Relating to A National Emergency Declared By the President on February 2019

Floor Speech

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Mr. DURBIN. Mr. President, last month, I launched a new series of floor speeches to recognize what is going on with prescription drug pricing across America.

When you ask the American people about the economic things that are on their minds, it is No. 1--the cost of prescription drugs. No. 2 is, have I saved enough money for my retirement? It really gets to the heart of the concerns families have every day. Each one of us knows that the cost of prescription drugs is going up, and we also realize how vulnerable we may be as individuals if one of those drugs is a matter of life and death.

I came to the floor 2 weeks ago to talk about the cost of insulin. Seven and a half million diabetics across America have seen dramatic increases in the cost of insulin--increases that can't be justified because the same American companies selling the same drugs in Canada do it for a fraction of the cost. Americans pay outrageous prices.

Humalog, which is one of the most popular forms of insulin, costs $329 a dosage in the United States. Twenty years ago, it was about $29. It has gone up in price 35 times in that 20-year period of time. How much does the exact same drug that costs $329 in the United States cost in Canada? It is made by the same company. Thirty-eight dollars. You look at that and you think there is something wrong here. The pharmaceutical industry is not focusing on giving American consumers a break.

What I want to talk about today goes to an issue that is hard to believe but true. A few years ago, the New York Times reported that nearly $3 billion worth of drugs was wasted each year. These are not ordinary drugs; these are cancer drugs used in chemotherapy. Medicare, Medicaid, and private health insurers spend billions of dollars on medications. Many of them are literally thrown in the trash. How could that possibly be?

You see, for many of the most expensive drugs, like new cancer treatments, the pharmaceutical industry produces them in a one-size- fits-all container, a single-use vial that a physician has to draw from to give a treatment to a patient. The dosage for the patient in the cancer therapy is based on the patient's size and weight. The problem is that the pharmaceutical industry insists on selling these drugs in excessively large vials that contain dramatically more medicine than the average patient would need, so doctors administer the proper dosage and throw away the rest.

Here is a graphic to illustrate what I am talking about. Here is why we are wasting billions of dollars each year on cancer drugs. One size does not fit all.

This drug, Velcade--the vial size available is 3.5 milligrams. The patient dose is 2.2. The amount that is left over is 1.3. Oh, you are going to recycle that? You can't do it. That is the end of it, and it is thrown away. In 2016, $300 million was wasted in this way.

This vial, the first one here that is produced, is a vial that would apply to a person who is 6 feet 6 inches tall and weighs 250 pounds, which means our linebacker Khalil Mack on the Chicago Bears--God forbid he would ever need it--that would be his dosage size. Most people are not as big as Chicago linebackers.

Why is Pharma sending us one vial, take it or leave it? Because they make money. They make money when we buy it and have to throw it away.

Takeda Pharmaceutical sells this drug for those who are suffering from multiple myeloma and lymphoma. As I mentioned, it is for a person who is 6 feet 6 inches and weighs 250 pounds. Takeda made $310 million in the year 2016 off of unused Velcade that got thrown in the trash-- $310 million.

What makes this even more appalling is that the pharmaceutical industry titans actually sell the same drug in smaller containers in other countries but not in the United States. Here, we are forced to buy the largest container and throw away the difference.

This chart shows that the same company--Takeda--that makes Velcade sells this drug not in 3.5-milligram vials, as in the United States, but, in Europe, in 1-milligram vials. It seems like a simple thing, doesn't it, that you would dispense this drug in a manner so that it is not wasted? Sadly, wasting and throwing away the drug is part of their marketing strategy.

Another Japanese company, Eisai, sells its chemotherapy drug Halaven only in 1-milligram vials in the United States but sells smaller vials--0.88 milligram--in Europe.

Merck's immunotherapy drug KEYTRUDA, which is truly a breakthrough, an amazing drug--research was done by taxpayers at the National Institutes of Health, which led to the development of this drug--they sell this drug, KEYTRUDA, only in 100-milligram vials in the United States but in 50-milligram vials in Europe. In 2016, Merck made $200 million on KEYTRUDA--this lifesaving drug--that was thrown away.

In 2016, I asked the inspector general of Health and Human Services about this waste of taxpayers' money. The inspector general uncovered that Medicare spent $195 million in just 1 year on 20 identified drugs for medication that was thrown away. That year, Takeda received $47 million in taxpayer funding for amounts of Velcade thrown in the trash. It wasn't alone. Genentech's Rituxan, one of the most common cancer medications, only comes in vials that are 100 milligrams or 500 milligrams. In 2013, Medicare wasted $10 million on Rituxan that was thrown away.

It is for this reason that I am presenting my second Pharma Fleece Award to Takeda, Eisai, Merck, and Genentech. Patients in America should not face higher drug costs because these Pharma fleecers choose to sell their expensive cancer drugs in excessively large drug vials that are necessarily going to be wasted.

Two weeks ago, I teamed up with Republican Senator Rob Portman of Ohio to introduce the REFUND Act--a simple bill that Senator Portman and I have introduced, and I hope others will join us. It says that taxpayers will only pay for the drug that is given to a patient, not for the part that is thrown away. Medicare already tracks how much of this medication is being discarded, so the REFUND Act simply requires Medicare to determine how much was wasted and to recoup the money from the drug companies. We then provide a portion of that money back to seniors for the 20-percent coinsurance they have to pay for the drugs.

An important point: When Medicare is paying for these drugs, and a lot are being thrown away, the seniors are still paying their 20 percent, even for the drug portion that is being thrown away. So Rob Portman's bill--the one I have introduced with him--says that the money recouped from the drug companies will go back to the benefit of these seniors. Under our new bill, this pharma fleecing for drug vial waste will soon come to an end so that not just the patients but our government will save money.

Remember the bottom line. When you ask the major health insurers today: What is driving the cost of health insurance premiums, they say: Senator, prescription drug pricing is No. 1.

Blue Cross Blue Shield, based out of Chicago, when I sit down with them, say: We spend more money on prescription drugs than we do on inpatient hospital care.

To give you an idea, it is out of sight. You can't turn on a television set, particularly if you are over the age of 50, without being bombarded with all these drug ads, right? You have heard them over and over again.

The No. 1 drug being sold on television today is HUMIRA. What is it for? psoriatic arthritis. It is serious. If you have that arthritis, that may be a lifesaver for you, but it is now being sold for that little red patch on your elbow called psoriasis. Interesting. Do you know how much HUMIRA costs each month? Five thousand dollars.

I have legislation that would require these drug companies to advertise the cost of their drugs on television. They tell us everything else; don't they? They tell us, if you are allergic to HUMIRA, don't take HUMIRA. I have never understood that warning. They tell us everything under the Sun, but they never mention the price. So what I want to do is get the price out in front of the public, and let them know what being perfect in a swimsuit is going to cost you per month.

From my point of view, there are people who need these drugs desperately, and we ought to try to get the prices within their reach. For those who are overusing and abusing the airwaves of America to advertise drugs--to try to push doctors into writing the scripts even when it is not necessary--we have to come to grips with this. If we don't, we are not going to have a serious effort to reduce the cost of health insurance and the healthcare costs that face our Nation.

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Mr. DURBIN. Mr. President, the President often claims that he knows how to make deals, but when it comes to the border, he seems uninterested in a good deal, a deal to provide effective border security, and he is hurting our military in the process. This week's vote to repeal the President's national emergency is a vote to restore sanity to our border security debate and restore Congress's constitutional power of the purse.

We all remember Donald Trump's idea that we need a 2,000-mile concrete wall from sea to shining sea and his claim that Mexico would pay for it. He said it some 200 times on the campaign trail and in the Oval Office. In December, after asking and failing to receive funding from Congress for this wall, the President said, ``I am proud to shut down the government for border security.''

What followed was the 35-day Trump shutdown, the longest government shutdown in U.S. history. It cost our country $11 billion, according to the Congressional Budget Office. After the President finally agreed to reopen the government, Congress provided funding to the Department of Homeland Security for smart and effective border security measures, including technology and additional Customs personnel. We did this because the President's own administration has stated that the vast majority of lethal narcotics that cross our southern border come through legal ports of entry.

But within hours of signing this bill, President Donald Trump announced that it wasn't enough. The President went on television to announce that he was declaring a national emergency over the border, and he announced that he was taking $6.5 billion from our military to build it.

Presidents of both parties have declared national emergencies. Each time, it was done in response to a specific crisis, in order to unlock certain statutory authorities. President George W. Bush declared a national emergency after the 9/11 terrorist attacks. In the 1970s, President Carter declared a national emergency as it pertained to Iran. Presidents of both parties have declared and updated emergencies relating to instability in Syria.

What Presidents did in those situations varied--sometimes levying sanctions, sometimes seizing assets--but each time, it was accepted on a bipartisan basis as necessary, legitimate, and in defense of our national interests. What President Trump did was different. For the last 2 years, he has struggled to fulfill a campaign promise, so when he didn't get his way, he created a fake crisis and declared a phony emergency.

The good news is that the American people aren't buying it. A poll conducted earlier this month by Quinnipiac University found that 66 percent of voters oppose the President's end-run around Congress and oppose his fake emergency declaration.

Newspapers around the country have concluded the same thing. The Tampa Bay Times editorial board said it clearly a few days after the President's announcement, ``Border wall is no emergency.'' In their words, ``It is not a national emergency just because President Donald Trump didn't get his way.''

West Virginia's Herald Dispatch newspaper concludes much the same, urging the President to ``take a realistic look at whether the wall is needed or if it's simply an unnecessary quest to satisfy his ego.'' That is common sense, but then common sense seems to be in short supply in this White House.

Not only is the President declaring a fake emergency, but he is using that crisis to take money. The President has told us that he will take $6.5 billion that Congress gave to our troops and spend it instead on a wall on the southern border. He is proposing to delay or cancel $3.6 billion in military construction projects--projects that our military told Congress it needed less than a year ago--and divert it to his wall.

Last Friday, Senator Schatz and I sent a letter to Acting Secretary of Defense Patrick Shanahan demanding to know which projects have been deemed, due to political interference, as less important than the President's wall. There are almost 400 military projects at risk. They cover 43 States, the District of Columbia, Guam, Puerto Rico, and more than a dozen foreign countries, including strong U.S. allies like Japan and the United Kingdom.

The President will have to cancel or postpone approximately 20 percent of these projects for his wall. What are we talking about?-- $800 million for essential training facilities like National Guard Readiness Centers, simulators, and firing ranges in Alaska, Arizona, Colorado, and Montana, to name a few; $1.4 billion worth of maintenance-related projects, such as aircraft hangars, and vehicle maintenance shops in Arkansas, Indiana, Missouri, Oklahoma, and elsewhere; $1 billion worth of projects for medical and dental care facilities, schools for military families, military barracks and dining facilities in Arizona, Missouri, Texas, and beyond.

For instance, the Marine Corps needs a new rifle range at Parris Island, SC. This base trains 20,000 new Marine recruits every year. Also on the list is new training center at Fort Bragg, NC, to provide top-notch training and prevent injuries among our special operations forces. They are using old warehouse right now. Are we really going to tell our military that their needs are being put on hold so the President can fulfill his campaign promise to build a wall? I hope those aren't our priorities.

In addition, the President also announced that he would take $2.5 billion in other military funds for his wall. The Pentagon tells me that they may take some of this money from excess military pay and pensions. Meanwhile, each of the military services--Army, Air Force, Navy, and Marines--have met with me to discuss a long list of urgent, last-minute needs, but with $2.5 billion being diverted for the wall, none of those leaders were able to say whether or not they would get the funding they need.

Last year, Hurricane Florence damaged 800 buildings at Camp Lejeune, New River, and Cherry Point, causing $3.6 billion in damage from wind and flood waters. A similar hurricane leveled Tyndall Air Force Base, in Florida. Both of them could use billions right now for repairs.

I am also told that the Navy needs hundreds of millions of additional dollars for unexpected ship maintenance. We can't afford not to make sure our sailors are safe on deployment. The National Guard has 2,100 personnel on the border, but it is starting to run low on its pay account. Unless DOD finds $150-300 million this year, the Guard will have to cut short its summer trainings in all 50 States to pay for this.

My subcommittee has identified almost $5 billion in military priorities that need attention now, but after the President takes $2.5 billion to pay for his border wall, which priorities will get cut?

This week, Republicans and Democrats in the Senate should join the House in rejecting the President's phony emergency declaration, and the Senate should reject any effort by the President to take money from our troops to build the wall.

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