social security's for identification and verification purposes outside of social security. this is something the social security numbers were never intended to do. it even sat on the card this is not for identification purposes. that is something that could be could evero bank open an account using a social security number. you have to prove your identity through other means. >> watch "the communicators" monday night at 8:00 eastern on c-span two. this is david mitchell. he is the president and founder of an organization known as patients for affordable drugs, here to talk about the cost of prescription drugs. good morning. guest: good morning. host: talk about your organization. what's behind it, who funds it and why did you start it? guest: patients 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 those stories to policymakers and elected officials and we're building a commitmmunity of patients and as 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 multiple myeloma. 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 argument from 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 what you just said? 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 take a 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 van hollen of maryland and

theblican senator, called we pay act, it is specifically aimed at ensuring 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. cell and gene 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 @cspanwj and make

your thoughts there as well for david mitchell then. 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 the 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 middlemen then? guest: no. we don't need to eliminate the middlemen. we need greater transparency. in the way drugs are provided downstream. 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 transparency in the way the whole system works. we need to enact those. i will talk more about those too. experience,your own 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 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 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 $3100 a year. i said that out of pockets can to $15,000 a year. so it's a very important bill and people should call the senate at 202-224-3121 and tell them to enact the grassley-wyden bipartisan bill to lower drug prices. host: before we take calls, there's been, as you probably have been following, large discussions about extending the role of medicare amongst the democratic presidential candidates. how would this handle prescription drugs and could the current system accept that kind of expansion when it 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 drugs can. -- drug companies. 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. rachel, 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, i don't necessarily agree that medicaid for all 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: rachel, i am 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 myeloma. my husband passed away from multiple myeloma in 2016 but he didn't actually die from the cancer. yeloma have multiple my

you know how it affects some -- your bones and how your bones disintegrate. but my husband actually died from kidney failure because of the calcium in his blood. it 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. at the time. 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. so 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, 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 twitter. doug saying, are you taking into consideration the cost of drug manufacturers for the liabilities insurance, 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 do with things like fraud, you know, 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 about it. get your thoughts on the matter. >> explain why this moves help people who are struggling to afford the medicine they take? >> you bet. so president trump heard exactly that, people are struggling with

the high cost of drugs here in the united states. so for the first time ever the f.d.a., the food and drug administration, is saying to states, to pharmacies and to wholesale distributors, we're open for business. if you can present a plan of how you can bring drugs in from canadian pharmacies and the canadian distribution system, we're open. we will approve that and we'll let you bring them in a way that's safe for the american consumer and also reduce their costs. we're also opening another pathway where pharmaceutical companies themselves could bring their own drugs in from outside the country in a way that would let them lower their list price on those drugs here in the united states. [end of video clip] host: mr. mitchell, what do you think of those proposals? 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 stage four large diffuse cell,

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 early on 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 f.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 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. we will let our guest respond to that. guest: kay, i'm very sorry about your 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 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 biosimilars which are the generic for biologics, they cannot exactly the same but

they have to have the same effect. so the point is that by using generics and using biosimilars, we introduce competition into the market, after the drug company has a period of exclusivity, 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 a drug. 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. and 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 patientsforaffordabledrugs.org, we can look into that for you. the countries abroad, canada, the u.k., every other country in -- developed country in the world, negotiate prices off of the list. i expect that it's cheaper abroad. i might add that those drugs cost just a teeny, weeny 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 capsule to make but the company that makes it sells it for $720. this is outrageous. host: do states have any power in this individually? guest: states do have power. 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 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 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 in aligarh perry,

meaning 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. i have diabetes and i have cancer. and they've 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 ar 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. host: you believe if it's passed, the president would sign such legislation? guest: we have to get through the house too. the house is likely to pass a stronger 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 to sign your prescription and you could get the drugs from there and they are 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. 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: patientsforaffordabledrugs.org. if you want to find out more about the organization and its effort, david mitchell is the president and founder. thank you for your time. guest: thank you for having me. >> c-span's "washington journal

," live everyday with news and policy issues that impact you. coming up monday morning marion smith on the hong kong pro-democracy protest against china. also, voting machine security with university of michigan computer science and engineering professor j alex halderman. and pbs host talks about his international conservation work and television series. be sure to watch c-span's "washington journal," live at 7:00 eastern monday morning. join the discussion. >> tonight on "q&a." staffrk times photographer talks about photos covering president trump. >> obviously he enjoys having us around. i really believe, despite his constant comments about fake news and the media and so forth, i really feel he enjoys having us around because it helps drive

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