out. >> watch "the communicators" tonight at 8 p.m. eastern on c-span two. ♪ ♪ the house will be in order. >> for 40 years, c-span has been providing unfiltered coverage of congress, the white house, the supreme court, and public policy events from washington, d.c. and around the country so you can make up your own mind. created by cable in 1979, c-span has -- is brought to you by your local cable or satellite provider. c-span, your unfiltered view of government. host: david mitchell is the president of a group that supports affordable drugs. talk about your organization. nts for affordable drugs is the only national

patient organization focused exclusively on policies to lower drug prices. we don't take money for from anybody who profits from the development or distribution of prescription drugs. we collect patients' stories and amplify them to policymakers and elected officials and we're building a community of patients and allies that can be mobilized in support of policies to lower drug prices. i started patients for affordable drugs because i'm a cancer patient. i have an incurable blood cancer, it's called multipy my leona -- my loama. it's incurable but treatable for some period of time, unknown. with very expensive drugs. in fact, i'm taking drugs right now. i took my first drugs today by mouth and when i leave here, i'll go for about three hours of infusion, they plug me in and pump drugs in. my drugs carry a price tag of $650,000 a year. and my journey as a cancer patient taught me a very important fact and that is, drugs don't work if people can't

afford them. i will die of my disease sooner than i want to if they don't invent some new drugs for me. i'll run out of options. that's why it kills people. drugs stop working. and so i care deeply about innovation and new drug development. but we have to make sure that we're balancing the innovation we're getting with prices that make drugs affordable and accessible. that's why we're doing what we're doing. host: i suppose you've heard the argue frment drug companies that will say it's the cost of that r&d, that development that ultimately factors in the cost of a prescription drug. what do you make of that argument considering you what just said? caller: there is no core -- guest: there is no correlation. many studies show this, between the cost of research and development and the price that is assigned to a drug. drug companies have monopoly pricing power in our country. and so they set the prices as high as they can. the fact is that all 210 drugs

approved by the f.d.a. from 2010 to 2016 are based on science paid for by taxpayers. through the n.i.h. the national institutes of health are the single largest funder of biomedical research in the entire world. we're paying for that. and what n.i.h. does with those wonderful drugs is it gives them to a drug company that can then set any price it wants. we believe that we need to restore balance, let's get that innovation, but let's make sure, especially with taxpayer funded drugs, that we are getting the prices. i might add one more thing. and that is that drug companies don't spend as much as they want you to believe on r&d. they spend many of them more on advertising and marketing than they do on research and development. host: when it comes to the n.i.h., they've worked a couple of vehicles in congress designed to look at this topic of prescription drugs, is there something you endorse? one does deal directly with the

idea of n.i.h. funding. guest: yeah. two weeks ago, a bill was introduced by democrat senator chris value-of maryland and republican senator -- value holen -- van holland -- van hollen and a republican senator, when we as taxpayers contribute to a science that leads to a new drug, that we get prices that are affordable for that drug. this is critically important, you know. we have these wonderful, incredible drugs coming to market. therapies that are being priced at anywhere from $400,000 to more than $2 million. there are 400 clinical trials under way right now for new cell and gene therapies. if they come to market each at $1 million, we're going to break the bank. we're going to break families' banks and we're going to break our country's bank. host: our guest with us here to talk about the cost of prescription drugs and if you have questions for him, you can call on the line, if you live in

the eastern and central time zones, it's 202-748-8000. if you look in the mountain and pacific, it's 202-748-8001. you can always post on our twitter feed @cspan wj and make your thoughts there as well for david mitchell. as far as the actual prices of drugs, aside from the legislative aspect, how do insurance companies factor in or other ways that people get discounted drugs, how do those factor into the cause you're behind? guest: we have an absolutely impossibly complicated system. and it's one that is very hard to reform because everybody in the system makes more when the list prices of drugs goes up. drug companies make more. but so do the pharmacy benefit managers. they're the people who manage our prescription drug insurance programs. they make more. hospitals and doctors mark up drugs based on list price. so everybody downstream from the drug companies makes more money.

we need to reform the system to set prices that are appropriate at list and then ensure that downstream we are setting up benefit structures that make drugs affordable to people. you know, people -- the drug companies like to say people only care about out-of-pocket costs. that's not true. patients talk to us all the time and there are surveys that show that people care deeply about what they have to pay out of their pocket, but they understand that if things are more expensive, their insurance premiums are higher and their taxes are higher to pay for the public programs that provide health care. so we really have to get at the price. just changing insurance design to lower out-of-pocket won't do it. host: you're calling for elimination of all the middlelemen then? guest: no. we need greater transparency. in the way drugs are provided down stream.

for example, pharmacy benefit managers are paid by drug companies based on getting a rebate. based on the price of the drug. it's actually a kickback. in fact, there's a safe harbor under law for this kickback. so as a patient, i can't know if the preferred drug on a formulary, that's the drugs that this health plan offers, whatever your health plan is, i can't know if the preferred drug on a formulary there because it's the best drug, it's the most effective drug among -- i'm sorry, if it's the least expensive drug among equally effective options, or if it's there because the p.v.m. was paid a big rebate by the drug company. we think that's a bad way to run a railroad. and it's all secret. all these rebates are secret. we need to change the way that operates and there are bills in congress right now that are moving in congress to provide greater transparaphernalia -- transparency in the the way the whole system works.

host: could you tell us what the difference is between the price you pay for your drugs and the list price of those drugs? guest: enormous. i am able, because the main drugs i take right now, the two main cancer drugs that have a list price of $650,000 a year, i can buy a medicare part b supplement that costs me $2,500 a year and it pays all my ow of -- out of pockets. if i was on an oral drug under part d, i could have out of pockets that would run to $15,000 a year. right now i'm lucky because i'm taking the infused drugs and i can buy the supplement. but for many, many people on medicare part d, who are taking very expensive drugs, they can have out of pockets running to $15,000 a year. there's a bill in congress to fix that. that people should know about. it was passed out of the senate finance committee about three weeks ago on a bipartisan vote. it would do two big things. it would cap increases in drug

prices in medicare at the rate of flanges -- of inflation. they would not be able to increase prices more than the rate of inflation. and number two, it would lower the maximum out-of-pocket cost that anyone could bear to $3,,100. a year. i said that out of pockets can run today 15,000 a year. so it's a very important bill and people should call the enate at 202-224-3121 and tell them to enact the grassley-wyden bipartisan bill to lower drug prices. host: before we take cause, there's been, as you probably -- calls, there's been, as you probably have been following, large extensions -- discussions about extending the role of medicare. how would this handle prescription drugs and could the current system accept that kind of expansion when comes to the cost of those drugs? guest: we don't get involved in coverage issues. we stick to our lane and deal with drug prices. but i will say that under

medicare, we should allow medicare to negotiate directly with the drug s can. in our country, there is a law that forbids the government from negotiating directly with the drug companies to get lower prices. every other country in the world negotiates. we don't. and the result is that we pay two to three times what all those other countries pay. we need to allow the government to use its purchasing power to negotiate with these drug companies that have monopolies and drive down the prices. host: this is the first call for you. this is rachel from vermont, with david mitchell of patients for affordable drugs. richle, go ahead, you're on. caller: hello. while i appreciate and understand that the consumer needs to be taken into consideration and that prices in this country are overly astronomical, i don't deny that, necessarily agree that

medicaid furel is the answer either. i am currently on medicaid myself because i am disabled and i am still not able to get what i need on it. i would still, if i were to have -- if i were to become, you know, infected with cancer or if i were to become infected with some other disease, i have done research and i have found that i still would not be covered in the ways i would need to be to be able to afford out-of-pocket because i only work part time. there's no way in heck i could afford the costs that come with that based on what i'm currently getting from medicaid. guest: i'm sorry about the challenge, your challenge, like those faced by millions of people in this country. the fact is that people are cutting pills in half, they're skipping doses, they're literally mortgaging their houses. we have patients who have gone

bankrupt. and the tragic -- there's so many tragic elements to all of this. but people taking insulin, for example, have died because they try and stretch their insulin because they can't afford to take the required dose. and this is something that should not be happening in this country, should not be happening to you or anyone, which is why we at patients for affordable drugs are working hard to try and help enact reforms that will lower prices and make them be within your reach. host: this is amy in orange park, florida. hi. caller: good morning. i was just really touched when i heard that you said that you had multiple myloma. my husband passed away from multiple myal mombings a in -- myaloma in 2016 but he didn't actually die from the cancer.

if you have it you know how it affects some -- your bones and how your bones disintegrate. but my husband actually died because of ailure the calcium in his blood. t destroyed his kidneys. we were told he would have to start dialysis but he could probably live at least 10 years on dialysis. he was 52. so we were in the hospital and they were going to contact the insurance company and we were going to do the surgery for his port to get on dialysis and the doctor came back and basically said, you know, sir, you are at the end of your life. we're not -- the surgery is too

risky and we're not going to do it. so -- but that's after first telling us that the surgery was going to be doable and i really believe that it was the cost of the drugs that the insurance company didn't want to keep paying me for because he was doing well, his numbers were low as far as the drugs he was taking, they were suppressing the multiple myeloma. o he died from kidney failure. so, you know, if that ever happens to you, if you ever start having kidney problems, you fight. don't let the insurance company tell you they're not going to help you. host: ok, amy, thanks for sharing your story us. we'll let our guest respond to that. guest: amy, i'm so sorry about your husband. that's way too young. you just hit me right where i live.

my kidneys are working ok. i'm relapsing right now, amy. my blood -- we haven't figured out how to arrest it, but we will. it's my second relapse. but, may i -- amy, i know what you're talking about. the way they diagnosed me is that i one day fell down and couldn't move. and it's because cancer ate through my t-11 vertebra, it was crushed. and then they did x-rays of my whole body, i have holes in my skull and forearms and pelvis. the fact that i'm talking to you today is a medical miracle. myeloma can be a really nasty disease but we are fortunate that there are drugs that can extend our lives now. i wish they were -- this had been there for your husband. they're just too damn expensive. host: this is a viewer off of twigger. doug saying, are you taking into consideration of cost of drug manufacturers for the liabilities they pay for outrageous settlements?

guest: i believe that the drug companies, including all the settlements that they make, are profiting handsomely with the prices they set. many of the settlements that have been reached lately have to , you things like fraud . ow, blocking competition the drug companies factor in their settlements for behavior they should not have engaged in and they're making a lot of money. they're doing fine. i don't worry about the drug companies. in fact, we need to lower the profitability of drug companies in this country. the drug companies have profits that run roughly two to three times the average of the s&p 500. host: the administration has made a pitch to import drugs from canada. the secretary for h.h.s. was recently on one of the other networks talking about this idea, want to share what he had to say abogs here in the

united states. host: mr. mitchell, what do you think of those proposals? caller: i think it's significant -- guest: i think it's significant that the administration cracked open the door to importation.

but let's be clear. a, it's the notice of proposed rulemaking. rules take a long time to make, if they are ever finalized. second, anyone who would want to import under that new rule would have to apply, that will take time. third, many drugs are excluded from this plan that the secretary outlined. fourth, it's a demonstration project. so it would only affect little pockets of the country. fifth, canada has 10% of the population of the u.s. cannot possibly supply our drugs , enough of our drugs, at those lower prices. so, anyone expecting that this proposal means help is on the way, is wrong. unfortunately. it starts the process. it may lead somewhere. but it's years away and it's only for a small proportion of drugs and people. host: here is kay from new york. hello. caller: hello. thank you for taking my call this morning. i hope i'm on topic and i'm a

little nervous because i've had so much experience with drugs. my husband was diagnosed with cell, ur large diffuse b-cell, non-hodgkin's. and i saw him through his cancer treatment. and i had an excellent insurance program at the time. and a drug plan. and i was able to get all brand name drugs that he took orly for a very low cost. he ultimately did not die from non-hodgkin's. my concern is that the f.d.a., i may be wrong, but i believe that the drug companies provide a great deal of support to the .d.a. and i'm very worried about generics. i personally am taking one prescription now that costs $25

under my employer plan a month. and under part d, it's now $1,000 a month. as high as $1,000, maybe as low as $600 a month. because i can only take brand. i cannot take generic. and my understanding is the f.d.a. ran a pilot program where they did unannounced inspections of the factories in india and china and then all sorts of horrors were discovered about the dangers of generics. and that pilot program was canceled. i feel generics are totally unsafe and not being properly regulated. and -- i'm losing my train of thought. i'm so sorry. my husband ultimately died because he took a new high blood pressure medication and within eight hours he couldn't breathe. i obtained a form, turned it into the f.d.a., letting them

know that the result of this drug was his death. because he couldn't breathe within eight hours of taking it. i spoke with a young doctor who had ferbed his residency -- finished his residency in a hospital and he said that he saw over and over and over again that this drug resulted in heart attack, stroke, heart attack, stroke, this loop. and death. and that the f.d.a. actually knew this. i turned it in but they already knew that this drug should have been taken off the market. host: thank you very much. thank you for sharing your story. guest: kay, i'm very sorry about your bus -- husband. the f.d.a., in my view, has a critical job to make sure that drugs are safe and effective. that doesn't mean sometimes mistakes don't happen and i'm sorry if one of those led to a bad outcome for your husband.

i do believe that generics are very important in order to help drive down the price. one of the bad things that's going on right now in this country is brand drug companies use a variety of legal ploys to block generics from entering the market and driving down price. one example is a drug made called h -- humera. they entered into deals to delay the entry of competition until 2023. in the european union they have competition for this drug and the people in the european union are paying 20% of what we are paying in this country right now. and there are a host of strategies, legal abuses that these brand drug companies engage in. there's actually legislation, bipartisan in both houses of congress right now, to address those and we need to enact those reforms this year. host: to clarify then, aside

from price, what's the difference between a generic and a brand drug? guest: generic is the same as a brand drug. in the case of biosims which are the generic for biologicals, they can not exactly the same but they have to have the same effect. using point is that by we ics and using biosims, introduce competition into the -- biosims, we introduce competition into the market, and that's how we drive down prices. host: this is from new hampshire. ray on there with our guest, david mitchell, patients for affordable drugs. ray, good morning. caller: good morning. thanks for taking my call. david, i suffer from the same cancer you do. multiple myeloma. guest: sorry, ray. caller: back in early 2017 i had a stem cell transplant.

that put it under control. and right now i'm on a maintenance dose of something. that runs just over $17,000 a month. luckily insurance picks up almost all of that. $40 co-pay a month. but i checked and to see, what is the price of this drug in canada? i found that it was just over $15,000 a month. , d i looked at europe and britain, and france and germany, and it's still in the $15 ,000-plus to $16,000-plus a month. i don't know if that's what the countries and their government-funded programs pay actually, or that's what the list price is, do you know anything about, like, again, you know, here's a list price in canada, of $15,000-plus, is that what the actual government's paying and if we brought that

here in the united states, would it be a lower price or still the $15,000 and only save me $2,000 a month? i'd like to hear your comments on that. thank you. guest: i'm not familiar specifically with that drug but if you send me an email, which you can do, my email is online at patients for affordable -- patientsforaffordabledrugs.org, we can flook that four. the countries abroad, canada, the u.k., every other country -- we can look into that for you. the countries abroad, canada, the u.k., every other country in the world, negotiate prices off of the list. i predict it's cheaper abroad. i might add that those drugs cost just a teeny, weany bit of money to make. if i told you, for example, there's another drug you may have taken, it costs less than $1 a capsual to make but the company that makes it sells it for $720. this is outrageous.

host: to detroit -- do states have any power in this individually? guest: state does have power and states are passing legislation to try and take steps to lower drug prices. massachusetts just enacted on a bipartisan basis an important new law that allows medicaid to bargain more aggressively with drug companies. but we have a new law in maryland, my home state, there is a law moving through the california legislature, nevada's passed a law on insulin prices. so around the country, because the priteses are so high and the federal -- prices are so high and federal government has not yet taken action to address this, they're taking matters into their own hands and doing what they can at the state level. host: you mentioned insulin. a viewer says, if you can explain the cost of drugs specifically designed for diabetes, including ins listen, why -- insulin, why they're so high. guest: they're so high because three companies have seized control of the market for insulin, for the whole world. eli lily, and two others control

80% of the insulin market in the world. they are three companies that can control prices. and they do. and they have, as a result of that market control that they exercise, they have increased the price of insulin 300% over the last 10 years. host: from california, this is jerry. hi. caller: yeah, hi. thanks for taking my call. i'm 70 years old. have diabetes and i have cancer. and they've writ me off -- written me off. i just want to say that i think you're doing a wonderful job and you're very brave. and it's just not possible to deal with this issue without getting into politics, insurance coverage and other issues. it's just -- it's all over the place. it's a structural problem.

and i'd also like you to comment on -- i'm a retired attorney. it's appalling that insulin is still protected by patent law. the history of insulin and the corruption surrounding the fact that they have this monopoly over it. eli lily is criminal organization. i don't regret saying that at all. i really appreciate what you're doing and you're extremely brave under the circumstances. and i'd really like to hear you what have to say about it. thank you very much. guest: thank you, jerry. jerry, the fact is there is no free market for prescription drugs in america. the entire system is -- has been built by drug companies over about a 40-year period.

they've spent billions of dollars lobbying and giving campaign contributions to build this system that gives them monopoly pricing power. it's government regulation and laws that enable the drug companies to take advantage of us and it's only government reform that is going to fix that problem. which is why it's so important for this new senate bill that's making its way through the senate to be enacted. the house will introduce legislation, we expect, right after the recess, to allow medicare to negotiate directly with the drug companies. there are a host of other reforms making their way through the congress and working hard to see that those get enacted. because we can't fix the system that is based on laws and regulations without reforming those laws and regulations. host: for the senate bill, what has leader mcconnell said specifically about his interest in passing it? guest: he hasn't said anything yet. the president supports this

bill. it did pass out of committee on a bipartisan vote. and we are going to be in the coming weeks pressing, by reaching out to people around the country and encouraging them to speak to their senators, and to leader mcconnell, to see if we can't get a vote on a bill that will cap price increases at the rate of inflation in medicare, and lower out-of-pocket costs dramatically in medicare much host: you believe if it's as ifed, the president would sign such legislation? guest: it has to get through the house too. the house is likely to pass a strong bill. the question is, if the senate passes a good bill and the house passes an even better bill, how do those two things get reconciled? that is not clear yet. by the way, that would be a good problem to have. host: virginia is next. from bloomington, illinois. hi. caller: hello. host: hi, you're on. caller: thank you. i just wanted to say that i had

gotten drugs from canada about six, eight years ago. and all you have to do is get their phone number from walgreen's or c.v.s., they're all up there too, and you can get your prescription, your doctor see to inyour prescription and mail it to them and you can get the drugs from there and they're a lot cheaper than they are here. guest: lots of people are going to canada, mexico, importing from elsewhere. the reason they're doing it is because drugs in this country are too expensive. you can buy a drug in canada for a fraction of what we pay in this country. we don't believe that that's the long-term best solution. wode like to fix our drug price -- we'd like to fix our drug pricing problems here with a made in america set of reforms and see to it that people get the drugs they need at affordable prices. host: patients for a-- patientsforaffordabledrugs.org.