pocket rather than relying on their insurance plan. i'm also currently working with senators tester, cassidy, and brown on legislation that would help improve transparency and accuracy in medicare part d drug spending. our bill would reform the application process of pharmacy price concessions, also known as direct and indirect renumeration

or d.i. rhode island fees, in the medicare part d program. sounds complicated. this one is sure that our seniors are not facing higher cost-sharing for their drugs or, again, being accelerated into the coverage gap. it is also help ensure local pharmacies are able to stay open. we've got to keep our local pharmacies open for a vast majority of rural america. and have them continue to stay open and continue to serve medicare beneficiaries and other communities who rely on them. and it would provide needed financial certainty for these pharmacies, which are often small businesses. my colleagues and i hope to see is this legislation included in the soon-to-be released senate finance package. these why us a few examples of -- these are just a few examples of where we are working to lower prescription drug costs. i have heard a lot of other ideas. they are small but much needed

steps that are making a real difference in our constituents' lives. but our work is far from over. we have to continue looking at both commonsense and complex solutions to the problem. this is a complex problem. and while as a congress and a country we may not agree on the best way to do that, we do all agree that it's a problem that needs to be solved. i look forward to continuing working with senator alexander and lankford, here on the floor here today and my other colleagues and the administration to find that pathway forward of lowering the cost of prescription drugs. i yield back. the presiding officer: the senator from tennessee. mr. alexander: i thanks senator from the west virginia for working reduce the cost of prescription drugs. that's the the question i hear most of course in tennessee ten. how can i reduce what i pay for out of my own pocket for health care costs? the most obvious way to reduce what you pay out of european own

pocket for health care costs is to reduce the cost of prescription drugs. surely, for franklin, tennessee, one of those americans who asked me that question. this is what she said. as a 71-year-old senior with arthritis, i rely on enbrel to keep my symptoms in check, my co-pays just increased from $est 5 to $175 every 90 days. at this rate i'll have to begin limiting my usage in order to balance my budget. there's never been a more exciting time in biomedical progress but that progress isn't meaningful if patients can't afford these new lifesaving drugs. last month our senate health committee, as senator capito mentioned, passed legislation by a vote of 20-3 that included 14 bipartisan provisions to increase prescription drug competition as a way of lowering

lower-cost generic and biosimilar drugs that reach patients. here's what that includes. the creates act. the senator from iowa, senator grassley, is on the floor. he and senator leahy and many others have proposed the creates act which will help bring more lower-cost generic drugs to patients by eliminating anticompetitive practices by brand drugmakers. that's in the bill we approved. or helping biosimilar companies speed drug development through a modernized database. that was proposed by senators collins, hawley, shaheen, stabenow. in this provision, mr. president, this legislation we approved by 20-3, there are 55 different proposals by 65 different united states senators, about the same number of republicans and democrats, all to reduce health care costs.

here's some other examples. improves the food and drug administration drug patent database by keeping it more up to date to help generic drug companies speed product development, a proposal offered by senators cassidy and senator durbin. another prevent the abuse of citizens petitions. these are used to unnecessarily delay drug approvals. senators gardner, shaheen, cassidy, bennet, braun, president trump included that in his 2020 budget. it clarifies -- another provision clarifies that makers of biological products such as insulin are not gaming the system to delay new lower-cost biosimilars. that came from senators smith, cassidy, and cramer. another provision eliminates exclusivity loopholes. these allow drug companies to get exclusivity and delay patient access to costly generic

drugs just by making small tweaks to an old drug. that came from roberts, cassidy, smith and president trump. another prevents the blocking of generic drugs. this is done by eliminating a loophole that allows a first generic to submit an application to f.d.a. and block other generics from the market. again, the president included this in his budget. another provision in our bill prevents delays of biosimilar drugs by excluding biological products from compliance from u.s. farm cope i can't standarda standards. it could delay patent access and lower the cost of drugs, again a president trump proposal. another increases in transparency on price and quality information by banning the kind of gag clauses that senator capito talked about. gag clauses in contracts between providers and health plans that

prevent patients, plan sponsors or referring physicians from seeing price and quality information. another bans pharmacy benefit managers from charging more for a drug than it paid for the same drug. so, mr. president, instead of remaining stuck in a perpetual partisan argument over obamacare and health insurance -- and i can guarantee you that's going to continue to go on for awhile -- we have senators on that side of the aisle and senators on this side of the aisle working together to lower the cost of what americans pay for health care out of their own pockets. since january, senator murray and i have been working in parallel with senator grassley and senator wyden of the finance committee. they're continuing to work on their own bipartisan bill. the senate judiciary committee also voted last month to lower the cost of prescription drugs. and in the house, the energy and commerce, ways and means, and judiciary committees all

reported out bipartisan bills on the costs of prescription drugs. as i've mentioned, president trump and secretary azar have been focused on this. last year the administration released a blueprint on steps the president would take to lower prescription drugs. last year the food and drug administration set a new record for generic drug approvals. generic drugs could be up to 85% less expensive than brand drugs. so i believe the cost of prescription drugs is an area where democrats and republicans in congress and the administration can find common ground to help americans reduce the cost of health care that they pay for out of their own pocket. i'm very hopeful that our bill with 55 proposals from 65 senators, which has been reported to the senate floor, will be placed by the majority and minority leaders on the senate floor before the end of the month. we can pass it. the house will do their job.

we can send it to the president and lower prescription drug costs. i thank the president. i yield the floor. bio. mr. lankford: mr. president. the presiding officer: the senator from oklahoma. mr. lankford: i rise to be able to talk to this body again about health care, the cost of health care, an issue going on for a long while around this congress, an issue supposedly settled when the affordable care act was passed but oddly enough the democrats have joined republicans saying they want to repeal and replace the affordable care act. they're not using the term

repeal and replace. they say they want do medicare for all and built into that is repealing the affordable care act and replacing it with something different. we're ironically on the same spot in some ways, that we both realize and have come to the same spot that the affordable care act didn't pass. actually did pass but it's not working. the challenge now is what to do with health care. we're trying to be able to break into pieces what we can do together to get this done beginning with the cost of prescription drugs. i continue to hear from oklahomans all over the state about how hard it is to be able to deal with the cost of prescription drugs, how rapidly the costs are increasing and how sporadic the cost changes really are. they'll have a drug that costs a small amount one month and come back ago month later and find a dramatic increase for the exact same drug. they can go pharmacy to pharmacy and find a different price for the exact same drug or find the pharmacy that's closest to them

doesn't offer that drug. a different pharmacy is the only one that's allowed to have that drug. and the complexity is driving them crazy, rightfully so. we're finding as we peel back the layers on pharmacy issues that the complexity is being built in too high cost overruns. for the past few months we've looked at every step in the drug process, in the approval, research, development, to try to figure out how it's actual little getting to the consumer and the cost. in the past several things having occurred. the administration has aggressively been proving generics. in fact the administration has approved a record number of generics. those generic pharmaceuticals are much less expensive than the branded pharmaceuticals and many of those have been waiting a very long time in the food and drug administration to actually be approved. the food and drug administration is rapidly getting those out the door. that helps consumers. something else we've done in congress is try to address something called the gag clause. the gag clause is one of those things that was just behind the scenes that no one knew, but

the pharmacists knew, because if you came in with your insurance card to pick up your prescription, the pharmacist knew the actual cost that you would pay if you paid in cash. and often you could get that same prescription paying cash less than you could with your insurance card. but the pharmacist was prohibited from actually telling you that. we in congress have addressed that in a bipartisan way to be able to release that gag clause and allow pharmacists to be able to actually tell people their options on pricing. you should say that is an absolutely crazy thing. who put that gag rule in? the system and the structure behind the scenes that negotiates all of it said if you want to be a pharmacy that sells these drugs, you have to submit to these rules. the culprit behind many of these issues as we found is a group called the pharmacy benefit managers. you'll hear it called the p.b.m.'s. those pharmacy benefit managers

are supposed to negotiate between the manufacturers and the insurance plans to lower the prices. and in many areas they have lowered prices. but they have also given preferred formulary placement to some of their preferred pharmacies so that some pharmacies get that drug and other pharmacies that are competing with them don't get access to that drug. and often it is the drug that is the highest margin drug only their pharmacies will get and other pharmacies will not. it's become an anticompetitive piece in the background when it was supposed to be something that was a highly competitive piece to be able to actually help the consumer. p.b.m.'s created one of the most elaborate systems of pricing which is a tremendous amount of market distortion and at times limited patients' access to those drugs. it's a system that they have been able to take advantage of and create financial incentives to be able to help their bottom

line in the process rather than to actually help the consumer oftentimes. and the rebates that many consumers have heard about, that they wonder who is getting rebate, they go to be able to pay for their pharmacy pickup and they're not getting a rebate but there is a rebate going somewhere. just not to them. so here's the challenge. we're trying to be able to peel back with greater transparency what is happening in the pharmacy benefit manager world and how a small group, actually three companies have 90% of the market nationwide for pharmacy benefit managers, how that middle man in the process actually handles pricing and negotiation. if you talk to any pharmacist that's an independent pharmacist anywhere in the country, and certainly across my great state, they'll all express their frustration with pharmacy benefit managers and their access to some drugs, not to others, and the stipulations they put there deliberately to be able to hurt them to be able to help others.

i join my colleague senator cantwell in trying to shine some light in the operations of p.b.m.'s within the drug chains. consumers deserve greater transparency. that will help us understand the actual costs of drugs and how those costs are actually getting to consumers or not to consumers in the process. the p.b.m.'s need greater examination and we're finally taking that up to be able to walk through the process. on the finance committee we're dealing with several issues. led by senator grassley, we're walking through part b of medicare, part d of medicare and trying to be able to examine what can be done to be able to help the actual consumers. our goal is how do we actually increase the options in drutionz that are out there -- drugs that are out there, how do we stop the cost increases and how do we decrease out-of-pocket costs for pharmaceuticals? in part b, these are drugs that are often intervened done in a hospital setting or inpatient setting, as we're working

through that process we're trying to find perverse incentives that are built in because right now physicians are actually paid a percentage of the medicine that they prescribe in part b. that means if there are three medications that are out there, if a doctor prescribes the highest-cost medication, they get a much higher reimbursement. it's not a flat amount. all three may be intra venus but whichever one is the most expensive helps the doctor the most. i'm not challenging doctors in saying they're always prescribing the branded drug and the most expensive in the process. that is between the doctor and patient to determine but there is no doubt a perverse incentive built into this that if they prescribe a more expensive drug, the doctor in his office actually benefit from it. we need to be able to fix that. in part d, there are reforms that can actually slow the growth in cost increases and allow people to have greater access to drugs. we're not interested in some

kind of formula where we're actually going to decrease the options to patients of what drugs they can actually get to in their formulary. that's the great thing about being an american is that we don't have limited formularies. it's very open in the process so that americans can try different pharmaceuticals and to see which one works best for them. that is not chosen by government. it's chosen by them and their doctors. but the part d definitely needs a redesign of the benefits structure because right now things like the doughnut hole drive up costs for consumers. but there is a way that we're exploring to be able to limit the out-of-pocket costs for beneficiaries. so there is a lifetime cap sitting out there, there's an opportunity to know that if i end up with cancer or some other rare disease, that i'm going to have this out-of-control cost on the pharmaceutical side. or to be able to know that there's a doughnut hole waiting for me when i get a couple of thousand dollars in, i'm suddenly going to have a very

expensive time so i can afford my insurance in january, february, march but in april to august i can't afford prescriptions anymore. we can't have that. we've got to address those issues because they dramatically affects the out-of-pocket costs. there are lots of other options. like the rebates, as i mentioned before. getting to the consumer, not to the companies. dealing with greater advantage with biosimilar drugs, similar to the generic drugs, just in a different category. a reduced cost to get to the drugs faster. we have to deal with some of the patent issues to mack sure that drug manufacturers can't hold on to patents abnormally long and generics can get out to people. we've got to end the practice of surprise medical bills. some folks have no idea what that is, other folks know all it too -- all too well. they saw that their hospital was

in network and go to the hospital in network, they go to the doctor in network but get a giant bill from an out of network anesthesiologist or the lab woulds out of -- or the lab was out of network and they get a giant bill. we are looking at that process where a doctor that sends them to a lab, that the patient assumed they were in network but they find out certain individuals that have taken care of them there are out of network. we are dealing with the issue of air ambulance surprise bills, which has been a great challenge for those in rural america, that they are having to be transferred long distances to get to a hospital and then get an enormous bill for an out of network air ambulance for a surprise billing. there are ways to address this to deal with the out of pocket costs and we are focused on areas where we can find

agreement and things we can do to work through the process. there subpoena much to be done, but the area of prescription drugs and the area around in network and out of network or surprise medical bills are where we should find common ground. i'm glad i'm part of the dialogue that we can find ways to get this resolve and get a better situation for american consumers an patients in the years -- and patients in the years ahead. with that, mr. president, i yield back. the presiding officer: the senator from iowa. mr. grassley: i want to update my colleagues and the american people about efforts to reduce the cost of prescription medicine. last week our country and the american people celebrated independence day, marking 243

years of self-government. as elected representatives, it's our job to have the government work for the people, not the other way around. for more than two centuries our system of free enterprises has -- enterprise has unleashed american innovation, investment, and ingenuity, we have advanced in science and medicine. it leads to lifesaving cures and promising treatments for cancer, alzheimer's, diabetes, and other debilitating diseases. however, prescription medicine too often smacks consumers with sticker shock at the pharmacy counter. the soaring prices leave taxpayers with a big tab, particularly under the medicare and medicaid programs.

and they weigh heavily on the minds of moms and dads all across the country. last week, i held -- last week i held meetings with my constituents in 12 counties across iowa. the cost of prescription drugs comes up at nearly every single q and a county meeting that i hold. iowans want to know why prices keep climbing higher and higher. they want to know why the price of insulin keeps going up and up and up. nearly 100 years after the lifesaving discovery was made. they want to know what can be done to make prescription drugs more affordable. i'm chairman of the senate finance committee, and in that position i've been working with

ranking member wyden from oregon on a comprehensive plan to do just that. we've held a series of hearings to examine the drug price supply chain. we're working on a path forward. we're taking care to follow the hippocratic oath. first, do no harm. in other words, let's be sure that we don't try to fix what is not broken. americans don't want to give up high-quality lifesaving medicine. that's why i support market-driven reforms to boost competition and transparency because with transparency brings accountability and a marketplace working more free of secrecy. congress needs to get rid of

perverse incentives and fix problems that undermine competition in the drug pricing system, including withholding samples by brand name pharmaceutical companies, pay-for-delay, product hopping, and rebate bundling. there's too much secrecy in the pricing supply chain. consumers can't make heads or tails about why they are charged what they pay pay pay for -- pay for their medicine. president trump has made reducing drug prices a top priority of this administration, and they have taken several steps under various laws, including even under obamacare, to do things that gives more freedom to consumers of medicine and other health care

priorities. in another instance on monday, the federal court took a negative move, knocking down a rule that would require drug companies to disclose the price of their drugs in television ads. this is very, very disappointing because senator durbin and i worked on this in the last congress, and i'm going to continue to work with senator durbin to get this job done so that congress must correct what the federal court said the administration didn't have the authority to do, and i disagree with the court, but congress can fix that. big pharma is already required to disclose side effects in their ads. consumers ought to know then what the advertised drug will cost. today i call upon my colleagues

to climb aboard that effort of senator durbin and i will be pursuing. let's pass the bipartisan health care bills thoughtfully crafted in various committees, and the previous three speakers spoke to some of those issues. let's get these various bills correcting some of these problems over the finish line. working together, we can drive down the price of prescription drugs without derailing quality, without derailing innovation, all of which saves lives and improves the quality of life for the american people. i yield the floor. the presiding officer: the senator from indiana. mr. braun: senator grassley and

i attended the rollout of president trump's executive order to get the health care industry on the move. the chairman of the finance committee, the chairman of the health and human services, senators like me, i'm an mainstream entrepreneur that came to the senate to discuss issues just like this. i probable -- i've probably been on the floor more than any other senator, and every time i do it i tell the industry, wake up. i took you on ten, 11 years ago in my own business to give good health care coverage to my employees. it was a litany year after year of your lucky your premiums are only going up 5% to 10% this year. you've all heard it before. it took risks, it took some novel thinking, but it can be

done. most entrepreneurs aren't going to put in the time i put in to make it work for their employees. when you hear democrats, republicans, three or four committees, the president of the united states talking about a health care system that is broken, you should get it through your thick head that there needs to be changes made. it shouldn't be coming from congress, even though it will keep coming. i think the message is out loud and clear, wake up, start fixing these things or you're going to have a business partner whose name is bernie sanders and another idea of medicare for all that we'd regret it once we got it but like most things here, like most big problems in this country, we wait too long to solve the issue. i'm going to give you a few

things of what led me to be passionate about it. when i had to give up my own company's good health insurance, i had a very generic prescription to get renewed. eight formcies in the little town of jasper, roughly, so i knew i would be able to get quotes, i had no health insurance. i was in between being a c.e.o. of a company and a senator. i said, i'm going to try to see what this would be like. i knew it would cost between $20 to $25, maybe a little less. the first place i called stumbled around and couldn't give me a quote on a common prescription. finally, after three or four minute, $34.50. called another place that i thought would be a little quicker on its feet, took ten seconds, and got a quote for $10, and they said, by the way, you can pick it up in ten minutes. that's more or less the way the

rest of the economy works, but health care consumers have gotten used to not doing any of that heavy lifting themselves. and, believe me, the industry has evolved from big pharma to big hospital chains to the health insurance industry, which is in the middle of all of it, things called pharmacy benefit managers where the companies give them $150,000 worth of rebates and less than half of that makes it to the consumer or to the pharmacy. the case is out there, we as senators, congressmen on the other side, shouldn't nead to be getting on the floors of our chambers to tell you the obvious. if you don't do these things, i don't believe we here at the speed at which we normally operate can do it quickly enough for you to -- for you to save yourself from that other

business plan which is medicare for all. so what do we do to prevent that? the industry, number one, should be out there doing what all other companies do, be transparent, where in any other part of our economy do you not ask and have plenty of information to work with, what does it cost and what is the quality? i know where i live people would drive 60 miles to save $50 on a big screen tv that costs $1,000. when i instituted a plan in my own business that encouraged my employees to do that, to have skin in the game, amazing things happened. every time you pick up the phone or get on the web and look for that comparison, it's kind of hard to find, but it's there, the industry just needs to get more of it and not hide behind a system that has benefited them. when we created that in my own

business, people shop around for prescriptions and routinely save 30% to 70%, as they do on m.r.i.'s, cat scans, and most other procedures. i put the time and effort into it. most c.e.o.'s, and you always hear about employees are happy with their employer-provided insurance, that's because the employers are generally paying for anywhere from 85% to 100% of it. so folks working somewhere don't really have skin in the game. so consumers of health care need to do what they do in all other industries,, in all other things that they buy, take the time to ask how much does it cost, and what is the quality and the industry get in it so we can fix the system before the other option actually takes place. there aren't enough c.o. --

c.e.o.'s or legislators to get the industry in shape and the industry itself knows what these problems are. get with it before you have a different business partner that you won't like. thank you, i yield the floor. a senator: mr. president? the presiding officer: the senator from louisiana. mr. cassidy: mr. president, i too, come to speak today regarding pharmaceutical costs and what can we do to make life-saving medications and sometimes medications that make our lives a little bit better, but make these medicines more affordable to the average american. and if there -- mr. president, i happen to be a doctor. and i can tell you i will approach these remarks as a

fellow who has seen medicine evolve, who has seen the incredible, positive benefits of pharmaceutical innovation, but also as a doc who sometimes saw that patients were unable to afford innovation. and the question in my mind is how do we give the patient the power to afford these innovative medicines. because if you cannot afford, it's as if the innovation never occurred. and for her it is as it never did occur. so give the patient the power. let me make some remarks about the pharmaceutical company. there have been incredible advances. when i was in medical school, cutting away part of one's stomach, not the belly but part of the stomach, as i would tell patients where the food goes after you swallow, cutting apart the stomach because of ulcer

disease, one of the most common procedures done in history and hen histamine blockers came along. all of a sudden a surgery which was done multiple times a week was scarcely ever done. and those medicines are now sold over the counter. now, this morning i've got a little bit of arthritis so i take my oil, antiinflammatory which used to be sold by prescription, now over the counter along with my h2 blocker, my pepcid which used to be sold by prescription is now over the counter. i take them in the morning. my back feels better. and all of this are medicines which are generic, routine, and we almost -- in fact, we indeed take for granted the innovation. i could go on. i'm a liver doctor. hepatitis c used to be an incurable disease which in a certain percent of those infected would lead to cirrhosis, vomiting blood at the end of your life, liver cancer,

and death. and now hepatitis c is cured by taking pills for several weeks. amazing. human immunodeficiency virus, aids. when i was in residency, when you got h.i.v., you died. there was no cure whatsoever. and now people live with it for decades. it is a disease you live with but do not die from and we speak of actually now developing cures for h.i.v. that is the promise of a vibrant pharmaceutical industry. lives that not only live when otherwise they would pass away but lives that are lived with better quality of life. now that said, if the patient doesn't have the power, the patient has no leverage in this situation. as recently with others in a conversation with the new head of the congressional budget office and the c.b.o. head said, you know, everybody has leverage in the health care market place except the patient.

everybody else has leverage but not the patient. that is so true. i'm going to give some examples about how the patient lacks leverage in the pharmaceutical marketplace. first i'll say if i go to church -- and i do go to church regularly -- and there is a bernie sanders supporter yanking on this lapel and a donald trump supporter yanking on this lapel and they're complaining about the same thing, they're either talking about surprise medical bills or the high cost of drugs. it is something that touches each american. but it doesn't have to be that. consumer reports did an article about a year ago now in which they sent secret shoppers out to retail pharmacies to buy five generic medications, a prescription for each five. and again generic, like the over-the-counter pills i'm taking. and they went and they paid

anywhere from $66 to $900 for the same five drugs. now we can assume that the acquisition cost was about 60 bucks because you can buy it some place, an independent pharmacy for $66 but three or four chain pharmacies were charging $900 for medications that they could acquire for less than $60. and you could argue why did the patient pay? because we have so little advertising, if you will, of cost competition of what a generic medicine would cost. so imagine you have a health savings account, you're going to go out and buy your prescriptions, you get charged 900 bucks for something that should cost you 60. this is a situation in which the patient has no leverage. by the way, you could say why didn't the insurance cover it? because these patients were posing as if uninsured.

so the retail pharmacies, the chain pharmacies had figured out it is the uninsured who do not have somebody working on their behalf that are going to be the most right for -- ripe for the picking for the high prices. wait, the uninsured are the ones that we're going to exploit, the ones paying cash. that is wrong, mr. president. that is not the patient having the power. it is the patient being used as a victim. there's other things we can see where it's called evergreen. you have a drug and you make just a little bit of a tweak to it that doesn't improve its importance or its efficacy as a drug, no clinical benefit, but it extends the intellectual property protections. now, laws that were conceived of passed by congress to reward innovation, to encourage creativity are instead being used to stifle competition and

to extend patent lives so we, the patients, and the taxpayers have to pay more. not for innovation but rather because somebody figured out how to evergreen. so on the one hand i am growing to praise pac