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Washington, D.C. – U.S. Senator Susan Collins (R-ME) appeared on Bloomberg’s “Balance of Power” with host David Westin today to discuss the rising costs of prescription drugs.
Senator Collins, the Chairman of the Senate Aging Committee, held a hearing this morning on efforts to improve the affordability and accessibility of prescription drugs. Senator Collins will also chair a hearing tomorrow that will explore policy solutions to lower drug prices.
In a bipartisan effort to encourage competition in the prescription drug marketplace and put an end to the harmful patent strategies that block new drugs from coming to market, Senators Collins and Tim Kaine (D-VA) introduced the Biologic Patent Transparency Act today.
A transcript of the interview follows:
“Balance of Power”
March 6, 2019
DAVID WESTIN: Health care continues to be of utmost concern to most Americans, and although Republicans and Democrats disagree about what to do about it the one thing they appear to agree on is that the costs of prescription drugs is too high. Republican Senator Susan Collins of Maine is Chair of the Senate Special Committee on Aging and just presided over a hearing on that subject. We welcome now Senator Collins to Bloomberg from Capitol Hill. Welcome Senator, it's good to have you with us.
SENATOR COLLINS: Thanks so much, David.
WESTIN: So tell us what you've learned so far from your hearing and tell us where you're going with this.
COLLINS: We're having a three part hearing. Today we focus on the impact of crushingly high prescription drug prices on patients, on those who required them. And what we've learned is that patients are going without needed drugs; that they have a terrible time affording these drugs; and that is taking a toll on their health and on their finances. Tomorrow, we will pick up and hear from policy experts on what we might be able to do, and then the third hearing later this spring, we will hear from Administration officials about their efforts to dampen the rise of prescription drugs and make their costs more transparent.
WESTIN: So as you know the Kaiser Family Foundation has done some research, some polling on this, and they find that almost 80 percent of Americans believe that prices for prescriptions drugs are high and to pick up on your point, almost a third, 29 percent say that they don't take all the medication they should because of the cost. What could be done about that?
COLLINS: That is what is most disturbing is when you hear from people who actually need these medications that have been prescribed by their doctors and they simply cannot afford the thousands of dollars each month, in some cases, that the medications cost. I think there are a number of actions that we can take. First, we need to have a more competitive prescription drug market place, and that means addressing, for example, the gaming of the patent system where a brand name manufacturer will, when the patent is about to expire on the drug it's developed, file a whole bunch of new patents and change the formulation of the drug just slightly as an attempt to keep competitors out of the marketplace. We've got to stop that gaming of the patent system. There are other actions that we can take as well. For example, sometimes the generic companies have a very difficult time getting a sufficient number of samples of the brand name drug in order to do the bio equivalency tests that are required by the FDA. That should not be allowed to occur as well. So those are a couple of ideas that we're exploring, and I've introduced a bill on the patent issue just this week, a bipartisan bill.
WESTIN: So one approach would get more competition from generics. Basically, both of those things sound like they would facilitate generics, which will compete down some of the prices. What about the so-called PBMs, the pharmacy benefit managers? We hear a lot about that, particularly from the drug companies who say the real problem here is there are these payments going to them, some people might even call them kickbacks, that that's really driving up the cost. Do you have any initial thoughts on that?
COLLINS: I certainly do. I have never seen a supply chain that has less transparency in it than for prescription drugs. And what we have are a series of middle men who benefit from the pharmaceutical company having a high list price because they get rebates that are usually a percentage of that price. The administration is, to its credit, proposed a new rule that would say if there are rebates, or better yet, discounts that those discounts have to flow down to the patient at the point of sale at the pharmacy, and that we need a different system for reimbursing those who are doing the negotiation–the pharmacy benefit managers. There are a lot of people getting very wealthy along this entire supply chain, and in the end, the patient often is not seeing the benefit of the negotiations that occur to produce a lower price.
WESTIN: Senator you're the Chair of the Special Select Committee on Aging up in the Senate. Do you envision ultimately legislation either from your Committee or perhaps from other Committees coming out to address this or is this something to be dealt with by regulation? By other means?
COLLINS: I think we need an all-of-the-above approach. Our Committee does not have legislative authority, but what we can do is do the hearings to identify the legislative solutions, introduced the legislation which will go to the Judiciary Committee or the Health Education Committee. And I also believe the Administration is right to pursue regulatory solutions since after all the Medicare program and the Medicaid program are big payers when it comes to prescription drugs. Another option that the Administration is looking at and we're also doing through legislation is where there are shortages of prescription drugs which occurs periodically in this country. We ought to be able to import from a country like Canada that has lower prices. In fact, it's really re-importation since we've sent the drugs to Canada in the first place. It does not seem fair to me that the United States’ consumers bear the costs of the research and development of drugs that benefit the entire world.
WESTIN: As I said in introduction, it appears at least the Republicans and Democrats overall can agree on some need to address prescription drug prices, but that's not all of health care costs. Health care costs as you know so well are rising dramatically as a percentage of GDP up between 17-18 percent now. A lot of those costs actually are not prescription drugs there are other things. There's not as much unanimity in that area. You've been very outspoken on this. Are there things that you are hopeful Republicans and Democrats can get together in the rest of health care to really bend that cost curve?
COLLINS: Yes I am. I think we need to look at more innovative health care delivery models. We need to modify some of our reimbursement policies. For example, there's a practice in Maine that does a terrific job of checking on people who have diabetes, which is one of our most expensive diseases in this country, and yet they can't get reimbursed by Medicare for making that weekly call to the patient to make sure they're complying with their diet, their medication, and to check on their blood sugars. And yet, Medicare will pay if that patient for diabetes has terrible consequences from uncontrolled diabetes and is forced to have amputations, or loses his or her sight, or has heart disease. So we need to look at what we reimburse for and help change our policies to help keep people well. That will lower health care costs in the long run.
WESTIN: Senator, before I let you go let me ask one question not about health care directly and that is about the resolution that's pending right now up in the Congress, passed by the House, about to be go before the Senate to rescind the president's declaration of emergency to build that wall. We just had Senator John Thune your colleague on earlier this hour and he said that vote might come next week. Where are you on that and how do you count the votes recognizing John Thune as a whip, so he's a vote counter?
COLLINS: I am for the resolution, and in fact have co-sponsored a resolution with Senator Udall of New Mexico. I feel very strongly that this is not about whether or not you're for the wall or against the wall or whether you agree with President Trump or disagree with President Trump. This is a constitutional issue. This is about Congress protecting its constitutional prerogatives to have power over the purse and to appropriate funds. If the president can repurpose billions of dollars for other projects that were turned down by the Congress that has enormous implications for our separation of powers and for our constitutional system. That is the job of the legislative branch, not the job of the executive branch or the judicial branch, to decide how money is to be spent. The president's role is to either sign the bill into law or to veto it. He does not have unilateral authority under the Constitution to move billions of dollars around without permission from Congress.
WESTIN: Senator, thank you so very much. Really appreciate your spending time with us today. That's Senator Susan Collins, Republican of Maine, joining us from Capitol Hill.