tv U.S. House Meets for Legislative Business CSPAN March 1, 2017 6:00pm-8:00pm EST
it from the office of personnel management and giving it greater independence from the white house. now, congress is attempting to undo this vision of a strong independent office of government ethics at a time when we need it more than ever. this bill would put the office of government ethics right back under the control of the white house. . and that is why this motion to recommit simply excludes o.g.e. from this bill. we appreciate the need for strong ethical guidelines, most strongly when people act unethically. every day we witness this white house struggle with honesty and credibility. we've heard the promises, we heard the promises last night, the ones we've been hearing all along. when you promise to create family-sustaining jobs by revitalizing american infrastructure, and then we find out he means to do it with
tax breaks to huge corporations , and none of the regular guarantees that the people actually doing the work will be treated right and paid fairly, that's when you have a credibility problem. when you promote yourself as a man of the people, but then we find out you have stuck your cabinet without a -- with out of touch d billionaire friends, -- with out of touch billionaire friends, that's when you have a credibility problem. when you promise to fix america's education system -- >> madam speaker, the house is not in order. the speaker pro tempore: the gentleman is correct. the house is not in order. the gentleman from pennsylvania may continue. mr. cartwright: when you promise to fix america's education system, but then we see you appoint betsy devos to head the department of education, someone with no education experience, someone who wants to gut public education, that's when you have a credibility problem. when you address congress and
promise to repeal and replace the affordable care act in a way that guarantees increased access, coverage of pre-existing conditions, and that costs will go down, but no one in america knows how you plan to pay for that, that's when you have a credibility problem. we don't need a white house with a credibility problem. we need these promises the president has made to come true. we need a stronger economy full of family-sustaining jobs. we need social security, medicaid and medicare to be protected. we need to have an executive branch we can trust. this is our future and we need to be smart about it. and i believe that smart people trust, but they verify. the problem is, we do seem to have a president whose relationship with the truth is
at best a nodding acquaintance. and this is why we need a strong opposite -- office of government ethics more than ever. and ronald reagan was right, it needs to be an office independent of control by the white house. we need it to keep our leaders from enriching themselves in public office. to keep our leaders honest. to help us trust but verify that our elected officials do what's best for the american people and not their own pocketbooks. we need it to ensure that our president is acting on our best interests, with nations around the world. we've already seen this president and his staff repeatedly lie and refuse to answer questions about their business and political ties with dealings in russia. we have seen at a minimum improper and potentially far worse collusion over rigging an election. and we have seen the administration attempt to influence investigations into their dealings with russia.
this president -- we need an office of government ethics to be independent of the white house, because this president has used diplomatic relations to promote his businesses abroad at the expense of the american taxpayer. he promised to drain the swamp and immediately started appointing his billionaire buddies to cabinet positions. and rushed their hearings through before they could even complete the ethics process. after winning the election, he -- the speaker pro tempore: the gentleman's time has expired. for what purpose does the gentleman from michigan seek recognition? >> madam speaker, i rise in opposition to the motion to recommit by my colleague. the speaker pro tempore: if the gentleman would suspend. the chair reminds members to refrain from engaging in personalities with the president. the gentleman from michigan is recognized. >> thank you. i want to thank the speaker, my colleagues on both sides of the aisle, for the robust process by which we consider this bill. the bill came to the floor through regular order in the
committee on oversight and government reform. we had a full markup which allowed for members on both sides of the aisle to offer amendments and insight. we had a healthy debate on a number of amendments and we just voted on some of them. this bill codifies existing policy which changes to only include independent agencies and improve government transparency. mr. mitchell: i oppose the motion to recommit. i urge my colleagues to oppose the motion and vote yes to final passage. thank you. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman yields back the balance of his time. without objection, the previous question is ordered. the question is on the motion to recommit. those in favor say aye. those opposed, no. the noes have it. mr. cartwright: i ask for a recorded vote, madam speaker. the speaker pro tempore: a recorded vote is requested. those in support of the request for a recorded vote will rise and be counted. a sufficient number having arisen, a recorded vote is ordered. members will record their votes y electronic device.
pursuant to clause 8 and clause 9 of rule 20, this five minuteth vote on the motion to re-- five-minute vote on the motion to recommit will be followed by five-minute votes on passage of h.r. 1009 if ordered, and passage of house joint resolution 83. this is a five-minute vote. [captioning made possible by the national captioning institute, inc., in cooperation with the united states house of representatives. any use of the closed-captioned coverage of the house proceedings for political or commercial purposes is expressly prohibited by the u.s. house of representatives.]
those opposed, no. the ayings have it -- ayes have it. the gentleman from virginia is recognized. mr. connolly: madam speaker, i ask for the yeas and nays. the speaker pro tempore: the yeas and nays are requested. all those in favor of taking this vote by the yeas and nays will rise and remain standing until counted. a sufficient number having arisen, the yeas and nays are ordered. members will record their votes by electronic device. this is a five-minute vote. [captioning made possible by the national captioning institute, inc., in cooperation with the united states house of representatives. any use of the closed-captioned coverage of the house proceedings for political or commercial purposes is expressly prohibited by the .s. house of representatives.]
the speaker pro tempore: the yeas are 241 and the nays are 184. the bill is passed. without objection, the motion to the sider is laid upon table. pursuant to clause 8 of rule 20, the unfinished business is the vote on passage of house joint resolution 83, on which a recorded vote was ordered. the clerk will report the title. the clerk: house joint resolution 83, joint resolution disapproving the rules from the department of labor relating to clarification of employers' continuing to maintain an accurate record of each injury and illness. the speaker pro tempore: the question is on passage of the joint resolution. members will record their votes by electronic device. this is a
five-minute vote. [captioning made possible by the national captioning institute, inc., in cooperation with the united states house of representatives. any use of the closed-captioned coverage of the house proceedings for political or commercial purposes is expressly prohibited by the u.s. house of representatives.]
the speaker pro tempore: on this vote, the yeas are 231 and the nays are 191. the joint resolution is passed. the speaker pro tempore: without objection, the motion to reconsider is laid on the table. the speaker pro tempore: for what purpose does the gentleman from alabama seek recognition? >> mr. speaker, i ask unanimous consent that when the house a journs today it meets at 9:00 a.m. tomorrow. the speaker pro tempore: without objection.
the speaker pro tempore: the chair announces the speaker's appointment pursuant to 22 u.s.c. 6913 and the order of the house, january 3, 2017, of the following members on the part of the house to the congressional executive commission on the peoples republic of china. the clerk: mr. walz of minnesota and ms. kaptur of ohio. the speaker pro tempore: the chair announces the speaker's 22 intment purnlt to 223 -- u.s.c. 2766-d the following members on the part of the house to the canada-united states interparliamentary group. the clerk: mr. higgins of new york, mr. meeks of new york, mr.
larsen of washington, mr. defazio of oregon. the speaker pro tempore: the chair lays before the house a communication. the clerk: the honorable, the speaker, house of representatives, sir, pursuant pleased c. 2702, i'm to re-apornte mr. john lawrence of washington, d.c., to the advisory to the records of congress. thank you for your attention to this appointment. signed sincerely, nancy pelosi, democratic leader. the speaker pro tempore: the chair will entertain requests for one-minute speeches. for what purpose does the gentleman from pennsylvania rise? mr. thompson: permission to address the house for one minute and revise and extend. the speaker pro tempore: without objection. the gentleman is recognized for one minute. mr. thompson: today commemorates
the 15th anniversary of march for meals. this month-long campaign seeks to raise awareness about senior hunger and isolation and there is government, local businesses and individuals coming together to ensure that america's seniors are not forgotten, as chairman of the agricultural subcommittee, i know how important this program is. one in six seniors might not know where their next meal is coming from. on march 22, 1972, president nixon signed a national nutrition program for seniors 60 years and older. this critical program commonly referred to as meals on wheels have delivered more than just nutritious meals to home-bound seniors in every community. meals on wheels programs have come together since each march in 2002 to prove this
collaboration between businesses and levels of government to ensure seniors are not forgotten. thanks to everyone who help seniors enrich their lives. the speaker pro tempore: thank you. for what purpose does gentlelady from new jersey seek recognition? >> permission to address the house for one minute. the speaker pro tempore: the gentlelady is recognized for one minute. rs. watson coleman: mrs. watson coleman: today begins women's history month and i am proud to use this occasion to lift up our achievements, our perseverance, and dedication to a more equal and balanced world. that's why it is so unfortunate that my colleagues on the other side of the aisle and president
trump's white house insist on harming women through their stubborn adherence to anti-women policy. one prime example is their assault on the affordable care act. the facts are clear. a.c.a. prohibits charging women more than men for insurance, a.c.a. establishes preventive services to be provided at no extra cost to women. including annual well women exams, breastfeeding support and supplies for new moms. birth control and screening and counseling for domestic and intimate partner violence. 9.5 million previously uninsured women now have coverage through a.c.a. 55 million now have access to vital preventive care at no cost. these are not alternative facts or fake news. if this is the trump republican's gift to us in celebration of women's history month, i hope they keep the receipt. i yield back.
the speaker pro tempore: a -- the speaker pro tempore: thank you. for what purpose does the gentleman from minnesota seek reck anything? -- seek recognition? proceed. >> mr. speaker, i want to offer a big congratulations to the girl's hockey team for winning its very first minnesota high school state championship. mr. paulsen: the hornets dominated in the championship game just last week in winning 4-0. senior forward lalita led the way with an early goal in the first period, finishing with two goals. on the other end, senior goalie, anna, stood on her head throughout the tournament, allowing just one goal in three games. the girl's squad finished with an impressive 28-1-1 record under head coach sammy, who is a former hockey player herself, bringing the title to her alma mater. the run of excellence is a testimony to their program's serious dedication on the ice, in the classroom and in their community. on top of giving their all in their support, these students
also strive academically and contribute in positive ways at home and among their peers. mr. speaker, we are so proud of these student athletes and it's fun to see them bringing their very first state high school hockey championship home. go hornets. the speaker pro tempore: thank you. for what reason does the gentleman from new jersey rise to seek recognition? proceed. mr. payne: mr. speaker, last night president trump delivered a speech that was long on campaign themes, but short on specifics. it seems the president is more interested in political theater than leadership. and it showed. he was very vague on every topic he discussed, from health care to trade to tax reform.
the campaign is over. but it's clear president trump hasn't moved on. where is his interest in governing and in leading this nation? i don't see it. just the day before, in his speech he discovered that health care is unbelievably complex. every day since the inauguration president trump has shown that he is ill-prepared, ill-temperaturered and ill-informed -- ill-tempered and ill-informed and he does not understand what governing is about. his speech did not change that. it is time for president trump to stop talking about bringing this country together and actually make an effort to do so. he needs to engage congress, including the congressional plaque caucus. he needs to move -- black caucus. he needs to move from platitudes to plans. and he also needs to act on a
priority of the american people. i yield back. the speaker pro tempore: members are reminded to refrain from engaging in personalities oward the president. for what purpose does the gentleman from california seek recognition? without objection, the gentleman is recognized for one minute. >> thank you, mr. speaker. my district is home to nearly 60,000 men and women who have served in our nation's armed forces and many more who are still serving today. yet for too long veterans have had trouble receiving veterans medical care in our area, instead being forced to travel to sacramento or farther from places like redding, chico or others. mr. lamalfa: i'm proud to announce the transportation and infrastructure committee authorized v.a. to lease new facility in redding, california. this new lease will consolidate two buildings into one, it will expand the regional v.a. square footage by over 50% in that consolidation. which will house an additional
17 mental health providers, a second x-ray unit, significantly increasing the types of care available in redding and in the north state. taxpayers have put up the money for the facility. now it's time for the v.a. to ensure that this facility is properly staffed, and these tax dollars are not wasted. instead, respected and, most importantly, our veterans are respected with timely care. i yield back. the speaker pro tempore: thank you. for what purpose does the gentleman from california seek recognition? >> i ask unanimous consent to address the house, revise and extend my remarks. the speaker pro tempore: without objection, the gentleman is recognized for one inute. >> mr. speaker, i rise on behalf of millions of students and graduates in this country that are struggling to finance their higher education and pay off student loans. yesterday i invited isiah garcia to the president's address. isiah is an advocate for
increasing accessibility and lowering the cost of a higher education. isiah and i share a similar story. sons of hardworking immigrant parents and the first in our families to attend a university. r. carbajal: both at the -- at u.c.-santa barbara, located in my district. like many students today struggling to afford the rising costs of tuition, we relied on student loans to put us through college. in the president's speech last night, we didn't hear one mention of the over 1.3 -- $1.3 trillion student loan debt crisis. i urge this administration and congress to commit to addressing the unsustainable future of student debt, by allowing students to refinance their debt at a lower interest rate and expanding access to pell grants. we can ensure that every student is afforded the opportunity to pursue higher education and better their lives, their communities and
our country. mr. speaker, i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. for what purpose does the gentleman from texas seek recognition? without objection, the gentleman is recognized for one minute. mr. veasey: mr. speaker, i rise day to honor the life of ahjela, a dedicated servant to her community and her family. angela was born in texas on . gust 2, 1926, to her parents she was a devoted and long-time member of cassa de dios church and served as the treasurer of the church for 32 years. not only did angela give her name, time and energy to the church, but she was also known for her community service. she volunteered faithfully at a local senior citizens center in dallas and even worked full-time for the senior citizens center.
despite her busy schedule, she had the time for her favorite pastime and that was putting puzzles together with her family. my heartfelt sympathy goes out to her four children, jesse, lucinad -- lew sinda, steve, five siblings, 19 grandchildren, 43 great-grandchildren, eight great-grandchildren and numerous nieces and nephews. i ask my colleagues to join me in remembering angela's 90 years of life. mr. speaker, i yield back the balance of my time. the speaker pro tempore: the gentleman yields back the balance of his time. for what purpose does the gentlewoman from new mexico eek recognition? without objection, the gentlewoman is recognized for ne minute. ms. lujan grisham: mr. speaker, we continue to see pharmaceutical companies put profits over people. even though 33,000 people are
dying every year due to the opioid crisis. a farmer raised the price of a life-saving opioid overdose edication from $690 in 2014 to $4,500 this year. the pharmaceutical industry has not only misled consumers and their providers to create a system where there are more opioid prescriptions than adults in the united states, that they are now jacking up the price of life-saving drugs and making money on this opioid crisis that they helped in fact create. meanwhile, the costs of the opioid epidemic fall on states, cities, communities, hospitals, counties, courts and local communities who quite frankly do not have the resources to keep up. and this is why i introduced a bill which would impose a fee on the production of opioids and use the revenue for opioid prevention, treatment and
research programs across the country. pharmaceutical companies have to be part of sovening the problem that they helped cause and to give back to the communities that opioids have ravaged. mr. speaker, i yield back. the speaker pro tempore: thank you. the gentlelady yields back the balance of her time. under the speaker's announced the of january 3, 2017, gentleman from georgia, mr. collins, is recognized for 60 minutes as the designee of the majority leader. mr. collins: thank you, mr. speaker. it is good to be back. it's good to be back on the floor. as we have been now for the last few weeks, doing the people's bills. and as i have promised, until we get some -- we continue to move forward, i appreciate the last speaker discussing pharmaceutical prices. i think it's another issue. but we're going to go straight to really what i believe is the bigger cause of problems in our communities and that is the pharmacy benefit managers and their ways that they're dealing with our community pharmacists and independent pharmacists.
and actually cause problems in the health care. mr. speaker, i do ask unanimous consent for five days to revise and extend my remarks and any others. the speaker pro tempore: without objection, the gentleman is allowed to extend. mr. collins: chairman sessions asked that his comments, he could not be here, unanimous consent to submit those to the record as well. the speaker pro tempore: without objection, he's recognized. mr. collins: thank you. all right. as we get starded now, we have a lot of speakers. this is something that's been on my heart for a while and know that it is -- it's something we have been getting more and more comments and questions about. especially when you're dealing with the pharmaceutical price as, the phrma industry. they say there was a bigger issue. it was not just big pharmacy and the problems we see in drug pricing. it was actually the end delivery that's going to the pharmacies and how the independent community pharmacists are being beaten down in a way that is really unseemly in our society. taking that health care line tonight.
so i've got a lot of speakers. i've got a lot of stuff that i'm going to be talking about. just as a reporter of mine, a community pharmacist is an important initiative of the health care system, serving as the primary health provider for 62 million people. especially in your urban areas, this is a vital life line. roughly 40% of the prescriptions nationwide and higher percentage in rural georgia, especially northeast georgia, are filled by our friends in the independent community pharmacy system. look, the problems that we have or we're going to be discussing even further tonight, we're going to delve into some issues that we want to see taken care of. we want to see this industry, especially in dealing with pharmacy benefit managers, put into proper perspective. so that we can actually take care of our constituents. the gentleman who has been a fighter and a leader with me on this from day one, since i've been in congress, and dealing with this issue, especially with transparency, is my friend, dave loebsack from
iowa. and it is a fight that we're going to continue to keep fighting. want to yield to him as he continues to tell the story that we've been trying to tell here for a long time. mr. loebsack: thank you, mr. collins. i really appreciate your friendship. i really appreciate your leadership on these issues. there's really no one in this body, maybe with the exception of buddy carter himself, who can tell the story of community pharmacists the way doug collins does, mr. collins does. thank you for putting this together. you've been such a strong leader on pharmacy issues. you've been a great partner on the legislation that we'll be discussing this evening. i'm proud to say that this is a bipartisan issue. one of the few in this congress at this point. one of the few in washington, d.c., at this point. we've been able to find a consensus on this. at least with respect to one bill, and i think we're probably going to be able to do it with respect to others as well. we know for a fact that
pharmacists across the country serve as the first line of health care services for so many patients around this country. people count on pharmacists' training and expertise to stay healthy and to stay informed. and most importantly, to stay out of urgent care centers and out of hospitals. that's why i'm proud to stand here today with my colleagues to recognize the quality, the affordable and personal care the pharmacists provide every day. and within that group of pharmacists we have a subset of pharmacists, and that's the community pharmacists and their pharmacies. they're also a great source, not only of the expertise they provide, but economic growth in rural communities like those in my district and across the state of iowa. . rural areas are very, very important in this as well. i'm a member of the small business caucus and i recognize how challenging it can be for hem to compete with the bigger
pharmacies. face munity pharmacists challenges to compete with large entities. as far as their business transactions are concerned. i frequently visit community pharmacists and see the great job they are doing. and one pressing challenge in particular that will be discussed tonight is the ambiguity and the uncertainty surrounding the reimbursement of generic drugs. they account for the majority of drugs dispensed by pharmacists making transparency and reimbursement absolutely critical to the financial health of these small pharmacist. but pharmacists are rurmed through maximum allowable costs and this is a list that outlines the upper limit or the maximum amount that an insurance plan will pay for a generic drug. these lists are created by
pharmacy benefit managers, as mr. collins mentioned. this is the drug middle man. but one of the problems is that the medthodology to get these lists are not disclosed and not updated, resulting in is a cists rurmed -- it major problem because when they aren't keeping the costs of drugs consistent, those could be a serious financial burden. and we know when they have a financial burden, that will affect their business and the economy in the area. that's going to affect their patients as well, and that, we can't have, folks, as we are moving in this country doing what we can to reform health care. and when we talk about reimbursement, uncertainty for pharmacists and uncertainty for
patients as i just said. so, look, when we deal with this issue, we have to be very transparent about it. we are going to be introducing later this week this prescription drug transparency act specifically what this act will do, will increase transparency of drug payments in medicare part d, the federal employ east health program and tricare, by requiring that p.b.m.'s do three things and mr. collins will talk about this. first, provide pricing updates at least once every seven days. second, dispose the sources to low costs and notify pharmacist in individual drug prices before they could be used as a basis for reimbursement. this is commonsense bipartisan legislation. we will hear more about that in
a couple of minutes. i'm thankful to talk about these issues and one more that i want to talk about and that is the mportance of access to local pharmacies. we know medicaid beneficiaries depend on their pharmacies. nd in addition to dispenseing, pharmacists include immunizations and point of care testing like flu. these are preventive and maintainance care services that fill in the gaps where shortages exist. i know we are looking at reform, maybe replace, the affordable care act, but we have to be very careful that we all recognize the importance of medicaid going forward and it's important for these pharmacies and for their patients as well. i thank you, mr. collins and i
appreciate you including me in this process. it is important to so many patients and i'm happy to be here for a few words. mr. collins: i know there are others that are joining us in this fight. i'm going to highlight a few things and go through some of our speakers. want to highlight that p.b.m.'s may not know about and they don't want you to know and that's spread pricing. what happens there is p.b.m.'s have the maximum allowable costs which mr. loebsack was talking about to determine the maximum that they will reimburse. but the process is hidden and no transparency in the process and that is the bill. p.b.m. manipulate the surprising. they charge a higher price for drugs and reimburse at the
maximum allowable cost. spread pricing allows them to skim money between the high rate they change for prescription. spread pricing is rising the costs of drugs by overcharging at the expense of retail pharmacies, consumers and health plans and that is probably one of the better things they do. we are going to continue to talk about it. i look forward to hearing from my friend, mr. babin, welcome to the show. mr. babin: thank you, mr. speaker and thank you, congressman doug collins for leading this topic on a topic that is near and dear to my heart, the community role of pharmacists in our society. as a rural dentist who practiced for 35 years, i can relate to the plight of community physicians who must overcome the
challenges of running a small businesses while serving their patients and patients. and just like my small hometown in woodville, texas, many of the areas in which community pharmacies are located are rural and have underserved, low-income and elderly populations. this can present unique challenges and result in community pharmacists performing a lot of services such as is -to-face services that not charged. and not typically reimbursed by private private insurance companies. the uphill battle that pharmacists face in just getting payment for the life saving medications they dispense on a daily basis and still be able to earn a small profit.
they rely on p.b.m.'s who negotiate with payors, including private insurance companies as well as medicare part d and other government plans for reimbursement levels for medications. the problem is the payment levels that make it up to the community pharmacists after the p.b.m.'s have skimmed off the top are well below the acquisition costs and fail to be delivered in tim -- in a timely manner in many circumstances and many circumstances. simply put, there is a dire need for more transparency throughout this process and for more accountability from p.b.m.'s and i co-sponsored legislation that would do just this last year. called the mack the transparency act and i now proudly support this bill again in this congress in the 115th. now is the time to act on this bill. as a dentist, it was my goal to
treat each patient to the highest standard of care, a goal that i share with all of the community pharmacists that i know. sadly, if there is no change in the conditions that community pharmacists are facing, many of these providers will have to close their doors. many already have and our patients suffer. for the sake of many rural communities that i serve, i hope to see the mack transparency act and other similar pieces of legislation move forward as well as a greater spotlight put on the actions of the p.b.m.'s so pharmacists can get the relief they need to continue practicing. thank you, congressman collins, for your leadership on this issue and i yield back. mr. collins: this is a something we need to discuss. we are not discussing simply a business model that was designed in a vacuum. it was designed to help. early on and i say this,
p.b.m.'s is a good members of the committee nism to provide pricing in between the pharmacies and the wholesalers, but when they started owning distribution chains and the actual end results pharmacies. they were negotiating for themselves and this is when the end user who pays and also the customer. and we are losing them every day. this is not right. when three companies control 0% of the market and use tactics and don't want pharmacists to talk about it and when clearly the pharmacist is, this is just -- i have said this and i have had people talk to me -- it's amazing this is happening. it is true and never been refuted.
congressman duncan. welcome you to the floor to talk about this important issue for our community. mr. duncan: i thank the gentleman from for yielding. he has become one of our greatest members and i appreciate him leading this effort tonight. it is sad and unfortunate with any big government program, a small number of individuals, our companies find ways to manipulate the system and become wealthy and six of 10 of the wealthiest communities are suburban communities of washington, d.c.,. i have read about the defense contractors hiring the retired generals and same thing is happening with the food and drug administration. they have hired the former top people at the f.d.a. and we have a crisis. and there are many parts of it. but one thing you don't know about it and you have to be a
pharmacist to understand what is going on. but i rise to join my colleagues in exposing, as i say an unknown culprit. pharmacy benefits managers, known as p.b.m.'s. they are middle man between pharmacies and drug manufacturers, but the relationships between them have become entangled and complex. for instance, one of the larningest pharmacy chains operates its own p.b.m. and one of the largest medical insurance companies operates its own p.b.m. they are supposed to be keeping down the cost of drugs by negotiating discounts and helping managing drug plans. despite these promises, though, i have heard from several pharmacy owners in my district
who say many p.b.m.'s are ripping them off by raising drug costs. they have tricks of the trade that include retroactively charging more for drugs that they have already sold and processed. i'm told p.b.m.'s take too long to update the market value of their drugs on the covered drug list and these tricks. according to one expert and pharmacy owner in my district very seen three primary causes. one, f.d.a. involvement including requiring trials, two, drug manufacturers hiking the price of generic drugs. ridiculouss charging prices. p.b.m.'s are the main culprit. this pharmacist met with me and shared an example. one of his senior customers came
in with a prescription. the prescription had a real or the l cost of $23 .40, but pharmacist found it was charging over 10 times of the actual cost of the drug. the pharmacist chose to absorb the ridiculous co-pay and charged his customer the actual cost of the drug. another pharmacist e mailed me describing how the practices are ack sell rating practices in the doughnut hole. he said all of these p.b.m.'s have these types of unfair compensation and it's not fair and hurts our seniors. more pharmacists have reached out saying they get pennies on the dollar that they sell. the actions are forcing them to deny access or give drugs away for free. the daily times" ran a story
called "sworn to secrecy." a pharmacist said his patients pays for drug that are higher. why? because of the flaw backses. he said some get fired up and don't and believe what we are telling them. . most people don't understand if their co-pay is high, then they care. susan hayes, a pharmacist in illinois, says that these p.b.m. clawbacks are like crack cocaine. the p.b.m.'s just can't get enough. some p.b.m.'s are facing lawsuits with accusations such as defrauding patients, racketeering, breach of contract and violating insurance laws. since 1987 when the first of the three largest p.b.m.'s incorporated drug prices have increased 1,100%, mr. speaker. and per capita expenditures have jumped by 756%.
the three largest p.b.m.'s make up about 80% of the drug market, which includes about 180 million patients. these p.b.m.'s often conduct business through mail order practices. they sometimes will automatically fill prescriptions month after month, even if the patient no longer needs the medication, resulting in terrible waste. patient as include veterans and medicare beneficiaries, endanger them, wasting their benefits and taxpayer dollars, and driving up the cost of drugs. as we heard president trump say in his address last night, we need to look into this -- the artificially high drug prices right away. a good place to start is p.b.m.'s. mr. speaker, p.b.m.'s must be more transparent in their operations so that they can be held to their a promises and to the law. -- their promises and to the law. p.b.m.'s must no longer be able to get away with conducting their business with such unethical methods that they're using now. in short p.b.m.'s must be held
accountable for their roles in the nation's drug crisis. i join in supporting our community pharmacists and i yield back to my friend, the gentleman from georgia. mr. collins: my friend from tennessee, you couldn't have laid it out any better. that's exactly what we're talking about. if every member of our body would go home and just go to their community pharmacist and go there, they would hear this all over the country. this is not -- i've been on this floor for almost 2 1/2 years talking about this and i've not had the p.b.m.'s come and say, no, that's not really true. because they do it. so thank you for being a part of this, lend your voice and your community to that fight. we're also very blessed in this body to have someone who doesn't have to have come to it like i did, and having to deal with it from a family's perspective or from my community. we have someone who is actually -- who has actually done this for a living. he's my friend from south georgia, he's a pharmacist, be has -- he has made his life. i saw he's a young harris
manziel, as he comes -- mann, as he comes. the gentleman from southeast georgia, buddy carter. mr. carter: well, i want to, first of all, mr. speaker, i want to thank representative collins for holding this tonight. and organizing this. and also for his advocacy and for what he has done to bring about attention to this very important, very important subject. this of course is something that's very dear to my heart. as the only pharmacist currently serving in congress, i take this very seriously. i take that responsibility very seriously. but it's more than that. because you see in my professional life, for over 30 years i had the honor of practicing pharmacy. i built up relationships over that time. relationships with families, with patients. when i see what is happening, when i see what is happening in pharmacy now, it's an affront. the an affront to me, it should
be an affront to all americans. my heart is in this. truly in this. in over 30 years of practice, i've built up the relationship, relationship with patients, with families. i've served grandparents, i've served parents, i've served children. total familiars. you can only imagine the -- families. you can only imagine the hurt it brings whenever sigh these people suffering. because -- i see these people suffering. because of what's been mentioned here tonight. right now in our country, prescription drug prices are something that we are -- that's in the forefront, in the news. and there's a problem. a real big problem. and that problem, yes, the pharmacy -- pharmaceutical manufacturers have a concern here and they have a responsibility. but there's a bigger problem. it's what i refer to as the man behind the curtain.
i wrote an op-ed about this. talked about the man behind the curtain. that's the p.b.m.'s. the pharmacy benefit managers. i'm going to call them out tonight. before i start this, i want to -- before i do, that i want to just say something about community pharmacists. because they play such an important and vital role in our communities. they directly interface and build relationships with neighbors and friends. i've been there. i've done that. i understand how important it s. representative loebsack spoke about it. he spoke about it as well. representative baseball an, representative duncan -- babin, representative duncan. all of them understand how important the community pharmacies are, how important they are to the health care system. but beneficiaries are facing increased costs for prescription drugs, without much of a basis or notification on why these costs are skyrocketing. so very quickly, i want to talk about why these costs have
skyrocketed. yes, as i said earlier, some of the pharmaceutical manufacturers need to be held accountable. they do. i say that you. but i also say that -- i say that. but i also say i'm a big fan of the pharmaceutical manufacturers. in my years of practicing pharmacy, i've seen nothing short of miracles. i can remember when i started practicing in 1980. i can remember the -- that people would come in to get an antibiotic and we'd have to dispense 40 cap sewells and have them take -- cappsles and have them take four a day for 10 days. now i can give them one capsule and they can take it and be one with it. we can treat people for things they had to go to the hospital before. we talk about the price of some of these drugs and, for instance, the drug that's used for hepatitis c.
yes, it is too expensive. and that price has come down significantly. it's only good if it's affordable. if it's not accessible and affordable, then not good. but stop and think about it. we cured a deadly disease. through research and development. the pharmaceutical manufacturers, putting some of their profits back into research and development, which i applaud. we cured a deadly disease. hepatitis c. that was killing people. again, that price needs to come down so that it's more accessible to people. but again, we cured it. so i'm going to cut the pharmaceutical manufacturers a little bit of leeway there. i think it's interesting that the president, in his first month in office, called the pharmaceutical manufacturers to the white house. and he told them, you got to do something about these escalating drug prices.
he also talked about those people who are on the other side of r&d, who are on the other side of research and development. he put a notice out. and he said, you better beware. because we're going to be watching you. the next day the stocks of two of the major pharmacy benefit managers went down. went down significantly. almost 2%. because they knew what was coming. and they know what's coming now. i can tell you, as we talk about p.b.m.'s, that the p.b.m.'s, first of all, let's talk about the profits that the p.b.m.'s -- a quick history. p.b.m.'s came about kind of i guess in the mid 1960's. all they were was a processer. all they did was to keep up th -- their goal and their charge was just to keep up and to process insurance claims as insurance came about and became more popular to pay for
medications. that's all they did. but over time they've evolved into more than that. if you look at what has happened over the past decade, the profits of the three major p.b.m.'s, representative collins alluded to this earlier. you got three companies who control almost 80% of the market. folks, that's not good. that's not competition. and that's what we have to have in health care. in order to decrease health care costs. competition. when you have three companies that account for almost 80% of the market, that is never good. but if you look at those three companies and you look at their profits over the last decade, you'll see that they've increased some 600%. billions of dollars. now, you can make the argument, well, the pharmaceutical manufacturers, their profits have increased too. yes, they have and yes, they should be accountable for that. however, at least they are bringing value to the system. by investing into research and development.
p.b.m.'s bring no value to the health care system at all. they put no money into research and development. all they do is to skim it off the top. as medications go up in price, they make more. representative collins alluded to spread pricing. and that's exactly what he's talking about. that's exactly how they're making their money. the more expensive a drug, the more money the p.b.m.'s going to make. that's all there is to it. i've served on the oversight committee, on the oversite and government reform committee, for the past session, in the 114th congress. e had a problem with mylan pharmaceuticals and a drug they had, epipen. went up to $600. unbelievable. here was a drug that is a life-saving drug, that people have to have. that we require, that we in congress actually passed legislation to require certain -- for that drug to be -- to be
on hand in gyms and in schools in case there was a problem. and yet they went up to $600. it was really interesting. because during the time that we were asking questions of the c.e.o., she mentioned, well, when it leaves us, it's this price right here. i'm just going to use round figures. it's $150. by the time it gets to the pharmacists and by the time it's dispensed to the patient, it's $600. and i asked her, i said, what's that difference there? where's that coming from? i don't know. i don't know either. there's the beginning and the end. the beginning is the pharmaceutical manufacturer. she. she doesn't know. the end is america the dispensing pharmacist. and don't know. that's what i'm referring to when i talk about the man behind the curtain. that's where the p.b.m.'s come in. they will tell you, well, we're taking that money and we're giving it back to the
companies. to the insurance. well, if they are, and they're not keeping any of it, then why are their profits going up so much? why are their profits going up over 600%? it's because they're keeping it. they're keeping it. and they're add nothing value whatsoever to the system. they will argue the fact, they will say, we're keeping drug prices down. oh, yeah? how's that working out for you? it ain't working out very well at all. because drug prices are going up. i mentioned the competition. the fact that we got three companies that control over 80% of the market. that decreases choices. one of the things, and we talk about community pharmacy and i know that's what representative collins is really wanting to focus on here tonight, and it's so very important. because folks, -- because, folks, we have to have community pharmacies. they are vital to the health care system. and many areas, the most accessible health care
professional is the pharmacist. particularly in rural areas. as they go, as they are eliminated, we are losing a vital part of the health care system. but p.b.m.'s are shutting out a lot of these community pharmacies. i can tell you, i alluded earlier to the fact that i have served grandparents and parents and grandchildren. and build up those relationships. one of the toughest things that i've ever faced is for those, for a family member to come in to me, literally in tears, and say, i've got to change pharmacies. i say, why? because my insurance company, because my p.b.m. they say that i have to get it from them through mail order. why do you have to get it through them? because they own the pharmacy. representative collins alluded earlier about vertical integration. that's what we see. the p.b.m., they own the
pharmacy that they're requiring the patient to go to. well guess what? that means they're padding their pocket even more. that's the kind of thing that we should be protected from. i'll give you a quick story. true story. back when i was still practicing pharmacy and owned my pharmacy. my wife had insurance through hire employer. he had -- through her employer. she had a different insurance than i had. she got her insurance and she got a prescription filled at my pharmacy. at my pharmacy. now, this is the pharmacy benefit manage who are owns the pharmacy. -- manager who owns the pharmacy. that night i got a phone call from the insurance company saying, well, your wife got a prescription filled here, at this pharmacy, but if she gets it filled at our pharmacy, we can give her a lower co-pay. we can give her a discount.
now, supposedly there's a firewall in between the p.b.m. and the pharmacy. but guess what, there wasn't that firewall there that night. not when i got that phone call. can you imagine? and what's that doing? that's taking parents away from the community pharmacists. that's unfair, unfair business practices. that's what we talk about. i don't want to give the impression i'm just here to try to make sure community pharmacies stay profitable and stay in business, although it is important because if they don't stay in business who is going to suffer? it's going to be the patient. it's going to be the health care system. folks, the only thing that's going to bring down costs in our system is competition. free market principles. that's what we're trying to do now in congress. through the repeal and replacement of the affordable
care act. we understand we've got to get free market principles back into the health care system. got to get competition in order to drive costs down. health care costs. we understand that. this is a problem. a big problem. now very quickly, i want to talk about three bills that -- that are being proposed. first of all, i want to talk about representative collins' transparency bill. transparency. that means give us the opportunity to see exactly what's going on. you mentioned transparency to a b.b.m. -- to a p.b.m. they gobert serk. oh my fwosh, no. we can't have that. we can't have transparency. but representative collins' bill, the mac transparency bill, which i'm proud to be a co-sponsor on, it brings about greater transparency in drug prices, drug pricing in general but in particular generic drug
pricing. many recipients of generic drug prices don't understand the cost structure. they don't understand how that works. where the additional costs come from. which are often levied by the p.b.m.'s. congressman collins' bill address this is issue an addresses more. under his legislation, a process would be established to help mediate disputes in drug prices. it would establish new criteria for p.b.m.'s to adhere to. this transparency bill is a step forward, not only for the industry but for the ben fish year. that's what's so very, very important. it's no surprise that costs are going up. no surprise at all. with the lack of transparency that's what's going to happen. we've got to have greater transparency in the drug pricing system. yes, that includes pharmacy. yes, it includes the
pharmaceutical manufacturer. but mostly it's got to be with the pbm. a e have a c.e.o. of a medication, of a pharmaceutical company, like we had, come up and testify before us here in congress and i ask her about that gap there and where that money is going, she doesn't know, and i don't know. there's a problem. that means we need more transpearncy. and that's exactly what happened. now i want to talk about another problem. it's called d-i-r-fees. direct and indirect remuneration. this will be the death of community pharmacies. d.i.r. fees are what they refer to as clawback fees. what happens is when you go into a pharmacy, get a prescription filled. the pharmacy's computer calls the insurance company's
computer, the p.b.m.'s computer, it tells us how much to charge the patient in a co-pay. it tells us how much we're going to get paid. however, with these d.i.r. fees, months later, after we've already been promised how much we were going to be paid, pharmacists are getting bills from these p.b.m.'s that are saying, well, we didn't make quite as much that quarter as we should have so we're going to have to take back this. going to have to claw back this muchism met with pharmacists from the new york state pharmacy association and they were telling me literally horror stories about getting bills for $85,000, $110,000, in clawback fees. folks, that is not a sustainable business model. when you're trying to run a business a community pharmacy, and you get a bill months later, in the hundreds of thousands of dollars, that is not sustainable. you can't stay in business that way. we have got to do something
about d.i.r. fees and thankfully, representative griffith from virginia has a bill addressing this. and i'm supporting him on that bill. in fact, in a recent survey, nearly 70% of community pharmacists indicated they didn't receive any information about when those fees will be collected or how large they'll be. again, ultimately, who ends up being penalized? who ends up being penalized? the patient. the patient ends up being penalized. and folks, understand, this is not a partisan issue. these p.b.m.'s don't care if you're a republican or a democrat. they care about one thing and that's profit. that's all. now let's talk about one other. let's talk about a bill that representative guthrie from kentucky has. h.r. 592. the pharmacy and medically
underserved areas enhancement act. under this bill, many of the individuals who seek consultation, especially seniors, especially seniors, can continue to receive that quality input and expertise. this bill is known as the pharmacy provider status. simply what this will do is to make sure that the pharmacists giving consultations, that they're being reimbursed for that. that's vitally important. pharmacies are -- are the front line in health care. there's so many diseases, the pharmacists who are graduating today are so clinically superior to when i graduated. their expertise is beyond anything that i ever imagined it would be. we need to make sure that we're utilizing that. that's going to be a key in helping us control health care
costs is utilizing all these allied health fields, making sure that we are using them to their fullest potential. and this bill will help us to do that. so there are just a couple of bill, three bills that are being introduced right now with community pharmacists. that impact pharmacies. but more importantly, that impact health care. and that are going to help us to have a great health care system. and to continue to have a great health care system. there are a couple of other things that i wanted to mention. i'm going to hold off on those because again i want to make sure that everybody understands the point that i'm trying to make. and that is just how important, how vital, the community pharmacies are. and just how bad the p.b.m.'s are and how they're wripping -- ripping off the public. they're ripping off the public. look at their balance sheet. look at the profits. again, they want to argue, they
will want to say, we're holding down drug prices. again, how is that working for you? it's not working. it's not working because they are pocketing the profits. if they were truly doing what they say they set out to do eric we wouldn't see escalating drug prices like we're seeing. yes, there are some bad actors out there, as there are in every profession. yes, we had turing pharmaceuticals and martin skrelli, this guy was a crook. no question about it. we had valiant pharmaceuticals and what they did, that's true. we -- just here recently, mare than pharmaceutical bought a drug that was available over in europe. brought it over here and got it approved in america. now they're trying to -- a very important drug for muscular dystrophy. they want to increase the price
an enormous amount that won't be affordable for patients. that is -- those are bad actors. and you -- as my daddy used to say, you're going to have that. you're going to have that. and we understand that. and those companies an those people, we have with valley and with turing and marathon, we're calling them out too. they need to be call out. but we also need to focus on what one of the biggest problems is in escalating drug prices, p.b.m.'s. they bring no value whatsoever to the system of they put none of their profits back in research and development. community pharmacists play an important role in our health care system. i'm proud to support our community pharmacists. i'm proud to have been able to practice in a profession for other 0 years, a profession -- for over 0 year that profession that i know brings a great deal of value to patients and to
their families. again, i want to thank representative collins and i want to commend him for his hard work. representative austin scott is here also. he's been a champion of this as well. they understand, they get it. and i appreciate their efforts on that. i appreciate every who has been here tonight. thank you for hosting this tonight, representative collins. i appreciate your support and i yield back. mr. collins: before you get going. you talked about getting a call from your own pharmacy. i was here, we were here six months ago, doing this, talking about this issue of mail order, talking about this i had a member watching us on the floor alk about her pharmacy and the p.b.m. problem, got a call because they got a prescription for their child the day baffer. they're getting a call in their office saying, if you switch from your local pharmacist, we'll do it better.
that's why we are doing this and on d.i.r. fees, we have this, describes what you're talking about. there's an interesting part of this d.i.r. fee issue. it forces medicare part d beneficiaries to pay inflated prices for point of sale that are higher than the actual cost of the drug. the cost of the drug will be recouped in d.i.r. fees which are retroactively assessed later. many are moving past faster, into the doughnut hole sooner, forcing them to pay more. especially those with life-saving drugs. a patient will be forced to pay out of pocket, might be forced to cut back or abandon treatment. pharmacists lose $5 ,000 per practice to d.i.r. fees each year. this makes it difficult for independent community pharmacists to keep up when patients pass through the ughnut hole, guess who picks
up? c.m.s. picks up. these costs have increased from $10 billion in 2010 to $33 billion in 2015. this is just dealing with issue. c.m.s., we've got to have greater transparency on this. this is why morgan griffith's bill is good. we're going to continue to fight on this. yet to have a p.b.m. tell me i'm wrong here. i know from your experience it's true as well. and with that, our other friend from georgia, austin scott, comes to the floor to talk about his experience with this as well. mr. scott: i had several parents in my office today. i thought i'd talk about a couple of the meetings i had. had a father there talking about his son, gabe, had a t-shirt on with h 4 g, hope for gabe. i listened to him talk about his son and the life threatening disease that his son has and the
threat that his son is under. the threat his son is under because of a u.s. pharmaceutical manufacturer named marathon. i'd like to report an email -- read part of an email. i hope you're well, i want to let you know my son gabe takes a he has l delplazacor, since he was 5 years old, he's now 11. three-month or a supply. we're getting it from europe available as not here in the united states. the f.d.a. approved the same drug for sale in the united states. what did the drug manufacturer do with the price of it? well, marathon took the price from $116 a quarter to
approximately $87,000 a year. now, this is what's happening. drugs that are available everywhere else in the world, it's not that they're being developed with extensive research and expensive research in our country. people are simply buying the right to sell the drug in the united states. and as soon as approved and available in the u.s. marketplace, it's no longer legal for people to import that drug. from europe. marathon priced the drug at $ 9,000 per year. reading again from his email in bold letters. the same drug we are getting today from europe for $450 per mark, then exclamation the exact same drug, we need your help here.
we need your help and specifically gabe needs your help. as i sit here and look at the american flag, there is no other country in the world that allows their citizens to be treated like this. none. none. and i'm embarrassed that this congress hasn't done anything about the abuse to the american citizens from the pharmaceutical and the p.b.m. industry. i know our president, and i'm glad that we have a president with the courage and the boldness that our president has had, to have executives to the white house. i would suggest that a good meeting also would be to have the parents, have of father of gabe, have the mother of gabe come to the white house. sit down in the same room with the tv's on, with the executives from those companies that are cheating these people. let's let the executives explain on tv in front of the
parents, in front of the child who needs that life-saving drug y it costs $450 in another country but should cost $87,000 in america. another group of parents that was in my office today was there representing the juvenile die beat. i'll tell you, i had a heart -- diabetes. i'll tell you, i had a heart-wrenching discussion about a woman's daughter. she has to have it or she dies. this mother talked about how she had a job in another country and how what she paid to have that same drug. a fraction of what it cost in america. i think it would be great, great for our president to have that mother and that daughter or the mother that was in my office today talking about her daughter, come and sit down at the white house. maybe the president of eli lily could come and sit down. maybe we could put the tv on,
the cameras on, so everybody in america could see the c.e.o. explain why insulin, which has been around for decades, costs as much in this country as it does when it doesn't cost anywhere near that in any other country. something's got to give. something's got to give. and the american families have given enough. i'm hopeful that we'll move sooner rather than later. american families can't take it any more. a drug that cost st $450 -- costs $450, that can be imported from europe, shouldn't cost $87,000 in america. on top of the issues with what's happening with the manufacturers, we've got the issue with the p.b.m.'s. why shouldn't you know what the p.b.m.'s are getting in a kickback? everywhere else you go, you get a price sticker. you know what the rebates are when you go to your local car dealer. they're readily advertised. why shouldn't you know as the
american citizen? my friend, mr. collins, and i have been working on it for years. we worked on it back in the state legislature. in fact, we passed a bill back in i think it was 1987 the first transparency act. that we passed in the state legislature in georgia. i hope that governors and members of the state legislatures will go back and address this issue as well. it can be done at the state level. the transparency issues can. that bill came to the house floor and it passed 150-0. not a single democrat, not a single republican voted against that bill. every single member that was there that day voted for the bill. mr. chairman, we know something's got to be done. i just hope that we take action sooner rather than later. and i would just like to make one last request. mr. president, i hope you'll invite these parents and their
chirp to the white house. i hope -- children to the white house. i hope you'll invite the c.e.o.'s of these companies to sit down at the same table. and hope you'll even invite the press to come and publicize the meeting. with that, mr. collins, i'd like to yield the remainder of the time and say thank you so much for standing up for the american citizens. i'm honored to be a friend of yours and thank you for allowing me to be in the fight. mr. collins: representative scott, you bring out this issue, you bring out with passion exactly what we need to happen. we go forward in this discussion. this is what the p.b.m.'s don't want to have. they don't want to have transparency thetcht don't want to talk about it. we've been talking about it now for years on this floor and it just continues to get worse. in fact, the prescription drug price transparency act we're getting ready to introduce in your part and others, just the other day they're already trying to undercut this bill. i recently saw an interview with the c.e.o. of pcma, the trade group for p.b.m.'s. the article misrepresented p.b.m.'s role in the marketplace. that's a shocker. really. distorting the fact that
p.b.m.'s ability to continue profiting at the expense of beneficiaries and taxpayers. so tonight, let's have a little fact check. let's look at this. the claims by mr. merit versus the truth. first, mr. merit claimed that p.b.m.'s play an important role from negotiating price discounts in order to pass those savings to customers. in fact, what he said was, we have an interest in lower price and bigger -- or bigger discounts and we're going to negotiate the most aggressive discounts we can. well, it is true that p.b.m.'s do effectively negotiate huge discounts. however, the patients never see this discount. rebate's reflected in their prices are out of pocket costs. these rebates have been discounted nearly padding p.b.m.'s profit margins. they do not increase patients' well-being. this allows p.b.m.'s to receive massive rebates and refuse to pass those savings along to consumers or customers. in fact, what is interesting, in fact, there is proof that transparency in pricing saves more money than the p.b.m.'s are willing to admit.
you want an example? let's look to texas. texas has one of the oldest mack-style laws. texas passed transparency legislation similar to the prescription drug price transparency act in 2013 of june. now, here we go. explain this one. since texas passed their law, their medicaid fee for service prescription drug expendtures or the top 100 drugs fell from $219.54 per prescription to $91.32. yep. you're doing a good job negotiating. for your bottom line. what else does he say? number two. he tries to distort the purposes of prescription drug transparency act by drawing concerns to transparency in the drug marketplace. he says, the kind of transparency to be concerned about is where competing drug companies and competing drug stores can see the detailed arrangement that we have with all of their competitors. seeing how they own part of the
competitors, not really a lot of things going on there. our legislation simply would not allow competing drug companies to see detailed arrangements that p.b.m.'s have with competitors. mark, quit lying. this statement is a misrepresentation of what price prescription drug transparency act does. competing pharmacies would not be able to see their arrangements their opponents have with p.b.m.'s because they would not be publicly disclosed. transparency measures and contractual agreements include confidentiality clauses preventing public disclosure. may i remind mark, he has gag orders in some states where pharmacists can't even talk about these issues and by the way they send letters to pharmacists saying, oh, don't go talk to your elected officials, because this you do, we'll cut your contract off. wow. that's concern, mark. furthermore, the disclosure of source of drug pricing and determination remains confident, -- confidential, only disclosed to pharmacies. p.b.m.'s distort transparency to mean only public transparency in an attempt to protect profitability that comes with keeping their
corrupt business practices in the dark. let's go on. the third. mark merritt says, we want to make sure that wholesalers who sell to the drug stores aren't trying to sell the most expensive thing and pass costs on to consumers. here we go again. this is getting familiar. it has little to do with wholesalers. p.b.m.'s design the formularies, yes, we understand this, mark. formularies that dictate what drugs are covered by insurance. because there's no transparency, p.b.m.'s are able to receive drugs at discounted prices but refuse to tell employers. p.b.m.'s are then able to still charge employers full amount of the drug, even though they're receiving it cheaper. p.b.m.'s often receive large rebates to incentivize them to include expensive name brand drugs, even though cheaper generics are available. listen, mr. speaker, listen. they receive large rebates to intend advise them to include
the expensive brand name drugs on their formularies. i had a shoon with that with my own mother recently. when she needed medication, they'd been on it for eight months. they had to re-authorize it after the first of the year. i said, is there another issue that she could have? they said, this is the only one on the formulary. p.b.m.'s don't control pricing, p.b.m.'s don't control what drugs come to market. another falsehood. p.b.m. substitute expensive drugs and overcharge medicare part d, tricare and programs. this means they're lining their pockets with the money from the taxpayers. fourth thing. if drug stores like those terms, they can sign a contract and if they don't like them, they can join some other plan. oh, i love this. this is classic, mr. speaker. p.b.m.'s hold the -- i've already talked about it. three of the largest p.b.m.'s own 8 to% of the market -- 80% of the market. 80%. because they have strangle hold on the market, community pharmacists cannot stay in business without being forced to contract with them. it forces the community pharmacists to sign take it or leave it contracts with
anti-competitive and unfair provisions and from transmitting it with a written consent. these are just crazy. i had one of my pharmacists who is on their plan actually had a letter sent to their customers that said, you're no longer on the plan. he called the p.b.m., the p.b.m. says, no, you're still on the plan. he says, why did you send the letter out? must have made a mistake. why don't you send a letter out telling them you're wrong. we don't do that, that's on you. yeah. because all you want to do is keep the money. follow the money, mark. it's easy. i understand running a trade association is tough. but at least be honest about it. the last thing. community pharmacists typically are paid by more -- paid more by plan because -- plans because there's not as much competition. well, five for five. community pharmacists in northeast georgia and across the united states are under constant threat of going out of business because of p.b.m.'s. p.b.m.'s exploit the market, prey upon community pharmacists using spread pricing and retroactive dirp's.
they also use a disproportionate share of the market to steer patients to pharmacies they own themselves. the prescription drug and transparency act is vitally important to improving fairness and transparency in the health care system. community pharmacists must be kept in business and patients should have the choice to receive care from their local pharmacists. community pharmacists might be afraid to stand up to p.b.m.'s, community pharmacists many times are basically scared into submission. i've stood on the floor of this house many times. my pharmacists can't speak. but i can. and i'll remind the p.b.m.'s one more time. you can't audit me. you can go audit for profit. which do you every day. you can go hit them. but you can't hit me. i will continue to be a voice for community pharmacists. these members are being a community form -- force. our numbers are rising every day. and the president himself has actually begun to look at those middlemen and those pricing. so tonight ends another night
of telling truth when the truth needs to be told. with that, mr. speaker, we end another time of standing up for the american people. and the community pharmacists. with that, i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. under the speaker's announced the of january 3, 2017, gentlewoman from the state of washington is recognized for 60 minutes as the designee of the minority leader. jay allen -- ms. jayapal: thank you, mr. speaker. mr. speaker, i ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous material on the subject of my special order. the speaker pro tempore: without objection, the gentlewoman is recognized. ms. jayapal: thank you, mr. speaker. today i stand here for this special order on behalf of our
congressional progressive caucus. we have decided that we'd like to use this special order hour to address our reactions to the president's address to the union last night. my part of hat, those remarks, mr. speaker, i would like to yield to my friend and colleague, mr. askin of maryland. mr. raskin: thank you very much, congresswoman jayapal. you've been such a sensational leader within the democratic caucus and within the progressive caucus. especially on the issues of immigration and the rights of refugees. and it is such an honor to be able to serve with you. i appreciate being able to spend some moments just reflecting on what took place in our chamber last night.
with the president's speech. we should start by giving credit where credit is due. this speech was not american carnage two. it w aasiro ulsa orllf e olt d apocalypc imagy anrhetorith w saw inhe inaugural address. hats off to the president's new speech writer, whoever that may be. however, having said that, i think it's simply old wine in a new bottle. steve basic extremist bannon infrastructure governed that address. despite the fact that the manners ha improved considerably. when i thought about president
trump's speech in this chamber last night, i thought about george or well. not because of "1984 "ing request. although ied a might -- admit my copy of this novel is sitting on my desk right now and the words, war is peace and ignorance is strength, have been running through my minds over the last several weeks. no, i thought of orwell not because of $1984" but waws of a great essay he once wrote called notes on nationalism. and in this in this essay , he contrasted pay tro -- patriotism and nationalism. two concepts that often get conflated. but at least in his view, they represent two very different things. patriotism, he argued, was a positive emotion. a passionate belief in one's own community. its people, its institutions, its values, its history, its
culture. an american patriot today, i would argue, believes in our magnificent constitutional democracy. our constitution. our bill of rights. our judiciary, our judges, our states and our communities. our poets. like emily dickinson and walt whitman and langston hughes. our philosophers like john dewey and ralph waldo emmerson, our ex-trirednafere -- extraordinary , dynamic culture which invites people from all over the world. our artists, our musicians like bruce springsteen and the neville brothers and dar williams. all these people and things are what we love about america and they evoke the positive emotion of patriotism. patriotism is all about uplifting people. drawing on what's best in our history.
finding what's best in our culture. invoking our founders, madison and jefferson and franklin and tom paine. invoking the people who founded the country once again through the civil war and the reconstruction amendment. abraham lincoln and frederick douglass. the people who transformed america in the women's suffrage movement, like susan b. anthony. the people who remade america once again in the civil rights movement like martin luther king, bob moses, and the student nonviolence committee. and the people who blew the doors off oppression of other groups like the lgbt community, like harvey milk. all these stand for an inclusive concept of america and patriots want to draw on this culture and history in order to continue to
make great progress for our people today. a patriot wants to improve the health of our people. the education of our people. the critical thinking skills of our people. the well being of america. now, nationalism is different. if you look at it historically as orwell did, nationalism has been not about building people up and improving their lives, it's been about militarizing ociety and getting everyone to sink their individuality, their creative personality, into a large, corporatist and authoritarian state, one that's destinned to exploit people's good will by motivating them through groupthink and hostility f war, the kind orwell the scribed in "1984" and in "animal farm." i'm sorry to say i didn't see a
lot of patriotism, in orwell's terms, last night. 90% of our kids go to public schools. but 90% of this president's emergency and this administration's agency seems to go into maligning and defunding public education and diverting public money away from public schools into private education. that's the betsy devos agenda. or take health care. the affordable care act represents a magnificent national investment in health care of our people. more than 22 million of our fellow citizens previously uninsured got health care because of the a.c.a. 30 million, if you include the expanse of medicaid that took place under the a.c.a. f you decide to go to a town hall, yours or someone else's.
you will meet people who will tell you their lives were saved because of the affordable care act. victims of breast cancer and colon cancer and heart attacks and strokes, and on and on. these things are just in the nature of life. we are all subject to medical misfortune. you know if you learn you have cancer, you have a heart attack, that's a misfortune. it happens to people every day. but if you have cancer or leukemia or you have a heart attack and you can't get health coverage because you lost your job or because you're too poor, that's not just a misfortune. that's an injustice because we can do something about that. because that has to do with how we've organized our own affairs as a society. but what did we hear from the president last night about the health care and well being of our people? repeal. and replace. the affordable care act. they've voted more than 50 times
to repeal the obamacare act. and never once to replace it. they've got no plan. the president did not offer a plan. the president restated the values of the affordable care act itself. and understand, the affordable care act was the compromise. because the logical thing to have done, as president obama said, if we were starting from scratch, would be to adopt a single payer plan, but because we were along a certain path , he felt we couldn't do that. and so he took the plan that was adopted at the heritage foundation. the conservative think tank. the one that was put in place in massachusetts by governor romney. romney-care. that's the affordable care act. but they couldn't tolerate that because they cared more about scoring political points against the president than they did about actually making health care available to as many americans as possible. so the president showed up empty
handed, again, no plan whatsoever. if there were a plan we'd be debating it. if they had something to offer we'd be talking about it. but they don't have it. they just want to repeal and consign everybody back to medical oblivion. millions of people going back to not having it. making everybody else's insurance premiums skyrocket. and just turning our backs on the families that now depend on the affordable care act. now, i will say the president mentioned in passing something that he made a big deal of during the campaign and i was happy he did. he went back to saying that we needed to give the government the authority to negotiate with the large drug companies, the prescription drug companies, for lower prices. and i was happy to hear my colleagues from the other side of the aisle in talking about the pharmacists just now, also
talking about the extraordinary power of the pharmaceutical companies and their predatory practices. well, what the president has said makes perfect sense on this point. which is, there was some special interest legislation that came out several years ago saying that the government could not negotiate for lower prices with the drug companies. when it comes to medicare. we do it with medicaid. we do it with v.a. drug benefits. but we can't do it for medicare drug benefits because somebody, some lobbyist, was able to get somebody to stick that into the bill. and the g.o.p. majority stands by it now. so i appeal to the president if you're serious about it, i will work day and night to get every democrat exvote i can to side with you in giving the government the authority to negotiate for lower drug prices. that is a common ground agenda. let's do that. but as to the general picture of
health care in the country, the president gave us nothing last night. we also got no jobs plan. we got no plan to confront the shameful inequality in our society. when the president and his cabinet entered the chamber last night, the net worth of this $9.6 billion. this is the richest cabinet in american history. these 17 people in the cabinet 43 millionealth than american households combined. that's one third of american household. when you look at the trump cabinet, you can see the net worth of one third of american families together. and the president who campaigned like a crusading populist, like william jennings bryan for
working people, creates a cabinet of billionaires and c.e.o.'s, people who profited like mad from nafta and all the trade deals that the president now denounces. he closed his campaign by railing against goldman sachs but goldman sachs may as well be the nickname of this cabinet. from secretary tillerson to steve bannon and many others, goldman sachs is all over this administration. and last night we also got more immigrant bashing and i know my friend and colleague, congresswoman jayapal will discuss this. how patriotic is immigrant -- is immigrant bashing? i'd say not very. tom paine said america would be a haven of refuge for people fleeing political and religious oppression all over the world. madison said it would be a sanctuary for religious and
political refugees. america would come to be ymbolized by the statue of liberty. give us your pooring your tired, your huddled masses yearning to breathe free. that's the spirit of america, we are a nation of immigrants. although the native americans were here before everybody else got here and the slaves were brought here against their will. but everybody else, we are immigrants or we are the descendants of immigrants. so if you attack immigrants, you are really attacking the dynamic and inclusive culture of america. a community of communities. and then there's the big proposal we got to slash $56 billion in domestic spending and put it into a great big new military buildup. and here we see the
fingerprints, of course, of steve bannon. you know, we could destroy the national endowment for the arts, the national endowment for the humanities, ethe environmental protection agency, the national institute of health, the state department, the peace corps, the national oceanic administration, the securities and exchange commission, the federal election commission, the cfpb, and on and on and still not come close to the $56 billion that they want to rip out of the domestic priorities of the american people and simply give to the pentagon. and for what? why? no one has told us why. what is all of that money going to buy? who is going to get rich off of all of that money? ladies and gentlemen, when you dd it all up, this program seems like it partakes of the ult ma -- ultra nationalist
politics that orwell perceived in authoritarian regime, not the kind of patriotism that reflects the best in our own democratic political culture. the great thing is that americans are deep patriots. we love our communities. we love our institutions. we love our values. we love our constitution. we love our bill of rights. and we are not going to fall for a right wing, ultra nationalist agenda that takes us away from everything that we love. with that, i yield back the remainder of my time and i thank the distinguished congresswoman rom seattle. the yapal: i thank gentleman for your tremendous work already in these first seven weeks, making sure we continue to recognize the tremendous responsibility we have here in this body to
protect that constitution and everything that it stands for. last night's state of the union address deserves a response for lots of reasons and unfortunately, none of them are good. last night we heard from this president a toned down version of his campaign speeches. the speech was well delivered. he stuck to his script, maybe the first major address that he has conducted where he did stick to the script. he had a lot of diligence in that. and he even started with some very necessary recognition of the anti-semitic acts that have been taking place across the country. and he denounced those acts. and he denounced the killing of an indian american in kansas. i, too, am indian american. and i