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tv   Representative Frank Pallone Discusses Prescription Drug Prices  CSPAN  July 18, 2017 1:15am-2:19am EDT

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emphasize here is that over the course of barack's presidency, there were scores and scores of people in illinois who had known him in years earlier, who were deeply disappointed with the trajectory of the obama presidency, in two ways. one, disappointed that barack forgot the people, many of the people, most of the people, who were central to his political life. announcer: sunday night on c-span's "q&a." announcer: next, a look at ways congress can reduce the cost of prescription drugs and the latest efforts to repeal the health care law. frank pallone stock about -- talks about blocking generics and allowing medicaid to negotiate lower drug prices. this was hosted by the center for american progress action fund.
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>> good morning, everyone. not much going on in healthcare policy these days, is there? my name is tovar, i'm vice president for health policy at the center for american progress and i have the pleasure of introducing congressman pallone who's been a leader in protecting the integrity of the medicare guarantee and of the medicaid program. making the nations food system saver, strengthening laws to keep our air and water clean, making health care more affordable and accessible and supporting initiatives that advance and protect public health.
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mister pallone is the ranking member of the house energy and commerce committee which has jurisdiction over issues pertaining to energy, environment, commerce, telecommunication and healthcare. there's a lot on his plate. from 2060 2014, congressman pallone served as top democrat on the committee subcommittee on health and is chairman during the 111th congress, mister pallone played a key role in authoring and passing the affordable care act so it's a good time to have him here. please welcome congressman pallone. [applause] >> thank you tovar and i want to thank the center for american progress for this today. i have to say a few more things about the center. first of all, right now obviously we are in the health care debate and the republican efforts to repeal the affordable care act. has done fantastic work in my opinion educating the public about the negative impacts of the republican repeal, and of
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course your twitter is part of that as well. there's so many things the center is doing that are being helpful because i often felt, i'm going to watch how i touch the mic. that most of the time after we passed the aca, there really wasn't a lot of information going on about the positive effects of this and in the last six months obviously that's changed dramatically to the point where very few americans, it was pulled and it was like 15 percent of americans, that's the same level of favorability of our governor, as you know. about 15 percent of the people view the republican repeal bill in a favorable light and a lot of it has to do with the center and other organizations out there pointing out the negative impact on the american public and on their health insurance.
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and also i mentioned to tovar when i came in, i remember i think it was in fall 2015 when the center put out the report about drug pricing and high cost drugs and that played a major role i think not only in the democratic platform but also in hillary clinton's comments and ultimately trump as well about how the high price of drugs needs to be addressed and was a priority mentioned many times during the presidential campaign on both sides of the aisle, the center had a lot to do with that as well. i'm going to talk about drug pricing in my comments but i think after we sit down and topher start answering questions if we have a discussion we will talk more about the aca. obviously i believe that what senator mcconnell is doing these last couple weeks, the changes initiated by senator crews and
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others in my opinion are just cosmetic. if anything, they make the bill worse than the original senate bill introduced and most notably the cruise provisions that allow health insurance companies if they enter the marketplace to also then offer junk plans outside the marketplace, that way the essential benefits package. it was dead enough when the senate bill says that states could waive the essential benefits package but now the cruise amendment and the latest mcconnell proposal that incorporates this is to go beyond that to even without the state waving it, the junk plans could be offered in states even more states, even those that don't waive it so i think again, we will talk a little more about it. the main thing i wanted to talk about was drug pricing so let me get to that. some of you know that last week
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on the floor we did pass reauthorization of the user fee bill that was not only for drugs but also for medical devices and generic. that is now going to the senate. we expect them to take fairly quickly or at least that's my hope and obviously that bill also is going to help with generics. generics in my opinion are still a major way to deal with drug prices effectively but the main thing i want to stress today is the problem with drug pricing is getting worse, not getting better even though we talked about this two years ago, even though it was part of the presidential campaign on that side of the aisle, even though president from continues to mention it from time to time, congress and the administration are not doing anything effectively about it. and we in our committee, the democrats on the energy and commerce committee have
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repeatedly asked our republican leadership on the committee to have hearings on the issue. and you know, they haven't said absolutely no they haven't done anything and we are six months into the two-year session and there still haven't been any hearings so we're still hoping we will have them but to me, not only are we not addressing this legislatively, we're not even having hearings on it. we did when we passed the fda user fee bill and committee, past a sense of commerce resolution which was done by voice vote, jan was the sponsor of it that said that the committee should address drug pricing. but you know, so far you know what the sense of congress are, they don't have any force of law so at least they indicated they do care on the republican side but we haven't seen any action so we're still going to push them.
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so the problem is that not only are hard drug prices, not only is the problem with hard drug prices getting worse, not only is it outpacing other increases in healthcare significantly, next year annual drug spending is expected to reach more than $500 billion in the united states. i can see the point, i don't even know if we're there yet but i think at some point we will get to the point where drugs are maybe even the majority of your healthcare costs. we're not there yet but we could get there. so as a result of those high prices, many american states, real barriers in terms of getting the medication they need which is why there's such an important issue. and it shouldn't be a partisan issue. we had a whole that the kaiser family foundation released this may that said that six in 10 americans said lowering the cost of prescription drugs should be a top priority and that was
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democrats and republicans so when you talk about republican americans, not the people that are elected or the leadership here, just republicans in general, they feel, democrats do which is probably the reason president trump and hillary clinton talked about it during their campaign. so what can be done? let me talk about what can be done and it's complex. some of these things are easy, like talking about negotiated prices, that might sound easy but a lot of these things are more complex and i want to stress there is no silver bullet so the reason i commencing different things as i don't think one thing alone is going to accomplish the goal or be a solution. so first thing i wanted to talk about is rams or risk evaluation and mitigation strategy. so that shows you the bureaucratic aspect of it here. and that's, this is the problem where brand-name companies delay in bringing generics to market.
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and that's because they use the rems to block access for samples of branded other words the generics are going to come to market, they have to have samples of the brand-name drugs and the rems program is used by brand names to prevent that because they don't provide the sample. you might say is that a big problem? i think it's a big problem. there was a july 2014 study conducted by matrix global advisors that's in the ongoing abuse of rems cost the us health system for $.5 billion in 2014, probably a lot more today. so we need to provide a way of reducing the ability of the brand name companies to block the drugs: the market by providing access to the samples
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and there's actually a bipartisan bill called the fast generics act that was introduced by peter welch and i forget you republican response but it is bipartisan and this establishes an fda approved authorization process or american manufacturers to obtain samples of these branded products. and i'm not going to go into detail unless you want to, that was something that we considered during the fta markup and it wasn't passed but we talked about it and we couldn't get the votes for it but we need to get the votes for it obviously. at some point. the other thing deals with exclusivity or this is the second, that deals with exclusivity. some of this is going to get a little in the weeds here, i'm sorry but that's why we're at the center, they get into the week. so exclusivity of course, we have a process in various ways where companies have a period of
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exclusivity where they're the only ones that can sell the product and they spend money and resources doing that. but and the exclusivity protects certain drug treatments from competition for a set period of time but today, drug manufacturers often retain that incentive even if they violated a criminal or civil laws so one simple thing is to say that if you do that, in other words if you do something like illegally promote the unapproved use of a drug treatment, you do something illegally either criminal or civil, i think they should lose the right to exclusivity for the related product which basically punishing bad actors if you want so that's the second thing i want to mention. the other thing, a third item is penalties for misclassification in the medicaid drug rebate program.
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you pay, i guess you get a larger rebate, right, if you classify your product as generic. and a lot of times you have situations where drug companies have misclassified their product as generic and by doing that, they make a lot more money, they get a larger rebate so the best example of that was epipen. epipen is a brand of drug, however mylan had classified the epipen as a generic drug for purposes of the drug rebate program and that meant they got you know, the changes recently, they made more money. there was a settlement which you know, a lot of people think was
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inadequate. as a result, you know, they had to pay back i forget how many millions of dollars but actually 1.27 billion is what we estimated the cost, i don't know what the settlement was what we like to see in legislation is stronger penalties so that you know, companies like mylan have a disincentive to do the wrong thing, too misclassified their product. fourth item, i already mentioned in many ways this is probably the most significant and the one you hear about the most is the medicare price negotiation. we half price negotiation with the va, with the military, we don't have it with medicare. and we should get medicare the ability to negotiate prices with the drug companies, that's an easy one. it's not easy politically but it's easy to explain.
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and president trump during the course of the campaign and since then has said he would like to see that. the congressional republicans continue to oppose it. under medicare part d the secretary, the hhs secretary is restricted by a non-interference clause from having any role in negotiating or setting prices so the first thing we would have to do is repeal that noninterference clause so that
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the secretary could do that. and then of course there are other aspects of that we can go into, i don't want to spend too much time. that was medicare, with regard to medicaid, what we really need to do there, medicaid is the state and federal match for the most part and so the federal government, the state decides they want to negotiate and in medicaid they can but there are ways for the federal government to help them do that so what we're suggesting is that we create a federal-state medicaid negotiating pool for high-cost drugs so under the rebate, under the medicaid drug rebate program today, drug manufacturers and medicaid agencies have to enter into rebate agreements with the secretary and the safe and negotiated initial research but many states have tried to join together to let purchasing power of a higher cost drug which does not have the authority to facilitate those negotiations between the state and drug manufacturers and there's a lot of money lost as a result so what we're suggesting is that we authorized cms and participating state medicaid programs to partner with sector contractors to negotiate elemental rebate for drug manufacturers. again, will call it a medicaid purchasing, that is essentially with would require legislation as well.
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now, i want to talk a little bit about generics in the medicare part d program and the way we can provide greater financial incentives for generics in medicare part d. in the fda user fee legislation, we did incentivize more generic competition. we did that in the fda user fee bill and if you want to talk about moreof that, we can but there are ways to provide more financial incentives for generics and there's the rems that i mentioned before. what we are suggesting here is first of all, improvements to the part d appeals process because a lot of people are turned down and then they appeal they don't know how to go about it so we have this process so that seniors or the disabled don't just you know, abandon hope. that they actually can take an appeal. but we also can offer
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the lowest possible copayments. right not now under medicaidpart -- medicare part d, we've been trying to keep the generic copayments low and that's saved a lot of money but it's been much more difficult to do that with the lowincome subsidy, the lower income population. a lot of them, they are the medicare beneficiaries that have the highest drug spending. their copayment amounts to step by statute so that means that part d plans can't lower generic copayments on their own to to encourage the use of generics, low-cost generics as part of the program so what we would have to do is again, pass legislation so that we could lower the generic co-pay and that would save money for seniors particularly low income, i mentioned the appeals process as well. i want to talk about a couple medicare improvements that we can make and talk briefly about transparency and then we will go
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to the questions part. in terms of the medicare improvements, one of the things that we can do is close the doughnut holes, when we did the aca we basically closed apart the doughnut hole over a period of time but that hasn't ended yet and there is still part of the doughnut hole that needs to be filled so i would advocate that we do that two years sooner than the current law and obviously that would help cost for seniors.
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we can also reduce costs for seniors and for the medicare program by tying reimbursement in medicare part d to the most common dosage of drugs. this hasn't really related to the opioid problem but a lot of the debate when we were dealing with opiates last session was the fact that a lot of times people would get a lot of pills. they would sit on the shelf and other people would use it and that doesn't relate to this but what we do is, what we see is drug manufacturers package bottles that contain too much of the drug for most doses so that increases the cost cause you're getting more prescription drugs
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that you don't need. so and it's billions of dollars, apparently so what we could do basically is incentivize companies to manufacturer files that more closely matched the need of the population and again, that can be done by legislation as well. the last thing i want to talk about is transparency and accountability of drugcompanies and their prices. we have some good actors, one of them is in my district, johnson and johnson, that both johnson and johnson and fantasy have agreed to disclose their drug prices increases every year. they went so far as, they're going to put limits on how much it would increase prices annually and this is an important first half but obviously they're doing this voluntarily, the only ones that are doing this as far as i know what for the past two years under the obama administration, the last two years of president obama, they set up a medicareand medicaid drug spending cash for that provided online tools where the public could view drug spending and utilization on certain drugs and it wasn't perfect but it's obviously an effort to create transparency and what i would say is that the trump administration should continue this. as far as i know they had, but they should because you know, without that i think it would be
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more difficult to get that kind of information. but also congress could take steps in legislation to institute reporting requirements for manufacturers in the rebate program and in medicare if a manufacturer increases the price of a covered out-patient drug significantly, they basically have to report it and i would advocate that as an important step legislatively. i mean obviously, if we're going to deal with drug prices, we have to have the data that is actually happening because otherwise it's more difficult and we had this in other parts of the health care system so it's not that unusual to do something with it. the last thing i wanted to say and we will have topher come back up here is a lot of these initiatives are things that i'm going to work with our committee members, democrat and republican, tried to develop comprehensive legislation in the fall that includes the thing that i talked about.
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and potentially others as well, i haven't mentioned everything. i basically talked about ways that i think would be most effective and probably be politically more viable, there are things out there that i think are less effective or maybe more difficult to do politically so i haven't mentioned them i want don't want to suggest it's the only thing but the main thing is we need to come up with workable solutions to address drug pricing and incentivize competition to encourage development of affordable drugs and i think those are some of thesteps that we could take in that regard and that we will work on. when we come back in the fall. so you want to come up here? what are we doing now? are you going to ask me questions? are we going to have a little dialogue? >> i think i want to say first of all that i think it's incredibly important that perhaps have a proactive, positive agenda for reform. we can't just be about opposing trumpcare, we can't just be
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about opposing trumpcare, we can't just be about russia, that's not how we're going to win the election. >> don't even talk about russia. [laughter] >> so we thank you for your initiative and all your work -- again,re welcome but it's a collaboration. i really think the incentive played a major role in this report , it really was sort of the start of rational thinking. >> one thing that you said that i wanted to ask you about , i found very interesting was when
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you were talking about committee hearings for the drug user fee legislation and were going to end up having morecommittee hearings on that legislation that on trumpcare. and you've been in congress a long time, right? >> almost 30 years. i shouldn't even mention it but i will. topher: have you ever seen such a slapdash, secretive process in your entire career? rep. pallone: let me say this, i don't find it funny because i don't know what the circumstances were but the past couple weeks i spoke at one of our energy and commerce hearings and i guess a couple republicans
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said you will become regular order guy, they literally told me that, i don't remember who and that's what i've always been. i guess i get that from john dingell, a regular order that we always should have a subcommittee hearing, a subcommittee markup, full committee? before we go to rules on the floor. that is regular order, simplified. it seems like we are getting further and further away from that. it seems like in the house, when they did the repeal they had full committee markup. nothing in the subcommittee. and i don't think a hearing in the subcommittee but this went to full committee markup so they skipped three levels of special order and the only reason i in approaches that is because not myself and others, democratic side,but if you know mcconnell didn't even do that. he just went right to the floor. so this is the problem is that i think that a lot of times the republicans went away from regular order because they don't want to know what they're doing. you're hearing the markups you
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have on both sides, remember, if you did regular order in the house and senate back in six or seven opportunities the bill, or if you go right to the floor there's only one. so i think that's becoming more common and the reason they're doing this is because it's less opportunity for people to know what's going on. topher: and some people are under the impression that if the senate passes this, that there's a chance that the house won't pass. >> wishful thinking. >> can you give people a message here about what's going to happen in the house? >> i think that's wishful thinking. i think it's quite clear that the place to stop this bill is in the senate. and i think the reason for that in my opinion is because the senate represents the whole state and what's happened in the house is we could get redistricting, you just have so many republican districts that are so republican that they're worried more about an attack from the right for not repealing
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obamacare than they are about that in general whereas senators because they represent the whole state still have a significant number of people who are you know, progressive orprogressive leaning who will be outspoken and say, don't do this, it's really going to hurt people. i think the places in the senate, not the house. topher; i totally agree. expert talking broadly hear about access to prescription drugs and costs. can you just talk a little bit about healthcare and how it affects people's access to prescription drugs, you talk a little bit about the health benefits and i just want to hear more about how bad trumpcare is. rep. pallone: topher, let me thank you and the center for
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really pointing out the problems with trumpcare or with the repeal, i don't even like to use the term trumpcare because this implies that this is a replacement and i don't think his replacement and the reason i say that is because we paid for the aca with $1 billion in tax increases, drug companies and medical device companies and some spending cuts. and the republicans repeal, most of it. the house is like 800 billion , or almost 900 billion butthe senators almost 800 million so there's no money left to pay for the subsidies for people to buy insurance or pay for the medicaid expansion so it's not replacing that at all. i'm not being offensive either. trumpcare implies that trump cares. [laughter] pallone: if he does, maybe he does theoretically but i don't want to give him a day of attention but he doesn't understand that this is not a
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real replacement. what was your question again? topher: how does the repeal affect access to prescription drugs. rep. pallone: the reason i went on to that is because one of the things that got very little attention until the last six months was the essential or guaranteed benefit package but it's always something that i was very proud of and i would talk about was i remember in north carolina i always wrote the story but in north carolina before the aca they were selling to policies for $15 a month that didn't include hospitalization and i would say that isn't health insurance because north carolina unlike my state of new jersey in have to guarantee any benefits.
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you could sell junk insurance. as become the focus of a lot of attention now, the newyork times wrote an article about it yesterday but for a long time nobody knew anything about it and not to take up a lot of time will never forget the day they were supposed to vote for the repeal in the house on friday and they didn't, they postpone it. that day i remember going to the cloak room and i watched both cnn and msnbc and there was one of the commentators literally had a like a, a wall, that had the guaranteedessential benefits and it was the first time that i ever remember any media outlet actually talking about that. which was significant because now it's kind of a major part of the debate and of course if you allow what the senate bill and house bill and the senate will initially did with the house bill to pass, is the way the essential benefits package, they could theoretically waive prescription drugs or limit in a significant way and you wouldn't have access to drugs and of course now as imentioned before, the latest amendments, which is basically cruz amendments, would basically make it even worse because it wouldn't even have to be up to the state to waive it. if you offer blue cross blue shield offered the policy within the exchange, and have a guaranteed benefit, then the cruz amendments would allow you to sell insurance outside of the exchange and waive the essential benefits package so you could get somebody, not only buying a
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policy and have hospitalization but they didn't have prescription drugs or even worse they say we're covering prescription drugs but there's a limitation on what they offer and the problem is people don't know. people buy that north carolina policy and they're getting hospitalization and they don't -- people buy that north carolina policy and think hospitalization and they don't know.
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they didn't know. topher: the only thing i would add is that even putting aside the cruz amendments, and putting aside the essential health benefits, when you are, when you have tax credits that are intended to buy a plan that only covers 58 percent of cost as under the senate bill,then you're going to have thousands of dollars in a pocket cost including for research and drugs and $6000 deductibles for people with low income so thereare many ways that this is devastating . the acaremember, unde even though some of the plans you have what i would consider a high deductible, there are limits and the house bill eliminates and i think maybe eliminates those restrictions effectively so the co-pays are going to get higher. and we don't know whether the cost-sharing subsidies even now, the president decides on a month-to-month basis whether he's going to provide them or not so you know, that's not
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good. it's not a good situation. topher: since you mentioned that, talk a little bit about the sabotage that's going on and you know, they're blaming, they're selling this bill by pointing to premium increases and insurer withdrawals as if it's the fault of obamacare. rep. pallone: i mean, there are two things. first is the direct sabotage and then there's the sabotage because if you allow us to move and make any changes that improve healthcare, that helping and i hope it goes so they can mention that but there's many forms of sabotage, the two most obvious are my understanding is now that remember, the aca requires you to have insurance and if you don't, then you pay a penalty through your income tax. my understanding is that if people didn't check the box on the irs form to indicate whether or not they had health insurance, they just ignored and a lot of people knew that was the case. then now the trump administration is not enforcing it so if you skipped it and
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didn't buy health insurance, you won't get a penalty so once you eliminate the mandate whichof course both the house and senate don't do, themarketplace collapses but they're already trying to sabotage and do not enforce the mandate. the other thing is the cost-sharing subsidies, people that get help with tax credits and subsidies that pay for their premiums also get help proportionately for their income. to pay for their deductibles and co-pays, the cost-sharing subsidies but the republicans took, went to court and there's so many things that they did to the aca, the court action and eliminating requirements for states to expand medicaid which means the people we thought would have medicaid were not one of the other things they did was to get the courts to rule that , to undermine the cost-sharing subsidies and so basically the court said that i
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don't know if they said it this way but effectively left it up to the administration to provide went to pay for it to pay them and from does it on a month-to-month basis. he started out in january saying i'm not sure i'm going to pay the cost-sharing subsidies, if the democrats are bad and i will doort repeal, that. it's a threat which incredibly to me that the president of the united states would threaten democrats by saying, i'm going
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to hurt people. but that's actually what he did and i think the day when they have to decide whether to pay is like around now, maybe the 20th or 25th, the end of each month and he waved until the last day to decide whether or not he's going to pay the cost subsidies -- so let me give you an example. theinsurance companies in start the costo of filing their rate increases or even indicating whether they're going to sell insurance like they do and then finalize and could be changed between june and november. so horizon with which is 70 some percent of our marketinsurance announced like a 24 percent ,
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they filed a 24% increase. and i asked the president , why are you raising, why are you bothering with a 24 percent increase. i can't imagine health insurance was going up that much, and he said they haven't. i said what is it? he essentially broke it down and said about eight percentof what we filed is for increased cost of health insurance. about 10 or 11 percent is if you review goes through, and there is no mandate. we figure the healthier and wealthier will drop out and it will cost. and i do remember, another six or seven percent was because trump decides from month-to-month basis whether to pay for the cost-sharing subsidies so i don't know whether they're going to be paid next year so whatever, all these different things up to 24 percent increase for what would be an eight percent increase. he says if the repeal doesn't go through and therepublicans drop it, and you guys then work togetherto improve the affordable care act then by november will get rid of all these other things and it will about 8%.
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sabotage is creating all these problems. topher: so let's talk about drug pricing and drug cost. you laid out a number on the form and i think there's a tendency on the left or in the progressive to really focus on medicare negotiation as a silver bullet and i think that raises some questions. number one, if you're really serious about doing that, you have to have some sort of enforcement mechanism or it's really just words on paper. pallone: i mean, you'd be even if you gave authority,ry that
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is that what you mean? topher: that's the issue to is the current secretary we have but there's also the issue that even if it were mandated, secretary burwell, that unless she is given the authority to set a formulary to in some way back up the threats, either by not covering the drugs or some other way, some other mechanism, we propose that there be sort of an arbitration as a backup to give the necessary threat to drug manufacturers that if they don't set a reasonable price through a negotiation that then there will be an arbitration that is you know,conducted through a nonpartisan independent entity that evaluates all the factors so there's that issue. rep. pallone: that sounds like a good idea to me. that's the incentive is out
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front on this so stating that obviously indicates how much you thought about it. i think that would be a good idea. topher: just as another example, in the senate, a bunch of senators have introduced legislation that as a backup would link prices to i think to the v.a. rep. pallone: i mean, i think you're going to have to do something like that, particularly if this were to happen it would be signed by president trump and he obviously supports in a negotiated prices and i guess thesecretary would go along with it because he's in his cabinet but i think you do need something like that would be a good idea. topher: the only other issue i want to raise about it is that i think it's not right to think
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about it as a silver bullet and to put so much emphasis on it because medicare negotiation is really just about medicare. and so it's really important to think about this in a holistic manner and to think about how you're going to address these prices as they are paid for through private insurance and so that's why i thought it was important that you lay out some reforms like the rem's and exclusivity that really get out the problem in the private sector. rep. pallone: no, i agree and that's why you did mention the other things and we also mention medicaid rebate program and i did also mention generic because i do worry that because of the media attention to some of these generics that you know, really have gotten out of line in terms of pricing that a lot of the media or even members of congress think generics no longer play a role in pricing and i think that's not true. so
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i want to emphasize thatgenerics can continue to play a role and that's why we address generics to some extent in our fta user bill and why i mention other things to because i do want generics to continue to play a significant role in reducing prices as well. topher: so i think maybe some people in the audience listening to your remarks and to your proposed reforms might be thinking this all sounds very good but we have arepublican president who although he's talked about prescription drugs a lot, no one can believe a word that comes out of his mouth. [laughter] topher: there's a republican senate and a republican house so how do we get this done? what is the strategy here if we are not talking about a legislative strategy in the
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short-term like attaching it to some kind of must pass legislation, isn't just about winning elections? rep. pallone: i don't want to give you that impression although i certainly like that the majority will do whatever we can to achieve that. but look, there were many things. not many. that were a few things president trump talked about during his campaign that i think myself and other democrats can agree with. one was the price of prescription drugs, another was renewed attention to the negative impacts of trade agreements, not moving on the transpacific agreements, renegotiating some of the others, major infrastructure
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initiatives, trillion dollar infrastructure initiatives. granted, a lot of those have gotten much attention in the president as it moved much on them. maybe with the exception of trade, we will see. the jury is still out on that what he's going to do. but i think there is this notion out there and i certainly hear it from my colleagues on the republican side that we are not doing anything and they are going to get blamed for not doing anything. one of the reasons i think mcconnell talked about extending, he didn't talk about it, he's announced that they are going to meet in august. not because he wants to repeal the aca but also because they haven't done anything. there's no legislative accomplishments by this congress for this administration so i think myfeeling is that if we continue to push and the senate continues to push and i continue to push at some point they're going to wake up and say wait a minute, i made these commitments as president, i've got to follow
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through on them. so you know, with infrastructure, we in our community committee put together a list america which lay down a marker for infrastructure. and this would be the same thing. you said mister president that you wanted to address this issue so let's lay down some markers and put together some legislation that will tell you what to do and what i don't think it's just an effort to you know, bring this up for a vote in 2018 although we certainly will to get done to actually see if we can push them to address all of these things it was jan czajkowski congress resolution in the fda bill. i just thought we have to have a vote we would probably vote against it and all the democrats would vote for it and chairman walden said, oh no. we will accept that and it was done by vioce vote so to me -- so to me that was an indication they don't want to be on record, they may not want to do much but
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they don't want to be on record saying they're not trying to address drug pricing. question andst we're going to turn to the audience to ask some questions. >> let's say that the senate repeal bill fails. what do you think the prospects are for that and what do you think should be in it? rep. pallone: that's the whole goal. my goal would be to have some drops in the repeal either because by august they can't vote or they have a vote and can't move forward.
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i mean, all ready they've lost to who say they won't vote to move move the bill forward and mccain is out this week so the goal would be that before they leave in august that they don't pass the repeal and senator mcconnell says it's over. president trump says it's over and then i think we could quickly move toward some kind of improvement that addresses some of the concerns those democrats mentioned. i don't have all the details of what they suggested but things like mandating the cost-sharing subsidies, reinsurance to create, to provide more carriers, to create more competition in the marketplace. i don't know if they'll do this but i will also like to see some way of mandating or creating a bigger incentive or state to expand medicaid. those type of things that, i think it's realistic if they drop the repeal and dropped the sabotage. but we are not there yet as you know. i think it is very likely they do the repeal.
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topher: i am afraid we have got to keep pushing. to stop it. should we open it up? >> thank you for coming here today. my name is steve from public citizen. we are in alignment on a lot of what you propose. many of them also included as part of this legislation to support the prescription drugs back. relating to exclusivity, i would ask what you would say to your colleagues about the measure? an additional six months? i would ask you what would you say to any of your colleagues
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that would be thinking about supporting a measure like that? rep. pallone: it is a constant battle as you know. on my part and others who are progressive to try to prevent exclusivity from being expended, right? i mean, there are so many examples. lost. a fight we kind of we had the fight on orphan drugs. moreess constantly wants exclusivity.
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in, you know, all i can say is i generally speaking try to prevent expansion and exclusivity of must there is some trade-off that is offered to the like as far as pricing. so i think that is just a constant battle. the companies will always want more exclusivity. they will want to fight generics unless they own the generic company. which some of them have purchased. we have to be vigilant and fight it unless it is absolutely necessary. >> i am phil with the ms society. one fight with exclusivity is with the insurance companies not with pharmaceuticals themselves. one is step therapy and another is with formularies based on scientific administration. step therapy is dangerous. particularly with mental health, ms.
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you have to try whenever they tell you to try first until it feels. -- until it fails. likeof these mechanisms ms, it takes about six months and when it fails it has already done universal damage. these formularies are purely based on negotiating between insurance companies and big pharma for how to get the cheapest price. the drug you're been on for 10 or 15 years, they remove it. rep. pallone: i agree. the certainly addressed and touched on the formulary issue in hand we can look at that as well. i understand what you are talking about. i don't have specific suggestions on how to deal with that but it is certainly
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something we should look at in developing legislation. topher: here is a sort of something, the vicious dynamic at work here which is that drug companies skyrocket prices, right? that encourages drug companies to jack up prices even more. it keeps spiraling out of control. i think at the end of the day the solution will have to involve a deal between the insurance industry and pharmaceutical industry. whereby, pharmaceutical industry agrees to price reasonably and in exchange, the insurance industry agrees to provide reasonable coverage of those drugs and not throwing up barriers. that is the kind of negotiation that needs to occur. the problem is we have to set up a dynamic where we force that conversation. there is nothing that is doing
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that right now. i mean, i think that was going if hillary clinton had won the race because there was this gigantic threat of regulatory action. but now there is obviously not that threat anymore. but, that is what is going to have to come to pass, i think. rep. pallone: hey, the one thing in the general sense i have found is that everybody ranks on insurance company. the main thing that i find is that they want certainty. can provide certainty, which obviously this administration is not doing much of, there is that which is
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helpful to them. it is kind of interesting to me that in this debate over essential benefits packages and the possibility of selling junk insurance, the new york times article kind of got into a yesterday -- that the insurance companies for the most part have not opposed. everybody thinks the insurance companies want to sell junk insurance but if you read the article, you do not get that impression at all. they don't even like what is being proposed. they do not like uncertainty. they want to know what they have to deal with, which is one of these. i mentioned horizon in new jersey. it is obvious horizon in new jersey would much prefer the repeal not to go through because then they would not have to speculate about what it is going to cost them, which is no-mandating. the cost-sharing subsidies and not paying.
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topher: yeah, if you have not read that letter that was released late friday night from blue cross blue shield, you should. because it was extraordinary. i worked in the senate for many years and i have never seen anything like that letter in terms of how strong it was and it was -- i think what you're saying, they want certainty. they also, i think, want to guard their public reputation. they do not necessarily want to go back to being the evil, bad guy i think. that is partly behind it. but it was quite something. one more question. let's wrap it up with one more question. >> michael cipriano, the pink sheet. congressman, i have a question about the user feed process. the white house issued a statement last week about the house bill, raising questions about the generic exclusivity provision.
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the 180-day exclusivity for competitive generic therapies. it is not clear if it was a veto threat or not by if the president does veto the bill, are you confident that congress can override a veto if that happened? rep. pallone: president trump does not veto anything. he probably does not even know half the time. he probably would not even know what was in it. >> i think you are right. >> can you talk about the consequences. if it were vetoed and this bill was not, if this authority was not reauthorized, what would happen term of the nations review of drugs? faithallone: i have no
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that the president would veto anything. there has been some thought the holes inwould put it. destroyergive me my therefore i will hold up the v.a. bill. saying that is the case but the people worked there, a start sending out peaks let's very soon. i do not want the workforce -- a lot of what we do in the fda bill is try to streamline and make sure the deadlines are good or even better.
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fdareason we are giving the medicaley is to process devices and drugs quicker and still safely. you don't want to workforce to start getting pink slips. because the people will leave. and, no one will be hired in the process. the process of review will get slowed down, which is the last thing i want. that is the main reason -- -- that is the main reason i cannot imagine that he would -- you know -- i did not read it that way. i will be honest with you. >> thank you for coming. thank you you all for coming and thinking about something for a moment other than repeal. it was good to get my brain thinking about other things, too. so, thank you. [applause] [indiscernible conversation]
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♪ c-span's washington journal, live every day with news and policy issues that impact you. coming up, a look at the budget. and a republican ajit committee -- budget committee person. watch c-span'so washington journal live at tuesday morning 7:00 a.m.. join the discussion. tuesday, taking up the nomination of police to gingrich to be a ambassador to the vatican. wednesday, the house budget committee marks up the house republican budget blueprints for
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fiscal year 2018. coverage begins at 10:00 a.m. eastern on c-span three. >> sunday on q&a -- >> when we look at president obama's domestic legacy, think there are two things that are haveimportant that will long-lasting, good consequences for the united states it can be some and forwards. sonia sotomayor and elena kagan, his two nominees to the supreme court. prize-winning biographer talks about his book "rising star: the making of barack obama," which covers barack obama's life up until his winning the presidency. the course of barack obama's presidency, there were scores and scores of people in illinois who had known him in
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years earlier who were deeply disappointed with the trajectory of the obama presidency and disappointed in two ways. number one, disappointed that barack forgot many of the people, most of the people, who were essential to his political rise. 8:00 easternht at on c-span's "q&a." >> representative karen handel is one of the newest members of congress after winning a special election in georgia's sixth district. declared the most expensive house raise in u.s. history. u.s. >> we are talking with representative karen handel. you have been in washington for a couple of weeks. what has it been like?


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