The Economy (Cong. Rec., Dec. 14, 2021)
Summary
This is S9132 of the Congressional Record, Senate, December 14, 2021, with interleaved columns. The page begins with the end of an article printed in the Record on insulin pricing, which describes pharmacy benefit manager rebates, a report by 46brooklyn, the biosimilar insulin Semglee, and a Nebraska father's out-of-pocket costs for his child's insulin. Under the heading The Economy, Mr. Thune says the latest inflation numbers show the highest level in nearly 40 years, and that used cars and trucks are up 31 percent and ground beef is up 14 percent, with the figures attributed to Mr. Thune.
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“The Economy (Cong. Rec., Dec. 14, 2021).”
Original at www.govinfo.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/crec-crec-2021-12-14-crec-2021-12-14-pt1-pgs9132-9ba39e1d85/
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S9132 CONGRESSIONAL RECORD — SENATE December 14, 2021
and don’t get any of that rebated money di- 46brooklyn used a fictional consumer who That would require the buy-in of all parts of
rectly. has a deductible of $1,644—a figure the Kaiser the drug supply chain.
The government report found that manu- Family Foundation says is the U.S. average. Some PBMs have created formularies that
facturers offered higher and higher rebates Each month, January through April, the don’t require rebates, but they struggle to
each year, in fear of being kicked off the pre- consumer in this scenario would pay close to get health plans to adopt them. The insurers
ferred formularies. That means they must the full list price for insulin, $408 in this case have come to expect and rely on the money
also inflate the list price each year to keep based on retail price data. Those same from rebates, and some have them written
pace. months, the health plan, paying $0 toward into their PBM contracts.
In July 2013, insulin maker Sanofi offered the insulin, would receive a $339 rebate. The ‘A MOMENTOUS DAY’
rebates of 2% to 4% of the list price—also manufacturer of the insulin would get the Ciaccia of 46brooklyn pointed to the new
called the wholesale acquisition cost or difference, or $69 in this scenario. insulin product Semglee as an example of
WAC—for preferred placement on CVS The rest of the year, once the consumer hit how dysfunctional the marketplace can be.
Caremark’s formulary, the finance com- his deductible, he would pay about $34 for in- In July, the FDA approved Semglee as the
mittee found. Five years later, Sanofi re- sulin each month. The health plan, after re- first interchangeable biosimilar insulin prod-
bates were as high as 56%. bates, would pay about $35, giving the manu- uct. Biosimilars are like generic drugs in
Critics of the rebate system say it amounts facturer the same total of $69. that they can be substituted at the phar-
to legalized kickbacks. In 2019, a class-action At the end of the year, this fictional dia- macy counter without needing a separate
lawsuit accused manufacturers and PBMs of betic spent a total of $1,906 for insulin while prescription.
engaging in a commercial bribery ‘‘scheme,’’ the manufacturer made $828. The consumer’s Semglee is interchangeable with Lantus.
conspiring to raise the prices of insulin drugs health plan via the PBM came out ahead, More biosimilars are likely to gain ap-
to increase the fees manufacturers paid to profiting $1,078 after getting more than $4,000 proval in the next few years. They’ve been
PBMs. worth of rebates. touted as game changers that will lead to
Pharmacy benefit managers say the manu- If all the middlemen and insurance were lower prices and more options for patients.
facturers drive up prices and keep out any cut out, and the consumer was simply Acting FDA Commissioner Janet
competition from generics. charged the net cost of the drug every Woodcock called it ‘‘a momentous day’’ for
‘‘Insulin pricing strategies used by drug month, 46brooklyn argued, the consumer people who depend on insulin. ‘‘Biosimilar
manufacturers to avoid competition through would save more than $1,000 a year while the and interchangeable biosimilar products
ongoing patent extensions on insulin prod- manufacturer would make the same profit. have the potential to greatly reduce health
ucts are a significant barrier to getting costs A study by researchers at the University of care costs,’’ she said.
down,’’ said Greg Lopes, spokesman for the Southern California found that manufactur- Biocon and Viatris, the makers of Semglee,
Pharmaceutical Care Management Associa- ers, often blamed for rising prices, actually launched two different versions of the drug—
tion, which represents PBMs. make less money as list prices rise. Since the branded one called Semglee and a non-
‘‘PBMs have introduced programs to cap, 2014, while list prices rose by 40%, the net branded version called insulin glargine.
or outright eliminate, out-of-pocket costs on price that manufacturers made off their in- The nonbranded version’s list price is
insulin, and PBMs have stepped up efforts to sulin products decreased more than 30%, ac- about $148 for a package of five 3-ml pens,
help patients living with diabetes by pro- cording to the study published in the Jour- which is 65% cheaper than Lantus.
viding clinical support and education, which nal of the American Medical Association. There is indication that the largest PBMs
result in better medication adherence and The PCMA disputed the accuracy of in the country won’t carry that version on
improve health outcomes,’’ Lopes said. 46brooklyn’s rebate scenario. their preferred drug formularies, instead of-
Manufacturers, PBMs and nonprofits have ‘‘By cherry picking an extreme and unreal- fering the branded Semglee, which has a re-
set up patient assistance and coupon pro- istic example of high patient out-of-pocket ported list price of $404 per package of five.
grams to reduce what patients spend on insu- costs, the 46brooklyn report does a poor job That makes it only slightly cheaper than
lin. Each program has its own requirements of depicting the health care experience for Lantus at $425.
to qualify, its own rules and restrictions, and most insured people with diabetes,’’ Lopes
patients have to be aware that the programs said. ‘‘For example, the report’s out-of-pock- The ACTING PRESIDENT pro tem-
exist. et cost assumption is actually significantly pore. The Republican whip.
Drugmakers often advertise their patient higher than the amount at which many plans Mr. THUNE. Mr. President, I ask
assistance programs, but the onus ulti- set or cap patient cost sharing for insulin.’’ unanimous consent that I be able to
mately lies with the patient to find and There are consumers who reported paying complete my remarks prior to the vote.
apply for free or reduced-cost insulin. Nu- $400 out-of-pocket for a month’s supply of in- The ACTING PRESIDENT pro tem-
merous organizations have developed data- sulin after insurance. Rod Regalado is one of pore. Without objection, it is so or-
bases of assistance programs to help patients them. dered.
navigate the sea of options, including A FATHER’S CRUSADE
PhRMA’s Medicine Assistance Tool, THE ECONOMY
Regalado had never heard of a pharmacy Mr. THUNE. Mr. President, the latest
RxAssist, NeedyMeds and Beyond Type1’s
benefit manager before two years ago.
GetInsulin.org.
That’s when his son Matt, then 14, was di-
inflation numbers came out Friday,
‘‘For the population that can take advan- and the news was not good. Inflation is
agnosed with Type 1 diabetes and Regalado
tage of those programs, that’s great,’’ said currently at the highest level in nearly
got a crash course in insulin pricing.
American Diabetes Association Chief Advo- 40 years—40 years. The last time infla-
His first trip to the pharmacy when his son
cacy Officer Lisa Murdock. ‘‘We think insu-
lin should be affordable at the point of sale
was released from a hospital came with a tion was this bad, ‘‘E.T.’’ and ‘‘Rocky
$1,000 price tag for all the testing supplies III’’ were in theaters, and the Green
for everyone.’’
and insulin he’d never purchased before. The Bay Packers were being coached by
Lopes pointed out that PBMs pass through
next month, when all he had to do was buy Bart Starr.
to health plan sponsors the vast amount of
more insulin, the price was still north of $400
the rebates they negotiate. In the case of
after insurance.
High inflation is taking a major toll
Medicare Part D, the PCMA said that on American families. Gas prices are at
The single dad of two said he thought he
amount is 99.6%. a 7-year high. The price of used cars
had good insurance until he found himself
‘‘The rebates are then used to lower pre- and trucks is up 31 percent—31 percent.
having to redo his entire household budget
miums and out-of-pocket costs for patients,’’
Lopes said.
to afford insulin. Propane, kerosene, and firewood are up
‘‘I thought how do people do this?’’ he said. 34 percent.
CONSUMERS CAN PAY HUNDREDS MORE UNDER The resident of Tekamah, Nebraska, start-
REBATE SYSTEM
Food prices have increased signifi-
ed making calls to his insurance, pharmacy cantly. Ground beef is up 14 percent.
Nonprofit drug price research group and doctors, trying to figure out a way to
46brooklyn released a report demonstrating lower his out-of-pocket costs. Then he called
Apples are up 7.4 percent. Pork is up 17
how patients end up paying more because of his congressman. percent; eggs, 8 percent. Baby food is
rebates. ‘‘The harsh reality is that the cost of insu- up 6.7 percent. Bacon and related prod-
It looked at a box of Lantus insulin pens— lin is artificially high and ever-escalating,’’ ucts are up 21 percent. And the list
which hold pre-dosed cartridges for easier in- U.S. Rep. Jeff Fortenberry, R–Neb., said in continues.
jection—with a list price of $425. According July when he and Rep. Angie Craig, D–Minn., Rent prices are up. Utility prices are
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to the Finance Committee’s report, Lantus reintroduced their bill aimed at capping up. Furniture prices are up, and on and
offered the PBM OptumRx a rebate of 79.76% prices. ‘‘Matt’s Act makes insulin prices fair on.
or $339 in 2019. for everyone by capping the price at $60 a
Inflation is so bad that, despite wage
The consumer’s health plan gets that re- vial and $20 a vial for those on insurance.’’
bate every month regardless of whether the Though legislative efforts have focused on growth this year, Americans have seen
consumer pays full-price in the deductible capping out-of-pocket costs, there has been a a de facto pay cut, with real average
phase or pays a smaller co-insurance amount push to eliminate rebates altogether and hourly earnings down 1.9 percent this
later in the year. drive down list prices across the market. year.
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December 14, 2021 CONGRESSIONAL RECORD — SENATE S9133
Inflation is what happens when you Back Bankrupt’’ plan by strategically Standing Rules of the Senate, do hereby
have too many dollars chasing too few sunsetting various provisions before move to bring to a close debate on the nomi-
goods and services. And a big reason the end of the bill’s 10-year budget win- nation of Executive Calendar No. 576,
Samantha D. Elliott, of New Hampshire, to
for our current inflation situation is dow. Of course, Democrats have never
be United States District Judge for the Dis-
the Democrats’ decision to pour a lot had any intention of actually trict of New Hampshire.
of unnecessary government money into sunsetting these provisions. But by Charles E. Schumer, Richard J. Durbin,
the economy earlier this year, de- claiming that they are going to sunset Tina Smith, Martin Heinrich, Eliza-
spite—despite, I might add—being these measures, they have been able to beth Warren, Patty Murray, Tammy
warned that their partisan $1.9 trillion sort of disguise the fact that their Duckworth, Tim Kaine, Gary C. Peters,
American Rescue Plan spending spree spending spree would actually cost Angus S. King, Jr., Brian Schatz, Mar-
could stoke inflation. nearly $5 trillion. garet Wood Hassan, Jacky Rosen, Chris
And you don’t have to take my word That is the Congressional Budget Of- Van Hollen, Jeanne Shaheen, Chris-
topher Murphy, Ron Wyden.
for it. Here is what former Obama eco- fice, not me. The Congressional Budget
nomic adviser Jason Furman had to Office, last Friday said, if extended— The PRESIDING OFFICER. By unan-
say recently when discussing our infla- the 10-year window—this bill would imous consent, the mandatory quorum
tion problem: cost $5 trillion. call has been waived.
The original sin was an oversized American Democrats are implicitly admitting The question is, Is it the sense of the
Rescue Plan. It contributed to both higher that they plan to extend these pro- Senate that debate on the nomination
output but also higher prices. grams, but they are saying that people of Samantha D. Elliott, of New Hamp-
That quote from Mr. Furman ap- shouldn’t worry, that the cost of these shire, to be United States District
peared in a New York Times article extensions will be offset. Well, I would Judge for the District of New Hamp-
that also noted: like to know just how exactly they shire, shall be brought to a close?
But some economists, including veterans plan to do that. The yeas and nays are mandatory
of previous Democratic administrations, say With massive new tax hikes, on top under the rule.
much of Mr. Biden’s inflation struggle is of the tax hikes they have already in- The clerk will call the roll.
self-inflicted. Lawrence H. Summers is one cluded in their bill—just how many tax The legislative clerk called the roll.
of those who say the stimulus bill [that] the hikes do Democrats think our economy Mr. THUNE. The following Senator is
president signed in March gave too much of necessarily absent: the Senator from
a boost to consumer spending. . . . Mr. Sum-
can handle?
And if Democrats had a plan for fu- Wyoming (Ms. LUMMIS).
mers, who served in the Obama and Clinton The yeas and nays resulted—yeas 59,
administrations, says inflation now risks ture offsets, why didn’t they include
those offsets in their bill, in the first nays 40, as follows:
spiraling out of control and other Demo-
cratic economists agree there are risks. place, along with an honest accounting [Rollcall Vote No. 495 Ex.]
Again, that is from the New York of the length of their programs? YEAS—59
Times. Is it because they thought that the Baldwin Hassan Reed
American people would balk if they Bennet Heinrich Romney
Inflation is spiraling out of control, Blumenthal Hickenlooper Rosen
and Democrats are preparing to throw knew the true cost of the bill, that Booker Hirono Sanders
more fuel on the fire. That is right. they might not be crazy about the idea Brown Kaine Schatz
Democrats are preparing to double of a bill that would cost them $5 tril- Burr Kelly Schumer
Cantwell King
down on the strategy that helped get lion? Cardin Klobuchar
Shaheen
I am hard-pressed to think of any- Sinema
us in this mess in the first place and Carper Leahy
Smith
pass yet another massive government thing more irresponsible than for Casey Luján
Stabenow
Democrats to pass their Build Back Collins Manchin
spending bill. Coons Markey
Tester
I am not sure whether Democrats Better—or their ‘‘Build Back Bank- Cornyn Menendez Tillis
simply don’t care about the inflation rupt’’—measure right now. Inflation is Cortez Masto Merkley Toomey
soaring, as I have just pointed out, and Duckworth Murkowski Van Hollen
situation facing American families or Warner
there is no clear end in sight. Even the Durbin Murphy
whether they are operating under the Feinstein Murray Warnock
delusion that they can somehow pass Federal Reserve is now acknowledging Gillibrand Ossoff Warren
another major government spending that this isn’t transitory. They re- Graham Padilla Whitehouse
moved that word from their descrip- Grassley Peters Wyden
bill without serious consequences for
the economy. tion. NAYS—40
Regardless, there is no question that We are emerging from a pandemic Barrasso Hagerty Risch
pouring another $1.75 trillion in gov- that required a lot of government ex- Blackburn Hawley Rounds
ernment money into the economy penditure and a corresponding increase Blunt Hoeven Rubio
Boozman Hyde-Smith Sasse
would likely make our inflation crisis in our debt, and we have no idea what Braun Inhofe Scott (FL)
even worse than it is today. government money might be needed Capito Johnson Scott (SC)
I say $1.75 trillion because that is down the road. Cassidy Kennedy Shelby
Passing a $5 trillion spending spree Cotton Lankford
what Democrats have been selling as Cramer Lee
Sullivan
the pricetag for their so-called Build that would add $3 trillion to our na- Crapo Marshall
Thune
tional debt is the very last thing that Tuberville
Back Better plan. But as we learned on Cruz McConnell
Wicker
Friday of last week from the Congres- we should be doing. Daines Moran
Young
I hope that at least some of my Dem- Ernst Paul
sional Budget Office’s latest analysis, Fischer Portman
the Democrats’ spending spree would ocrat colleagues will think better of
their spending plans before the Amer- NOT VOTING—1
far exceed $1.75 trillion. When you take
away the shell games and budget gim- ican people are forced to discover just Lummis
micks, the Democrats’ spending spree what ‘‘Building Back Bankrupt’’ is The PRESIDING OFFICER. On this
would cost almost $5 trillion—5 tril- really like. vote, the yeas are 59, the nays are 40.
lion. And, of course, the tax hikes in I yield the floor. The motion is agreed to.
the Democrats’ plan, as large as they CLOTURE MOTION
f
are, wouldn’t even come close to fund- The PRESIDING OFFICER (Mr.
PADILLA). Pursuant to rule XXII, the CLOTURE MOTION
ing that amount.
The Democrats’ Build Back Better Chair lays before the Senate the pend- The PRESIDING OFFICER. Pursuant
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proposal, if implemented over 10 years, ing cloture motion, which the clerk to rule XXII, the Chair lays before the
as they plan, would add an eye-popping will state. Senate the pending cloture motion,
$3 trillion to our national debt. It turns The senior assistant legislative clerk which the clerk will state.
out that Build Back Better is more like read as follows: The legislative clerk read as follows:
‘‘Build Back Bankrupt.’’ CLOTURE MOTION CLOTURE MOTION
Democrats have attempted to dis- We, the undersigned Senators, in accord- We, the undersigned Senators, in accord-
guise the true cost of their ‘‘Build ance with the provisions of rule XXII of the ance with the provisions of rule XXII of the
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