Executive Calendar

Floor Speech

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Ms. COLLINS. Mr. President, I rise today in support of legislation I have introduced with several of my colleagues--Senators Murkowski, Barrasso, Stabenow, and Cassidy--that would remove a barrier that prevents patients from getting the most affordable prescription drug prices at the pharmacy counter.

Mr. President, Americans have the right to know which payment method--whether it is using insurance or paying with cash out of pocket--would provide the most savings when they are purchasing prescription drugs. The two bills we have introduced would establish some clarity in this incredibly opaque drug pricing system.

Nearly 60 percent of Americans, including roughly 90 percent of seniors, take at least one prescription drug. In 2016, Americans spent more than $330 billion, including a staggering $45 billion out of pocket, on retail prescription drugs. The Federal Government picked up another $139 billion through Medicare, Medicaid, and other programs.

Prescription drugs amount to nearly 18 percent of all healthcare expenditures and are the second fastest growing expenditure within healthcare. Moreover, two-thirds of personal bankruptcies in our country have been attributed to the cost of medical care, including prescription drugs. To make informed decisions, at the very least, we should have the right to know how much our prescription drugs cost.

At a series of hearings held by the Senate HELP Committee, I have questioned repeatedly one particularly egregious practice that conceals prices from patients at the pharmacy counter. This practice is the result of what are known as ``pharmacy gag clauses.'' These are contract terms that prohibit pharmacists from proactively telling consumers if their prescription would actually cost less if they paid for it themselves rather than using their insurance plan. In other words, if the consumer is using insurance, pharmacists can actually be prohibited from disclosing whether the consumer is paying the lowest possible price. In fact, the pharmacist is prohibited from sharing this vital information unless the consumer explicitly asks.

Most consumers would never guess that it would be cheaper for them to pay out of pocket than to use their insurance plan to purchase the medicine they need. Insurance is intended to save consumers money in this situation, but that is not always the case. Gag clauses in contracts that prohibit pharmacists from telling patients how to obtain best prices obscure what the true cost of the drug could be and the fact that it could be lower than what the patient is paying. Several recent investigations, including by the New York Times and NBC News, have highlighted this unacceptable practice. For example, a consumer paid a copay of $43 for a cholesterol drug; however, had that same consumer paid cash rather than using his insurance, the cost would have been only $19. Another investigation told the story of a consumer who used insurance to pay $129 for a drug when the cost would have been just $18 had he paid out of pocket.

From Maine to California, the stories are endless. And this practice is not an outlier issue. According to a survey by the National Community Pharmacists Association, more than 50 percent of community pharmacists reported that gag clause restrictions prevented them from telling patients about other less expensive options, such as paying in cash, at least 10 times in the past month.

Recently, I was at the pharmacy counter at a grocery store in Maine, and the couple in front of me decided not to take the prescription they needed because the copay of $111 was more than they could afford. I could not help but wonder: If they hadn't used their insurance, would they have been able to purchase that drug at a lower price? It is so counterintuitive that very few consumers are going to think to ask the pharmacist that question.

I first learned about these gag clauses from pharmacists in Maine who were frustrated that they were prohibited from providing their patients with information on the most cost-effective way for them to purchase the medication they had been prescribed. Pharmacists are barred from speaking up, and those who do face penalties for doing so. Pharmacists are on the frontlines in helping patients manage multiple medications, and they would also like to help ensure that their patients are getting the best, most affordable price.

The first bill we have introduced, the Patient Right to Know Drug Prices Act, which is S. 2554--which I have cosponsored with the four Senators I mentioned, Senators McCaskill, Barrasso, Stabenow, and Cassidy--would prohibit pharmacy gag clauses in healthcare plans that are sold on the exchange and in group plans as well. The second bill, the Know the Lowest Price Act, which is S. 2553--which I am a lead cosponsor on with Senator Stabenow--would ban these clauses in Medicare Part D and Medicare Advantage plans.

Specifically, both bills would prohibit health insurance plans and any pharmacy benefit managers with whom they contract from restricting the ability of a pharmacist to provide a plan enrollee with information about any price difference that may exist between the price of the drug under the insurance plan and the price of the drug purchased out of pocket. Our bills would also prohibit penalties from being imposed on any pharmacist who shares such vital and valuable information.

Some States have already taken action to combat this problem. For example, the State of Maine enacted a law last year that prohibits charging an insurance enrollee a copayment or other charge that is higher than the cost of the drug to the pharmacy provider. The Maine law also protects pharmacists who disclose information related to out- of-pocket costs from being penalized by insurance companies or PPMs under gag clauses. These are commonsense solutions.

In announcing his drug pricing plan last week, the President, I am pleased to say, stated his intent to ban any gag clauses that would apply to pharmacies. While the administration can take some steps administratively to curb this practice, the enactment of our two bills would ensure that this protection for pharmacists and for patients is required under law.

As consumers continue to face skyrocketing prescription drug prices, we ought to do all we can to ensure that Americans are getting the best prices possible. As Congress looks at innovative ways to bring down prices and to increase transparency throughout the healthcare system, our bills tackle an overlooked issue that directly affects consumers and pharmacies across our country.

Our legislation has already received strong endorsements from more than a dozen organizations, including Patients for Affordable Drugs, the American Pharmacists Association, the Pharmaceutical Care Management Association, and other groups, ranging from the Arthritis Foundation to the AIDS Institute.

It is only logical that pharmacists want to be able to provide their customers with information that will help them afford the medications they have been prescribed. It is absolutely unacceptable for pharmacists in this country to be banned, under gag clauses, from providing that invaluable information to patients, particularly those who may be struggling with the cost of prescription drugs.

I urge my colleagues to support banning pharmacy gag clauses and the passage of both S. 2554 and S. 2553.

Hon. Senator Susan Collins, Washington, DC. Hon. Senator Claire McCaskill, Washington, DC. Hon. Senator Debbie Stabenow, Washington, DC. Hon. Senator John Barrasso, Washington, DC. Hon. Senator Bill Cassidy, Washington, DC. Hon. Senator Ron Wyden, Washington, DC.

Dear Senators Collins, McCaskill, Stabenow, Barrasso, Cassidy, and Wyden: As an organization that represents patients hurt by high prescription drug prices, Patients For Affordable Drugs NOW is acutely aware of the importance of patient access to information on drug prices. Today we are writing to endorse The Patient Right to Know Drug Prices Act (S. 2554) and The Know the Lowest Price Act (S. 2553).

Pharmacy Benefit Managers (PBMs) often write contracts that prevent local pharmacists from communicating with patients openly about the prices of drugs. PBMs are a black box in the drug distribution pipeline, and these contracts extend their lack of transparency into our community pharmacies.

Patients For Affordable Drugs NOW has heard from patients all over the country who are cutting pills in half, skipping doses, and going without food to pay for their drugs. It's wrong. At the very least these patients deserve to understand where their costs come from and how to find the best price for the drugs they need. Your leadership on this issue is greatly appreciated, and these bills are a step toward giving patients the information they deserve.

Patients For Affordable Drugs NOW strongly supports S. 2554 and S. 2553 and urges Congress to move quickly in passing them. Sincerely, David Mitchell, Founder, Patients For Affordable Drugs NOW. ____ American Pharmacists Association, March 22, 2018. Hon. Susan Collins, Washington, DC. Hon. Claire McCaskill, Washington, DC.

Dear Senators Collins and McCaskill: On behalf of the American Pharmacists Association (APhA), and our 64,000 members, I am pleased to announce our support for the Patient Right to Know Drug Prices Act, S. 2554--legislation to permanently remove a significant barrier imposed on pharmacists from pharmaceutical benefit managers' (PBMs) use of ``gag clauses'' in contracts. APhA appreciates your efforts to increase patients' access to more affordable and cost-effective medicines by empowering pharmacists to inform patients that a medication may be less expensive if purchased at the ``cash price,'' rather than through their insurance plan. For years pharmacists have been frustrated by their inability to help their patients who they knew were struggling with high co-payments.

APhA, founded in 1852 as the American Pharmaceutical Association, represents pharmacists, pharmaceutical scientists, student pharmacists, pharmacy technicians, and others interested in improving medication use and advancing patient care. APhA members provide care in all practice settings, including community pharmacies, physicians' offices, hospitals, long-term care facilities, community health centers, managed care organizations, hospice settings and the uniformed services.

America's 300,000 pharmacists are the health care professionals most often at the front lines of informing patients about their medication costs or copay amounts and explaining complicated insurance coverage policies. However, under many contracts with PBMs, pharmacists cannot inform patients that a medicine is less expensive if they pay the cash price and do not run it through their health plans.

Thank you for your efforts in removing this barrier on pharmacists--the medication expert on the patient's health care team--to assist patients in receiving the affordable medications they need. APhA is committed to working collaboratively with you and other stakeholders to improve the accessibility and affordability of effective medications. If you have any questions or require additional information, please contact Alicia Kerry J. Mica, Senior Lobbyist, Government Affairs. Sincerely, Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA, Executive Vice President and CEO. ____ [From PCMA, March 15, 2018]

PCMA Responds to ``Patient Right to Know Drug Prices Act''

Washington, DC.--The Pharmaceutical Care Management Association (PCMA) released the following statement on legislation, the ``Patient Right to Know Drug Prices Act,'' introduced today in the Senate:

``We support the patient always paying the lowest cost at the pharmacy counter, whether its the cash price or the copay. This is standard industry practice in both Medicare and the commercial sector.

We would oppose contracting that prohibits drugstores from sharing with patients the cash price they charge for each drug. These rates are set entirely at the discretion of each pharmacy and can vary significantly from drugstore to drugstore.

Fortunately: to the degree this issue was ever rooted in more than anecdotal information, it has been addressed in the marketplace.'' ____ April 16, 2018. Hon. Susan Collins, U.S. Senate, Washington, DC. Hon. John Barrasso, U.S. Senate, Washington, DC. Hon. Debbie Stabenow, U.S. Senate, Washington, DC. Hon. Claire McCaskill, U.S. Senate, Washington, DC. Hon. Bill Cassidy, U.S. Senate, Washington, DC.

Dear Senators Collins, McCaskill, Barrasso, Cassidy, and Stabenow: On behalf of the patient and provider organizations listed below, all of which are members of the Coalition for Accessible Treatments, we write in support of the bipartisan Patient Right to Know Drug Prices Act (S. 2554), which would prohibit health plans offered through the exchanges or by private employers from using so-called gag clauses that can be used to prohibit the disclosure of pricing options to patients.

We are also supportive of legislation you introduced with Senator Wyden, the Know the Lowest Price Act (S. 2553). The bill would similarly afford protections for patients enrolled in Medicare Advantage plans and Medicare Prescription Drug Plans.

As you know, some pharmacists are required to sign ``gag orders,'' which typically apply to generics and prevent the patient from making the cheaper choice of paying out-of- pocket rather than paying a higher co-payment. In fact, in some cases if a patient were to pay the cash price, they would pay less for their medication than if they used their health insurance. However, a pharmacist that has signed a gag order would be prohibited from informing a patient of this option.

Research published earlier this month in the Journal of the American Medical Association found that overpayments affected 23 percent of prescriptions filled out of the nearly 10 million claims that were evaluated. The study also calculated that these overpayments totaled $135 million in 2013.

Thank you for your leadership. It is critical that patients are made aware of payment options at the pharmacy counter and understand whether utilizing insurance or paying out-of- pocket would provide the most savings to purchase needed medication. We look forward to working with you on these and other important access issues affecting patients with chronic diseases. Sincerely, The AIDS Institute, American Academy of Dermatology Association, American Academy of Neurology, American Autoimmune Related Diseases Association, American College of Rheumatology, Arthritis Foundation, Hematology/Oncology Pharmacy Association, Leukemia & Lymphoma Society, Lupus and Allied Diseases Association, Inc., National Psoriasis Foundation, Sjogren's Syndrome Foundation. ____ CVS Health, Woonsocket, RI, March 15, 2018. CVS Health Applauds New Legislation to Better Inform Pharmacy Choices

Bipartisan ``Patient Right to Know Drug Prices Act'' and ``Know the Lowest Price Act of 2018'' introduced in the U.S. Senate

Woonsocket, R.I., March 15, 2018--CVS Health (NYSE: CVS) today released the following statement regarding the ``Patient Right to Know Drug Prices Act,'' introduced by U.S. Senators Collins, McCaskill, Barrasso, Stabenow and Cassidy and the ``Know the Lowest Price Act of 2018,'' introduced by U.S. Senators Stabenow, Collins, Wyden, Cassidy, McCaskill and Barrasso. These bills prevent companies from instituting contract provisions, known as ``gag clauses,'' which prohibit pharmacists from informing patients if the cash price of a prescription is lower than the cost the patient would pay using their health insurance.

``CVS Health applauds the introduction of the ``Patient Right to Know Drug Prices Act,'' and the ``Know the Lowest Price Act of 2018,'' which will help ensure all consumers can make informed decisions about their prescription drug costs at the pharmacy counter. CVS Health's own pharmacy benefit manager, CVS Caremark, does not engage in the practice of preventing pharmacists from informing patients of the cash price of a prescription drug, known as ``gag clauses.'' Actually, our contracts with all dispensing pharmacies in our network require that CVS Caremark members always get the benefit of at least the lower of the pharmacy's cash price and the plan's copay. If a CVS Caremark plan member's copay for a drug is greater than the dispensing pharmacy's contracted rate, it is not our practice to collect that difference from the pharmacy. We are pleased to see these bills align the industry to these consumer best practices and applaud Senators Collins, Stabenow, Wyden, McCaskill, Barrasso, and Cassidy for their leadership.'' ____ [From CISION PR Newswire, Mar. 16, 2018]

express scripts endorses ``know the lowest price act of 2018'' and ``patient right to know drug prices act'' (By Express Scripts)

St. Louis, March 16, 2018 /PRNewswire/--Express Scripts (NASDAQ: ESRX) today released this statement in support of S. 2553, the ``Know the Lowest Price Act of 2018,'' introduced by U.S. Senators Stabenow, Collins, Wyden, Cassidy, McCaskill and Barrasso, and S. 2554, the ``Patient Right to Know Drug Prices Act,'' introduced by U.S. Senators Collins, McCaskill, Barrasso, Stabenow and Cassidy.

Express Scripts is against clawbacks and gag clauses, anti- patient practices that have been used by other pharmacy benefit managers.

``Express Scripts has long supported the goals of S. 2553 and S. 2554, and we have worked with state lawmakers across the country to prohibit the anti-consumer practice of so- called ``gag clauses.'' We applaud the Senators for leading on this important issue. Since we are already in compliance, we are prepared for an effective date of today.

``Drug makers want plan sponsors and patients to think that pharmacy benefit managers gain from this anti-consumer practice, which is clearly not the case. We encourage swift consideration of S. 2553 and S. 2554 so lawmakers can focus on the real issue--high drug prices set by manufacturers.''

As part of its mission to put medicine within reach of patients, Express Scripts believes its members should pay the lowest cost possible, and be informed about the out of pocket cost of their medication in advance of filling a prescription. We provide members real-time pricing information, customized to their individual plans, via our website and mobile app. Moreover, pharmacies in our retail network are not permitted to charge a member more for their copay under their benefit than the pharmacy's cash price.

While there is never an instance where a pharmacist or pharmacy would need to tell an Express Scripts member about a lower cost by paying cash because the claim would process at the lower cost, we agree that so-called ``gag clauses'' are not in patients' best interest. Therefore, they are not part of our retail network agreements.

More information on this issue can be found at: http:// lab.express-scripts.com/lab/insights/drug-options/keeping- copays-affordable.
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