The committee will come to order. Without objection, the chair is authorized to declare a recess of the committee at any time. This phone Committee Hearing is convening regarding the patients perspective and the devastating impacts of marketing drug prices on American Families. I recognize myself for five minutes, to give an Opening Statement. Today we are closing this work period, the way we started our work. With a hearing on the Prescription Drug prices. This is a bipartisan issue and i have focused on for many years. The first witness at our hearing this congress was a woman named antoinette worsham. A mother whose daughter died at 22. Years of age after rising insulin because she could not afford it. And it was the subject of our hearing on hiv prevention drugs in may. Today, five patients and her family members are here to share their stories. I urge all members to go back to your districts and to talk to your constituents about their experiences struggling to pay for lifesaving drugs. I fear you will discover that we are facing a drug rising prices in america. Weve seen time and time again Drug Companies skyrocketing prices, forcing families to make gutwrenching choices every day. Many families have now have to choose between caring for themselves and their loved ones or paying for basic necessities. Each skyrocketing prices are forcing families to take on that, sacrifice their homes or sacrifice their health altogether. Imagine having to pick between having a roof over your head or protecting your childs life. Between eating that day or taking a pill that you need to simplystay alive. For americans around the country, these intuitions are everyday reality. Think about it. Americans are dying every year while pharmaceutical companies enjoy more and more profits. Our Witnesses Today represent the one in four americans who struggle to afford the drugs that keep them healthy and in many cases keep them alive. Unfortunately, Drug Companies continue to raise prices, rich in record profits and lavishly reward their executives and shareholders, all while stifling competition and preventing access to lifesaving drugs. Drug Companies Make up only a quarter of the healthcare industry. But they collect more than half of its profits. Some drugs are developed with federal funding. Yet the industry ignores its responsibility to the american taxpayer and makes massive profits from our investment. Drug Companies Use a variety of tactics to increase their profitability. They use loopholes in the patent system and to pay for a delay in agreements with competitors to extend a monopoly so they can keep increasing their prices. And even when there is supposed to be competition, socalled competitors increase their prices in lockstep. Stopping their pockets while the American Families are left paying the bill. To be sure, we all want Drug Companies to be successful. We want them to innovate. All of us depend on pharmaceuticals, the pharmaceutical industry to develop cuttingedge therapies and breakthrough drugs. But what we cannot abide is the profiteering at the expense of patients and the american taxpayers. That is why the committee has been investigating the pharmaceutical industries price increases. This investigation which began in january focused on the seven, 17 i costing drugs for the Medicare Part b program. Our investigation has made significant progress but we plan to do more. Let me be very clear. Committee will take all the steps necessary to ensure full compliance with our investigation. Including with our requests to Drug Companies to document showing why. They increase their prices dramatically. And how theyre using the proceeds and what steps can be taken to reduce the prices. Our investigation will allow the American Public to lift the veil on the industrys pricing practices. And we will help inform the policies and solutions to bring drug prices down. This is a problem that everyone even in this override polarized time has come together to address. And i am hopeful that sharing will be another step in that direction. Now, i yield to the students english Ranking Member of our committee, mister joyce. Thank you mister chairman, cost of Prescription Drugs is way too high. The chairman knows and i know and our constituents know it and certainly our panelists know it and i want to thank you all for being here today. Some on the other side of the aisle these high prices are present a year of capitalism that markets dont result work and the result is companies exploiting patients to line their pockets. It gone so far as to embrace socialism at the answer, the reality is they have a situation completely backwards. Its not a free market that is the result of drug prices being too high, the fair stems from Government Intervention in the pharmaceutical market area and how to get here . The laws and relations the government has put in place have led to the use of the system and the lengthy approval process at the fda. These and other loopholes delay competition. These challenges are taught , they require is the role of parsley and do the report together to figure out how to make a system work better. And we made some progress, both administratively and legislatively. The Trump Administration has been improving generics at a record rate. October 2018 fda approved 100 10 generic drugs and approved 18 more including 23 first generics for grant competition in 17 complex generics resulting in 26 billion in savings, for the consumers. From may 27 inning through september 2017 there was an average of almost 73 generic application approved for a month off from about 57 approvals per month. From january through april and in may of last year president from signed into law the right to try bill. Which allow terminally ill patients access to experimental treatments as soon as they are up each by the fda rather than having to wait the yearit takes for the drugs to go through the entire bureaucratic process. The law provides treatment for patients who exhausted all other existing options and we are working on a number of bills including a few that have passed the Judiciary Committee unanimously, one of those bills is the create, a bill that i cosponsored which creates acts to make sure generics get timely access lifesaving drugs though they can be available to more people more quickly and im hopeful the bill will be put on the house floor in short order. Theres speculation or policy will be putting forward a drugpricing bill when we returned from the august recess. I hope the approach democrats take is different than what we saw in the past to seek to deliver Real Solutions to our real concerns. Democrats set backthe American Healthcare system drastically the last time they were in charge. When they rushed a partisan bill through congress with no republican collaboration. It would be wrong to salvage the obama administrations disastrous healthcare legacy by putting controversial parts of the bill in the drug pricing package. The us is light years ahead of the rest of the world when it comes to groundbreaking medicine and its no wonder. Our pharmaceutical companies and 169 billion annually on research and development. Certainly companies are entitled to make money on the drugs that invest in and i hope we can agree on that but that process cannot be distorted by Government Intervention that results in inflated prices. We must work to find ways to preserve americas innovation but ensure the system works so that these innovations to as many patients as possible. I want to thank David Mitchell for joining the panel, good to see you again. This commitment is inspiring, thank you for returning and i know you testified in front of the subcommittee which i chaired last congress and im grateful for laura mclinn and jordan duchenne. Thanks to innovation by companies in the United States, jordan is not walking but running and living a complete life and he would be here today i understand, hes at summer camp which is where kids need to be in the summertime but i alsowant to thank our witness. I look forward to a productive discussion and i thank you for holding this hearing and i yield back quick thank you very much. Now we will turn to eyewitnesses who are here to share their stories. First we have mister David Mitchell. He is a patient and a founder of patients portable Affordable Drugs from my state, bethesdamaryland. Welcome. Ms. Ashley craig, a patient from easton texas, miss laura mclynn, a mother of a patient from indianapolis indiana. Miss sarah skipper, a patient from indianapolis indiana. And pam holt. Patient from indiana. Before i swear you in, let me explain to you that we dont have in many witness, as many members here today because we were expecting to be in session today and were not area which means that members , a lot of members had to leave to go home. But i understand we appreciate you being here and i want to make sure some people asked me whether i should, what i would hope for this hearing and i said out of respect to you all, i wanted to make sure that we held this hearing and so i hope that you understand that. And if you would all please rise and raise your righthand , i will begin joining you in. Raise your right hand. Class use where or affirm that the testimony you are about to give is true, the whole truth and nothing but the truth, so help you god. Let the record show that the witness answers in the affirmative. You may be seated. The microphones are extremely sensitive so please speak directly into them and without objection, your written statements will be made part of the record. With that mister mitchell, you are now recognized for five minutes. Thank you chairman cummings, Ranking Member jordan, thank you and to my congressman, thank you for being here. Im honored to be here, im David Mitchell, founder of patients for Affordable Drugs and more importantly i have an incurable blood cancer and Prescription Drugs are keeping me alive. Every two weeks i spent half a day at a clinic and an infusion of drugs are currently priced annually hundred 50,000. I relapsed twice and unfortunately, im failing on this current drug regime, eventually im going to run out of options. So the importance of innovation is not the radical for me, its literally lifeanddeath but my experience as a patient will be one irrefutable fact and that is drugs dont work if people cant afford them. When i learned i was sick, my doctors put me on the drug revlimid, handholds will talk about her experience but for medicarepatients in general , outofpocket costs and run to 15,000 a year. The principal reason, its so expensive because it measures has gamed the system and refused to sell samples, to Generic Companies want to bring a competitor tomarket. The changes alone in making high prices for drugs johnson and johnson, i think one of its drugs called selects, the Monthly Price is 36,000, it has increased almost 20 percent in just a little over three years. Or pfizer, ned jackson from utah as fibromyalgia and neuropathic pain. Was prescribed lyrica but when she found out it would cost her ive hundred 50 out of pocket, each month, even with a discount card, he decided to take only a third of the dose her doctor recommends her. But to address the problem of outofcontrol prices, we have to come to grips larger facts. Despite what Drug Companies tell us, skyhigh prices are not about innovation read multiple studies show that there is no correlation to the cost of our r d and the price of a drug. And taxpayers put a huge portion of the bill for the basic science that leads to new drugs. Every single drug approved by the fda from 2010 to 2016 was based on science funded by taxpayers through the nih. In fact, the nih is the single largest funder of Biomedical Research in the world. And while independent analysis show that nine out of 10 Drug Companies spend more on advertising and marketing and they do on our and the. Why do Drug Companies charge so much . Because they can. Drug companies should profit when they develop innovative drugs but we are out of balance right now and its costing us in our family finances, our Health Outcomes and our lives. I want to suggest three things we can do to rebalance the actual risk of innovation with a fair price for patients. One, perform patent law, too, and the days of monopoly without taxpayer negotiations and forced transparency from drugmiddlemen. Drug companies are abusing our system to extend their government granted monopolies and use a whole array of tactics, mister jordan mentioned rent abuses, anticompetitive days, evergreen, sham petitions. We need to correct those and there are bills moving through congress to do that. Next, we need direct medicare price negotiations and we need to restructure Medicare Part d. Our cursor Current System isnt working. We take pay 2 to 3 times what other countries pay for the same drugs. One big reason is that other countries negotiate, weshould too. International reference pricing is proposed by the ministration or inflation caps that were passed out of Senate Finance. Our bipartisan vote, areother ways to approach this to restrain list prices. We also need to restructure part b along the lines of the legislation declared yesterday. And finally we need more transparency around abms. These Huge Companies cut deals that determine how much patients pay but its all secret. Competition, free market cant work without transparency. Right now theres a fundamental question Drug Companies want us to ask about drug prices. What are we willing to pay to save a life . And while thats easy when its your childs ability to live, to breathe, when its your wifes diabetes, when its your owncancer. The answer is anything. But thats the wrong question. The question we should be asking is what is the right amount of money that Drug Companies should make on these drugs. With literallyhundreds of Clinical Trials underway for new gene therapies that are currently priced at half 1 million or more , we cant pay just any price to Drug Companies demand. Neither American Families nor our Healthcare System can afford that. I feel grateful to be here today representing patients across the country. I believe the moment is at hand and we can address this problem and with bipartisan support, we will. Thank you again for having me. Thank you very much mister craig. Chair cummings, Ranking Member jordan, members of the committee. Thank you for having me share my story my name is ashley craig, im 35 years old and i live in houston texas. Im one of the thousands of americans who took the world topselling drug known as humera to treat a autoimmune condition which causes pain and inflammation. After getting approved for the drug i had to pay 753 a month. To say this was a Financial Hardship would be an understatement. The drug costs more than my car payment, more than my business insurance, more than my food bill each month but ive made the decision to suck it up and pay because the drug works. After months of successful pain and system management, we raise the price and mynew Monthly Payment was going to be almost 1100 a month. I simply cannot afford it any longer and had to make the difficult decision to we myself off the drug that had provided me months of release. It was already expensive for me at 750 a month and i couldnt afford 40 percent price increase. Let me tell you a little bit about humera. The drug is far from new, its been on the market since 2002 and the price has gone up nearly 400 percent at 5174 a month. They are making billions on the backs of patients, 20 billion alone a global sales last year. That is more revenue andevery nfl team combined. And avenue has done everything in his power to block competition for generics off the us market. They deals with more than a Dozen Companies try to develop stemware, filed 247 Patent Applications in order to delay a petition in the us. So while was hiking prices and blocking competition in the us, bio similar came into market in europe and as a result abby began selling humera for 80 percent less. Overseas. Unfortunately, thats not the end of my story. I had a similar experience on emerald which is another jog examined by your investigation, the prices again led to on affordability and i stopped taking the drug. As a resultmy symptoms came back. To give you an idea of what a full body psoriatic flareup feels like, id likeyou to imagine getting a terrible sunburn, the kind that makes your entire body feverish. Then add falling into a bed of fire and read that is what it feels like during a flare up without medication and that is why i am here today. Because there are two bills in the house of representatives that would help patients like myself. Hr 1499 and hr 2296 have both passed energy and Commerce Committee , the first bill would stop Companies Like add me from paying off Generic Companies that plan to bring a competitor to market. In exchange for this payment, the generic manufacturer often delays its products entry into the market and patients like me are stuck facing bills of 1100 per month for humera. The second bill called the fair drug pricing act would increase transparency and require justification for price hikes like the one abby enjoys taking on the back of patients like me. Thesebills are just the start , they would not solve the problems are drug Pricing System and all the ways that Drug Companies abuse their monopolies and americans like me are desperate for relief for high cost Prescription Drugs and you have the opportunity to advance legislation that hurts two of farm is most egregious drugs. I hope todays hearing is in the last stopand thank you for your time. Chairman cummings, Ranking Member jordan, members of the committee, its an honor to be here. My name is Laura Mcglynn but most people know me as jordan mcleans mom. I come here today simply as that. Jordans mom. The words i speak on my own and they come straight from my heart jordan is my amazing, funny, kind, compassionate , faith filled little boy but hes also in a race for his life because just before his fourth birthday doctor told us he has a rare and fatal muscle wasting disease called duchenne muscular dystrophy. According to the Natural History of this disease, has already lived about half of his life at 10 years old. It affects one in every 5000 boys in over a short time it robs them of their ability to do the things most boys love to do. Walk, run, play, climb, participate in sports, ride bikes, use the bathroom independently, feed themselves, dress themselves. Eventually even the strength to hug their moms is ripped away. Jordan is the best ones ever so for him not to be able to do that to me is not okay. The heart and lungs are eventually affected which leads to a young and devastating life expectancy. The cause of innovation and laws that progress has passed over the years, im here today to tell you that my jordan now has hope. He is the enemy of hope. He is a fine and Natural History of this disease and he is a direct participant in helping to create hope for others area about two and half years ago, jordan became one of 16 lucky boys in north america to be accepted into a Clinical Trial for a therapy designed to slow the progression of his duchenne. Hes made weekly trips out of state to receive infusions without a single complaint ever. During this time weve noticed that jordan is doing things we were told that 10yearold child with duschene wouldnt be able to do. Hes still walking quitewell, playing outside for hours. Hes climbing stairs in a normal way while most kids at this age cant climb the stairs at all or cant do it very easily. He is dancing, running, jumping and catching balls. Keep in mind duschene robs boys of these very things. Just last Week Research team showed me mri images that some of jordans muscles and they told me that they did not look like the images of a person with duschene muscular dystrophy. When jordan was first diagnosed there was no Clinical Trial that he could participate in. Now there are multiple treatments in his priceline. It is incredible how fast the science is moving but jordan and other kids like him cannot afford to see this innovation flow or stop. I desperately need the ion test, doctors and Drug Companies to continue to develop drugs for my son and the millions of others with devastating diseases and for that reason, im here today to remind you that we must continue to encourage and reward innovation. Because of bipartisan work that many of you have been a part of over the years, backpack designation, accelerated approval, innovative trial design, i expect drug is going to be approved soon. When that happens its probably going to be expensive as are most drugs for rare diseases. These are old drugs thathave been around for years though. Lets be careful in these conversations about drug pricing, not to mesh those two. Innovation is expensive and its also the only thing thats going to help ensure that boys like my jordan can be a part of the first generation to change the Natural History of this devastating disease. If we lose innovation, we lose the most valuable thing we cant put a price tag on. Human life. We cannot afford to let that happen. So as we work to tackle these issues of access and affordability of existing treatments, treatments in Clinical Trial and treatments in cures yet to be discovered for boys like my son was 16 and waiting because he doesnt have anything yet, i implore you to do so carefully and remember that one size does not fit all. We cant afford to discourage those discoveries and the development of new therapies. If we had done that 10 or 20 years ago, jordan wouldntbe doing what hes doingtoday, wouldnt be benefiting from these treatments. Home in indiana today , parents are gathering to pick up their kids from camp and they are hearing all about their adventures. I wont be there for jordan, instead with his blessing i came here to share this with you. The critical importance of driving toward the promise of new and better treatments for all of those who wait area i cant wait to get home to hug him tonight andhopefully ill never have tostop receiving those hugs. Because jordan cant be here today , to speak for himself, i did want to leave you with a favorite quote of his from jeremiah 2911 from his favorite book. It says for i know the plans i have for you declares the lord. Is to prosper you and not to harm you, to give you hope in the future. Thank you today all of you from the bottom of my heart for wanting to get hope tangible, for caring about the future of millions of patients depending on you to keep innovation alive and for also caring about helping patients access these treatments which is very important. Keeping in mind though please one size does not fit all. I hope youll ask questions and i welcome each of you to reach out to me after the hearing to continue this important dialogue. Lets Work Together and keep doing the right thing. Click thank you very much mrs. Skipper. Good morning chairman cummings, Ranking Member jordan and members of the House Committee on oversight and government reform. My name is sarah sweaters, a member of affordable now and t1 international. Thank you for inviting me to come speak with you today and for taking the time to listen to some of the ways pharmaceutical companies are putting corporate profits above the lives of people like me. As a resident of indianapolis indiana , i live in the shadow of eli lillys National Headquarters and my life has been at the whim of the Company Since i was diagnosed with type i diabetes when i was five years old. Since then eli lillys refusal to control the cost of the drug i depend on has reaped heartbreak and hack on my life. My sisters and those who care about us. Idont remember my life without this burdensome disease. Being diagnosed at such a young age, i had to grow up fast. I had to appreciate life early on because if michaels was miscalculated by one unit, it would cost me mylife. I can remember being in the hospital multiple times a week, nurses secretly spying on my mom to make sure she wasnt eating my food because my blood sugar would drop so fast but in actuality, mybody was rejecting the insulin. I can remember showing teachers bars on my fingertips fromchecking my blood sugar levels because they didnt believe i was diabetic when i complained about not feeling well. Having such a huge responsibility at such a tender age makes me feel robbed of mychildhood. Being the middle child i tried to stay in my lane is a little sister even though my brother may not think so and i feel , i take my duty as a big sister seriously. When my baby sister shelby was diagnosed with type i diabetes at the age of seven, bar of setting a good example was thousand times higher. I remember seeing my sisters and mother weeping. I recall taking shall be in the bathroom of the Doctors Office and trying to comfort her and tell her it would be okay. Shelby and i have a fear of going through the same challenges as are in joy, our mothers after that passed away at 47 due to complications of type i diabetes. My sister and i have been fighting for our lives since we were children and it has not been easy to read and it hurts to know that some type i diabetics travel to mexico or canada for insulin or even byinsulin on the black market. The fact that for people under the age of 30 died last month due to rationing and not being able to afford their insulin is gutwrenching. According to a survey done by t1 international, one in four people ration their insulin. This is unacceptable. This is why the movement to make insulin affordable for all is so important. During my freshman and sophomore year, i had to ration my insulin for reasons to this day i still dont understand why i was denied medicaid and i aged out of my pediatric and a criminologist. The last prescription i received from my doctor came with a note saying im sorry, but this is the last prescription i can fillfor you. My professors knew my predicament and yet some could care less and didnt care to help me in class since i spent the majority of it in the bathroom or asleep. I survived by eating less food so that i can take less insulin and my files. This is a fear that i had to live through throughout my education. This is the reality that so many people with diabetes face every day. Lets shift gears. Its may 2018, im working fulltime for a Big Corporation with benefits but even with insurance, my insulin supply, my 30 day insulin supply was 1000. Thats just insulin, that price does not include test trips, needles and other vital supplies. I couldnt afford to purchase my full supply of insulin so my sister rest herlife by sharing hers. One night i took my nighttime dose of insulin and left the file on the dresser for my sister to see. I assumed you would think i had already taken my dose and i left the file on the dresser but she didnt. She thought i still needed to take my insulin for the evening so she took less of her normal dose to ensure there was enough left for me to take area she put herself at risk. The next day she went into diabetic ketoacidosis, had to be hospitalized for four days, the veins in her body blue and she had have a in her neck and almost went into a diabetic coma. I couldnt afford insulin because eli lilly and others refuse to control the cost of insulin. It almost cost my sister her life. Pipe price gouging is killing people. These pharmaceuticalcompanies are committing murder and getting away with it. You all as leaders they in making change and while young people can continue to die from rationing, you are just as responsibleas the people profiting off their lives. Change for this issue will not be experienced if the marathon continues and while as a patient advocate like me, i will not stop seeking out until you find a way to put it in and to the insulin price crisis in america. No matter how long it takes, we will be building our numbers and demanding change of our lives depend on it. Thank you. Thank you very much ms. Holt. Chair cummings, Ranking Member jordan, members of the committee, thank you for inviting me to share my story. My name is pamela holt, im from granger indiana outside of south bend. Atthe age of 40 i was suddenly widowed mind my husband died from a heart attack. I raised three children on my own. I was fortunate that time to be a teacher and an administrator with what i felt were good benefits that set me up for a good retirement. That all changed however when i was diagnosed multiple myeloma three years ago. Multiple myeloma is an incurable but treatable blood cancer. Upon my diagnosis i underwent a bone Marrow Transplant and chemotherapy. Im blessed to be in remission today. Im living on borrowed time but imthankful for every day. However, to keep my cancer at bay i must take the drug revlimid. Initially this was good, i get to live longer, spend summers at our favorite lake in wisconsin and that im grateful for but when i learned the cost of rezlemid, i was horrified. The price of rezlemid is over 250,000 year. Last january, on Medicare Part d because i am 70, i went in and out of the doughnut hole paying 4950 that first month and then more than 8000 outofpocket over the rest of the year. This is on medicare with a good supplement. That cost was totally unaffordable for me. After just one year, its set me into serious debt. I was entirely underwater and i had to make the heartbreaking decision to refinance my house. It was three years from being paid off and now im starting completely over. In the last year ive been fortunate to receive a grant for the cost of my revlemid outofpocket but this assistance is yeartoyear and it can always fall through. Its income dependent. I dont feel i should have to depend on these yearly grants to be able to live. At an afford a medication that i need to survive. There are years that i do qualify and years that i dont qualify. I feel ive been my life doing some of the right things, intruding to my community, teaching public schools, raising my children. I dont feel its right that despite all this hard work and careful planning, i face financial challenges because of the cancer i have no control over. Im really thrilled and grateful to the additional time revlemid has given me. But having cancer is really hard. I shouldnt have to lose my savings and stress over finances just to stay alive. Im encouraged by the Action Congress is starting to take in the hearings of the last couple months and im particularly grateful for this committee for listening. What patients need most is real change to the system and congressional action that will bring down drug prices. For me, one solution would be that creates which mister jordan talked about. Create addresses the company that makes trout revlemid uses to deny Generic Companies access to samples of revlemid. This prevents generic competitors from coming to market and allows celgene to set the price of revlemid high. I came to dc last year to encourage congress to pass this important piece of legislation. Im grateful that the bill as passed the house energy and Commerce Committees and i really hope it gets over the finish line as soon as possible. Thank you. Thank you very much, i yield to myself. First of all, i want to thank my witnesses for being here. Clearly, you have shared very, very personal stories of pain. I often say that so often out of pain comes our passion to do our purpose. Pain, passion , purpose and so we thank you. You are here to remind us of the actions of Drug Companies in raising prices have real consequences for real people. This skipper, let me start with you. What is the most difficult choice you or your family members have had to make because of the price of a Prescription Drug and then just so youll be prepared, ms. Holt and miss greg, im going to ask you the same question. Thank you. I feel the most difficult thing was just keeping up with the rent. We had to move around a lot and my parents, it was either we paid the rent or we, me and my sister lives, as an adult now i feel that ive made the sacrifices really just enjoying my life. Im 23 years old and im tired. And i dont want to be tired anymore and i dont want anybody else to feel like how i feel and i feel like its unfair that not just only book for people under the age of 30 who died last month but any and everyone has been affected by rationing that they didnt get to have that decent quality of life. I want to give you that same question, miss mclinn, what have been the most this difficult decisions you have to make . You said something that was so powerful when you talk about your son like a race against time and one of the things that ive noticed is that nih is a phenomenal place. What is the most difficult decision had to make for your situation maam. One difficult situation that i have to say was a decision was a decision that was difficult but also a decision when he was diagnosed i did not even think i would be able to be in the position to have to make a decision. Jordan qualified for two Clinical Trials for similar drugs that are designed to do the same thing. I actually had to make a decision at the last minute to choose one drug company over the other because of the Clinical Trial design. In one of the Clinical Trial designs, our boys were asked a third of them to be on a placebo for 96 weeks. It is really hard when you know what happens so quickly and at this age because like i said at his age we never thought youd be doing the things he is doing. So he was receiving a placebo for 96 weeks, we know what happens. So we know what happens when these kids do not get treatment. For me, its a bittersweet thing to say, i never thought i would be able to have Clinical Trials to choose for my son. Im extremely grateful for the innovation but i also think i know this is not the purpose of this committee but it is worth saying since you asked me the question we also need to continue to rethink the Clinical Trial design for rare and fatal diseases as well. For me probably one of the most difficult decisions is having to make the choice to go unaffordable immunosuppressive. The current one i am on that is affordable, i just got married, my husband and i had to make the decision, i cannot have kids if im on it. It is absolutely not allowed because it is a hard chemo drug. That sucks. To be quite frank. I wish there were generic options for me, i dont mind paying for drug but it needs to be accessible and affordable. I am selfemployed, i do well, there is no way anyone could afford 1100 a month and they just keep producing new biologics. Which are even more expensive than the current ones on the market because there are no generics available. That is huge for some buddy like me. Thank you. I think the most difficult thing was the induction therapy, the chemotherapy i needed i went to the drug counter and my bill was over 4000. I cannot pay. I was shocked so that was delayed three months until i came up with the cash in order to pay that to start my treatment. That was difficult. It was also really difficult to refinance my home. I am thankful i have a home to refinance, other people are not that lucky but to be that close to being debt free and having to start over was very difficult for me. Again i have many, many more questions to ask but my minutes are up so we will now yield to ms. Miller. Thank you, mr. Chairman. I want to thank each of you for being here and sharing your stories. They are heartwrenching and very real and personal for you and for your loved ones. Im grateful for you coming and sharing with us today. There is a difficult balance that somehow we have to strike in all of this in your bringing suggestions to the table that need to be looked at. So all of this needs to be looked upon from the big perspective, you all are in a situation where the cost of medication for you and your loved ones is astronomical. And there is about 5 , fewer than 5 of americans are having to pay the list price on drugs. And i dont know if any of you have to pay the list price or getting help on that or not. Fewer than 5 actually pay for list price and you all spoke specifically and i went back and looked at a celgene, that took over 14 years for them to develop that drug, 800 million to produce on drug and from what ive been able to see there is about 140,000 patients taking these genes and medicines and been assisted through celgenes, patient support programs which is contributed over 1. 4 billion. Back to patient who are involved in taking the similar drug. They reinvest some 37 of the revenues back into research and development. Somehow we have to strike a balance. There is no question as to the enormous cost people like you who are here today and all of us in this room are grateful for the tremendous job that Drug Companies are doing to come up with drugs that help. But being able to get those drugs back to us in an affordable way is another issue that has to be addressed. I am grateful for you coming here. We are blessed to be in this country where this companies are putting that money into research and development to help with situations like this. One thing that i was intrigued about with your situation and reading about your story is the right to try interest that you have and you worked with governor pence can you tell us a little bit about your experience with that fighting for the right to try. When jordan was five we actually did not have a Clinical Trial available to us. I heard about a drug that was coming up through the pipeline but based on the inclusion criteria i did not believe that the time that jordan can make it into the Clinical Trial. I am passionate about patients receiving access. Im dispassionate that they can receive access. At the time jordan did not qualify for a trial so we started fighting with the right to try which says if the drug has made it through phase one and a patient wants to try it and you have a drug company and the doctor im willing to make that happen then you have to have a right to do that. So we did start in her home state of indiana when mike pence was a governor at the time. It passed with bipartisan support across the nation. Then we started to work on federal legislation which was passed into law last may, the law does bear jordans name and jordan is not receiving the treatment through tripathway. He is receiving treatment through Clinical Trial. Im happy to tell you about our friend matt who is a former navy pilot battling als and he did not make it into the Clinical Trial. But a few months ago jordan got to be there with matt when he received his first treatment of an experiment or treatment for als for the right to tripathway. It is been really awesome to be on that journey and for jordan to see that come full circle and see someone who has been able to benefit and last week matt became the first person ever to receive a fourth treatment and he is doing very well. Thank you, mr. Chairman. Before we go to ms. Norton. Mr. Mitchell would you comment, i want this hearing to be effective and efficient. Would you comment on what mr. Heights makes a good point any talk about research and develop in the fact their programs to discount drugs. A couple of things people on medicare pay out of pockets and partly based on list price. People who do not have healthcare coverage pay based on list price and secretary azor and two thirds of all americans are paying in whole or in part based on list price. That is the first thing i want to straighten out. That is a lot of money for a lot of people when prices are high. Second, i know that with respect you just quoted cell gene about rubble meant that was a drug invented and derivative of it. It was invented in the 1950s and celgene stumbled into it and accidentally based on Clinical Trials that was done in academia. That drug came to market in 2005. The reason is the company gets to extend by abusing the laws that are put in place. I fully agree that when they bring a new drug to market we want them to profit. Our whole system is based on a. Five years for small mil molecus and they make a lot of money. But at the end of that. Congress has said we are supposed to let market down price your competition. And celgene has prevented that from happening. The result, it was introduced in 2005 with 6000, it cost 18000, one capsule cost 720. This is an old drug. There is no excuse for this. Cell gene is not piling on the money back in r d, they are milking an old drug which is how they are keeping the stock price up and if we did not let them do that they would be forced to innovate to make money which is what we want them to do. Think agreements. Ms. Norton. Thank you very much. First for this hearing, thank you for the testimony we heard today and i appreciate mr. Mitchells. No one on the side wants anything less then a return for the extraordinary work that the Drug Companies do. We have had evidence here over a great deal than what anybody would regard as fair return and of course people go to canada and theres every reason to believe that Drug Companies want a fair return to. I think youve made the best case that we couldve made by describing your own experience. I would like to ask a question, i was intrigued by she and her sister. Had diabetes, is this type one . Yes. This is very serious diabetes. In those drugs we would want to look at to see whether there has been an increase over time you know of any improvements that a been made with insulin when you get insulin, are you told youre Getting Better insulin then you wouldve . It is been the same. So the drug has self has not changed question. No. What about the prices . The prices have gone up i believe over 300 in the last ten years. If the drug was miscalculated by one unit you can risk your life. Yes. Did you ever ration the drug . Yes, when i said i had to eat less food, with insulin there is a little calculation of how many carbs youre going to eat and you have to figure what your blood sugar and a correction factor and was correct for your blood sugar. I did not have enough insulin so i ate less food, i did not have a choice but to take less insulin. Because i was not getting the consistent supply so i had to eat less food because they did not have enough insulin to take care of myself. You return to make your insulin, what insulin you had last longer . Yes, maam. How could you calculate, did you have some scientific way, measurement to calculate if you are at risk when you decided to take less insulin on how much insulin to take less then what was calculated . I dont have any pancreatic function. So if i do the math, if i give you an example, if my sugar is 250 in my target is 150 i would have to subtract the 250 in the 150 and divide that by what is a correction factor. So for every 35 points over my target i would have to take one unit. And then i would add that, im on a scale for every 7 grams of carbohydrate i would take one unit. So that is how you calculated. But if i do not have an actual monthly supply of that, i have to figure out how to make that stretch. So by eating less food, i was not able to affect leaving this calculation to you sounds itself very risky and understand that your sister was hospitalized in nearly died last year as a result of rationing insulin. How did that happen . Did she incorrectly calculate . We were literally sharing the same vial of insulin. So we were both using the same vial of insulin. So she took less then what she was supposed to take to ensure that there was enough insulin left in the mile so i take my dose. But she did not realize i had already taken my dose so she took less so i could be able to take my dose. All i can say is case made. Thank you very much ms. Miller. Thank you, chairman cummings and recommender jordan and all of you for being here today. Thank you for sharing your family story and your experience as a mother and grandmother, its really heartwrenching to hear, i am so glad that the innovation and research is helping jordan and giving him so many other people hope. In your testimony you discuss important im not finding a onesizefitsall solution when it comes to treating patients. Can you talk about what this means for your family customer. Just for an example, jordan has every disease that affects one in 5000 boys. The drug that he is trying right now is really only designed to help a of patients. So jordan has a rare disease and a rare subset of that. So we have lots of drugs right now coming up in the pipeline for lots of rare diseases. Even though jordan is doing well and he is a treatment now, it is not a cure and its designed to slow the progression of his disease. He is ten, he is still young but he is doing well. But we need more treatment to continue to be developed. We need treatments for joseph who is 16 years old. We need treatment for all of our boys and treatments that have yet to be discovered. It is not a one size fits all. And like i said in my testimony, we hear heartwrenching stories that these other witnesses are sharing. I want to be careful that we are not missing the two together because something has to be done about this but we have to and that companies are still going to work in the space and so do other people. At the nail on you on the he. We all want to do something. It seems to you are buying time and by the time your son is 16 you are hoping that it has been changed even more. Again it is so heartwrenching you what suggestions would you have for congress on better encouraging the innovation and reward it . I honestly dont have a big answer to that. I just came here today to remind you as you are having these discussions, just remember to not make decisions if youre changing policies, please do not make decisions that will impact the innovation. I think it is okay that some companies are making a profit, how much i dont know. I look at how much money, and jordan alone we travel outofstate, he is two and half years and in the first two years we went outofstate every single week. And we are just one. He is one of 16 and this is a small trial. Some are much bigger than this. I look at how much money and i dont know how much, traveling is not expensive, i think of the doctors, nurses, surgeries, hes had two biopsies where they took a sample of his muscle before he started the trial and another 124 weeks later to cephus producing more and im happy to tell you all 16 boys are which is incredible. When you think about the surgeon who did that, the nurses, the scientists, the storage of the muscle biopsies, there is so much that goes in. There is a lot of expense that goes into Clinical Trials and i want to make sure we are not forgetting about this as we have these conversations. I think your grasp is great and we all can learn from this. One of the hardest parts of my job is trying to see the unintended consequences of whatever we make as a law or a rule because five years down you may be dealing with something we do not intend to happen. We are always trying to be so careful with what we do. Thank you very much for being here today and i yield back my time. Thank you mr. Welch. Thank you. I want to thank you is not always we had an opportunity to do this. But today is one of those days and i thought i would give you my reaction. Its not for you to tell us what we should do. To bring these prices down. You are the face caused by a failure and not bring the prices down. In each one of you has a separate story, i know you lost your husband at 40 and raised the kids alone and you and your sister are sharing your insulin. And what i love about listening to you, you live your life. You have a challenge, its outrageous should not have to be contending with medication, that can happen to anybody sitting appeared thats just the lock of the draw. And one is phase of that is not for anything, they dont know why it happened. There is nothing you did to make it happen. But then you own it now. You have to make a decision in each one of you made the decision to live your life, you will fall in love and get married and you live without. That is really what it is pretty fine so inspiring that you are not angry. Youre frustrated, you are worried but i did not hear anger. You are entitled to anger at us. Because it is our job to make certain that these companies dont rip off the system, dont rip off the taxpayer, dont gain the system and its for us to figure out how they are doing that. And you testified mr. Mitchell many times and i think youre as knowledgeable as anybody about all the ways in which the companies but the prophets ahead of people. But i think it is really helpful for you to be with us to hear you because we are starting to come together. We passed he has been a to get the prices down for years. And its starting to make a difference. It put a significant dent to bring the cost down by 500 billion. And i get so frustrated with the sudden supplication of the Companies Making a lot of money who would do anything that is close to paid for all the medications and all the other countries except ours. It will in innovation. [laughter] it may end hundred Million Dollar paydays. Which i hope it does. But bottom line, we are all in this together, and we have to have politics is about trying to find ways were the things that are common problems will come up with solutions that work for all of us. There has got to be a commitment that another chairman has in many of us if you get medicati medication, youve got to be able to afford it. I just want to say on my behalf, i bet i speak for everybody. Thank you so much. For deciding to keep living your life each day despite the challenging phase. We will do our job to deserve your respect that you have earned yourselves. I want to say thank you. Mr. Mitchell i have a little time left. Im going to use your time if you allow me. I just want to say secretary azor who said, i have been a pharmaceutical ceo and im aware of the old talking points that if we take 1 dollar out of profit that the engine of innovation will grind to a halt in this country. I am tired of the talking points and so is president trump. I want to say amen. Thank you all very much. First of all you are living proof of something that ive long believed, we have all those lobbyists running around the town with no highpriced lobbyists, we appreciate your passion and obviously your love for your son jordan. You talk about your situation and if you dont mind, how are you covering these tests and trials that jordan is a part of. The drug company pays for. I think that is really important to know that these Clinical Trials are expensive and the money does not always come from taxpayer money, i know some does and i know there is funding for rear disease his disease is being paid for by his drug company. All of the doctors and nurses in the drugs, all of it, they are paying for that. And that is why, believe me none of us want high drug prices. And no one in this country thinks we want that. I want the point that there are drug prices that are high in jordans case is reasonable to expect that his drug is going to be expensive for that reason you mentioned in your Opening Statement, three things that need to happen. Can you walk us through those again. You talk about this balance that we need, you want the innovation to happen because in your Opening Statement they will not find what needs to be found for you to continue to live. It is critical for price matters too. That is where were at. Lets figure out how we can keep both. I really appreciate you, and the chance to repeat them sir. We need to reform patent law that creates a and help advance in congress. It is important, paper delay deals that do not allow generics to come to market timely and citizen petitions which the Drug Companies and 92 are by the fda. And former commissioner flagged as a problem. This is to make the system that you all built work. So that we can reward the intimation and love to make a lot of money because you did innovation and you took a risk. Exactly right, there is a reason patent protection in the constitution. We want the innovation and take risks and come up with great ideas into it. Exactly. We want to make account. So that time you intend is over and competition has been driving the way it is today. It is not working, that is one. Two, we really fundamentally believe that the United States should do what ever every other country does in which a bargain with the Drug Companies and strike them on interference cause. We think that negotiation is the essence of a capital system. When your situation where someone could come in and dictate a price to you, that is not freemarket. That is giving then a monopoly to be enforced to the taxpayer expense. Third, down the supply chain and the problem with the system is when list prices go up everybody down the supply chain makes more money and so they all have an incentive to have list prices continue to go up and pbms, chief among them and we think secret rebates are about policy, we dont think they work for patients, there is a patient i cant know if the drug is there because its the best drug or the least expensive among equally effective drugs or there because the pbm got up big kickback. This is happening, we would like you to address transparency with pbms. Those are big things. I understand and i appreciate that. The key to me, we have an amazing system where we do get innovation and the greatest drugs developed, brought to market right here in the United States, we have to make sure that continues but happens in a way that people can actually afford medicine that they need in treatment that they need. Thank you all for being here today and i yield back. Mr. Truman thank you very much. I want to praise you for calling this hearing at the beginning of her recess. And i wish all of the media who swarm over this congress when we conduct oversight into governmental corruption are here today because this is a crime too, this is corruption and a nationwide scandal. I must say that this is the most inspiring witnesses that ive seen since i got to congress and i hope that every american takes the time to watch her testimony today or tonight or over the weekend and i wish i had an hour to question all of you. Mr. Mitchell, a special attachment to testimony because it is so lucid and brilliant and clear and because youre my constituent and you make the district proud and i wish i knew someone when millions of twitter and snapchat followers all over america who could retweet your testimony. Maybe prevail on our freshman members of the committee to make you see this today mr. Mitchell. My friend from ohio watched his remarks with an attack on socialist but its not socialist for jacking up the prices to make Prescription Drugs unaffordable for millions of americans and it is not socialist who are stifling competition. Its a Large Pharmaceutical Companies themselves. And this would be no surprise to my beloved added smith who understood that the companies are in the business of of self interest. Thats what makes the market work. But if you allow them to get so big and powerful they will destroy competition. Every freemarket economist is understood that that is what is going on. You make profit by paying off generic competitors to stay out of the market and they will do it. If they can make extra profit by changing new drug patents for old drugs that along been on the market they will do that. If they can inflate profits by lobbying congress to keep us from engaging in the market activity and negotiating for lower prices they will do that too. And our job as representatives in congress is not to bow down the large corporations but to stand up to them for the Public Interest and for the people. Mr. Mitchell, in just two years, as a person dealing with an illness, you have built a community of more than 150,000 patients and families despite lower Prescription Drug prices to fight for real competition in the fight against monopoly pricing and medical services. You say that these high drug prices are not about innovation. That means in the single most, explain why high drug prices are not about innovation. And multiple academics have studied this between the cost to develop a drug and the cost at which it set. It is set high as a buddy can set it for profit maximize. As long as we let them do that they will continue to do that. Why would they stop . It is their job to take care of their shareholders. That is my concern that that wrecks the balance between ensuring that we give a really good rich return for excellent Innovative New drugs and ensure that prices set that is affordable. May i give you one example. Yes and a followup. Nih reports director of reports, there is an impending cure coming for sickle cell so we checked and it turns out that nih has invested 300 million and it reported a spending 100 million a year on sicklecell cure. These gene therapies are coming to market between 500,002,000,000. If we have a cure for sickle cell that comes out of nih that will be for 100,000 people in this country who have sicklecell it will cost us 100 billion. There are 400 gene therapies and development. Let me followup. Im a proud representative not only of you but the nih which invest billions of dollars in scientific and medical research to fight the killer diseases that our population is struggling with. When they come up with breakthroughs, those scientific inventions and discoveries are used by these companies. So should the Public Investment in the research be considered more deciding about the regulation of Prescription Drug prices . His time is expired but you may answer the question. Thank you, mr. Chairman. Yes, we believe it should we think we should Pay Attention will me talk about the financing because we need to give them tax breaking for that. Tax papers get Tax Advantages for doing the research. By the way, dont stop that. Keep it going. I need new drugs or in going to die. That is straight up a fact. So we want it but we want them to come forward at prices we can afford. Mr. Keller. Mr. Roy. Thank you, chairman. And specifically i want to think the chairman for continuing to have hearings on this topic and shining the spotlight on this issue. I concur with my colleagues to say this is an inspiring hearing of sorts and listening to the great panel and something i hope we have bipartisan interest in trying to solve and have been particularly interested in what you had to say, i would agree with my colleague from maryland that you presented in a lucid way in a way that shares what i believe and i will also add the quote from ms. Mcluhan, its okay companies are making a profit, how much i dont know. That pretty much sums up my general philosophy on this. I want innovation to continue, i Want Companies to make the maximum dollar they can make to encourage innovation within boundaries recognizing that our patent system is constitutionally prescribed and critical to the formation of these drugs. I was listening to your testimony in a spent a lot of time with people dealing when i was at md anderson with hodgkins lymphoma. I was sitting here looking through my old email files and found july 28, 2011, which would be this coming sunday would be eight years with an email back and forth with my wife when i was at the Doctors Office thinking id walking pneumonia and starting to figure out i did not. So i now know that was july 28 was the day and i found out a few days later and got the result that it was hodgkins lymphoma and i said is that the good kind or the bad kind, and the doctor said well i guess its a kind. But going through that obviously changes your perspective. I was on a trial. I spent every two weeks from august through january of 2012 going down there in the trial clinic section at md anderson and getting treated with this and it was not fda approved at that point. It was fda approved for relapse patients. And i was a new patient. And i am very grateful that that drug was be brought to market in a Pharmaceutical Company was making money doing it, some of the research that went into developing that as mr. Entered came through nih and other avenues of research including the university of texas and other avenues. So for me the question that im try to wrestle with, and often in congress we dont acknowledge what we dont know. And when in fact we generally theres a lot more we dont know and we know. But i dont know the answers to how much money that is coming through nih and publicly funded research that goes to a privately Held Corporation and what agreement exists and how much profit should be allowed. Because i cringe when i think about what the government is setting which is allowed. As my calling for marilyn was talking about, we dont always have a full market going on here in terms of competition because we have issues. I dont want to be a filibuster because i can be here for an hour and have a giveandtake because of been intrigued what you will have to say. I am interested in a number of different legislation including the ones i mentioned and i think you mentioned some legislation each of you have. In looking at all that, i am in legislation 3199 the term act that patient for portable drug which i think mr. Mitchell you are part of the founding is a port of train to stop the gains that they display by dragging these things out and tweaking the formula and moving it down the line. These are things that we need to look at and provided that your rightly pointed out that we preserve innovation, make sure there is an abundance supply of drugs are continuing to be developed and able to distribute that around the world with companies that are structured to do for profit. But we have a lot of work to do to make sure the patent system has not gained pbms and theyre not driving up prices and getting more transparency in the process. And i think the threepoint outline i just used my five minutes without asking a question and i apologize but i perceive the questions that you guys have answered and the time here taking the time out of your busy schedule to be here and i think the chair for having this hearing. Thank you very much ms. Ocasiocortez. Mr. Chair i appreciate you holding this hearing, i think first and foremost to each and every one of you i want to say personally that i am sorry, im sorry youre going through the things youre going through. I know that i understand and have experienced not all of what you have experienced but some of it. When i was 16 years old my father was diagnosed with a rare form of lung cancer. He was in experimental trials in order to save his life. My family almost lost our home in order to try to keep him alive and try to keep her family together, a lot of folks many people know that i was working in a restaurant when i got elected. But they dont know why. And the reason why was because we lost my father to a rare form of lung cancer and we cannot find treatment for him. And the other thing i want to say, none of this is your fault. And so often we are made to feel guilty for the things we cannot afford, there is no reason that her treatment should be this expensive and the first place. One of the things that i wanted to get at is the idea that all these drugs should be as expensive as they are right now. I dont think that is true. And you said that with your insurance it is 1000 a month is that correct . Yes. When insulin was first developed, the patent was sold, you know the story . For a dollar. That is how much the patent for all insulin was sold for. Do you know the reason why its 1000 with insurance for you . I dont. Neither do i. I have no idea. And frankly i dont think corporations understand. Or give us the reason why. How much money has been spent on research and development in between 2006 and 2015 about 465 billion was in research and development and i think every dollar put into research and development of pharmaceutical is a good dollar spent. But mr. Mitchell are you familiar with stock buyback . I know what they are. And what is a stock buyback. Is when companies decide to purchase shares of its stock in order to drive up the stock price. So between the ten years, 465 billion was spent on research and development, the amount that pharmaceutical spend on the same time to buy their own stock for the sole purpose of driving up the price was 516 billion. So they spent more than their entire budget on research and development on a tactic to drive up their own stock price. Stock buyback used to be illegal in this country. Once they were made legal, they were allowed and one of the things, when a company buys their own stock drives up the prices of their stock and something that is not talked about, ceo paid is tied to stock price. Ceos right now are not incentivized to invest in research development. There incentivized to raise the stock price. So there is a lot of debate as to what can be structured, whether we can go singlepayer, maintain insurance how it is, make it more competitive, et cetera. But one very clear thing that we can see is that if we eliminated stock buyback we could reduce the cost of companies by at least half with the research and development in stock buybacks. Again i want to thank each and every one of you. For sharing your stories today. There is no reason for drugs is civil is insulin which cost 21 in canada for a 10milliliter bottle to cost the equivalent of a mortgage payment or sometimes to mortgage payments. With that i yelled. Mr. Meadows. Thank you mr. Chairman and they give each of you for your testimony today. My apologies for being a little bit late. I was at the white house working on Prescription Drug prices. And i want to let you know that this is bringing a number of us together from opposite sides of the aisle. And a number of conversations with the chairman, we both have a passion to not just make this political but to make it real. And mrs. Cooper skipper, you shd never have to ration yourself with insulin, you should also be able to have the affordable drug as ms. Ocasiocortez mentioned because that is a drug that is been around for a long time. I tell you, there was one regulation that was changed a week ago that will start the help with that, there is more that is been proposed. We need to work in a bipartisan way. You have a commitment and im here to tell all five of you, you have a commitment for a bipartisan effort to make sure we do this. My good friend from vermont mentioned that they passed something out of senator grassleys committee yesterday, is that the perfect answer, i can tell you it is not. But i can tell you that democrats, republicans are looking at this very, very closely and help is on the way in the near future, i tell you that i believe that we must announce an initiative that hopefully will gain traction legislatively in the house and in the senate. And act on that, i believe in september when we come back from recess, mr. Mitchell i want to hit on one area, you mention pbms. The middleman that continues to in ways im up prices. It is become part of our Delivery System and as we look at that, we created pbms and i dont know if you know that but when hmos came around, we actually created pbms and were seeing this artificial increase in Retail Prices that makes it very difficult, would you agree with that . Here is the problem the list price set by the drug company. But we have a system downstream as patients we have a real problem with secret rebates. Because we dont think they are designed to serve us we think theyre designed to serve the people who make money. Thank you for sharing the fact that your benefiting from the Clinical Trial aspect. One of the things that i believe would be helpful and perhaps you could be a great advocate for this, as we look at Clinical Trials the expense of getting groundbreaking drugs to market, there is a clinical one, clinical two, clinical three trial. What i believe just a have done a few drugs, hiv and a few other cancer drugs, once we do the clinical to trial and shown there is safety, allow those to go ahead and come to market. Allow those so why we are doing the clinical three trial and we know that the harms are limited, that we go ahead and allow those to come to market and allows Smaller Companies who are intubated to bring them to market. Do you think that would be hopeful questioning. Yes. I was hopeful that was going to be your answer. The other aspect that we have to get to is because of the way we have structured Prescription Drug prices, not just for Medicare Part d but because of the pbms and it is a very integrated system in terms of delivery. Your retail price, net price, rebates, but when they start to try to hit on one lever or the other, it has an opposite effe effect, for example if we were to actually work on one area and say were going to eliminate the pbms, some companies actually take the rebates that they get from pbms to lower insurance prices. So it is a very complex thing. Here is my commitment to you, i believe it is one that the chairman supports, i tell you it is one that the ministration support because i just left. We will lower Prescription Drug prices and we are going to do that without increasing insurance premiums to pay for it, it is time that we act in the time is now. I thank you all for being here i yield back. I want to think mr. Meadows, hes absolutely right. There is not a week that goes by that we are not trying to figure this out and trying to work with the white house to get it done. From another angle i want to thank you for working with us. Ms. Presley. Thank you, mr. Chairman and i would like to say how much i appreciate your leadership and a source of pride for all of us on the committee. That the very first hearing that we had in this committee and the session was on reducing Prescription Drugs. I want to thank all of you for being here. You said you are 23 years old and tired, we are tired. Like you that millions of families are suffering, it is not only those of you individually battling this fall the people who love you. In support you in this journey and the fact that you have to weapon ice your experience in order to be seen and heard. You think desk for listening but i think thats too low of a bar, its our time to act in your rationing likely medication in exchange for far too long. Weve been rationing our response in our compassion in our due diligence. It is critical that we act and react in a bipartisan fashion. Although insulin has not changed since the mid1990s, the prices skyrocketed in communities of color have been impacted. According to the macon Diabetic Association black americans are more than 70 more likely to be diagnosed with diabetes than white americans. And one in three adults in this country will have diabetes by 2015. The price of insulin has tripled from 3200 to 6000 over the last decade and a possible price tag especially for our young people and young adults. Could you speak, have you been obtaining insulin in recent months and years . Through donations, donations from people from my community, church and sharing with my sister. That is burdensome also because i feel like im taking away from people who could also be using this Life Sustaining medicine. But also it makes me appreciate that there is some good in the world and the selflessness of some people. I cannot tell you the last time i filled a prescription for my insulin. So it has been really hard to guesstimate how long my supply is going to last. You talked about getting a new job with help care coverage. Could you speak a little bit about that and what that coverage has meant and the difference has been. It has meant good if i want to go to the doctor for a checkup, get my teeth cleaned, get new glasses, go to the gynecologist or anything like that. But for what i actually need to live, it is hard. It is really hard and i dont understand, i just dont understand. So a little bit more, there are other associated cost with people often overlooking in this. If you can expand upon that. So it is not just insulin, i need needles, test strips, i need alcohol swabs, glucose tablets, extra food in general and then i also have celiacs disease, so its not like i eat anything, it is been very costly to live and i do feel sometime sometimes i did not put this on myself so why do i have to suffer. Why do we have to suffer. So there was a recent busby article speaking about the fact that many twentysomething will no longer if youre not carried on your print insurance, the precarious position and is particularly accused with regard to someone like you. Living with type one diabetes. I understand that you and your sister have not been able to use apparent insurance in recent years but have faced some of the struggles who lost their parents employer coverage at that age. Can you tell me what happened when your mother lost her job . When you were children im sorry. Its hard things started to spiral out of control. I was really scared. A few months after she lost her job i was suicidal because they did not want to continue to struggle. I did not know how me and my sister were going to make it. I did no know how my mom is going to provide for herself. So losing her coverage put us in a really bad spot. Thank you. And think all of you. Too Many Americans are cutting corners in their medical care simply to stay alive. Determined. [laughter]. I know i am the eldest of 14 and ive been taking care of people of my life so when i have the motions, it is because ive seen challenges. This committee has told so much. I just want to thank all of you so much for picking up because i know that i can speak to some of us here but there is a lack of urgency. Right. Lack of urgency when the mother was talking about missing and coming here because she had to be a voice for so many people that cant be in this room. I know how hard it is. Sometimes our kids are going to be fun and we are the ones actually feeling more guilt than they are. Its like mom we are doing great and went to my friends one of the things that this broken system and the frustration that i have, i think youve all put a human face for something for years. It hasnt truly been translated into the human impact until he got so broken down and sent to the. Where you have people rationing and actually dying right before your eyes. We have allowed corporate greed, we have allowed corporate greed to come before the people. We, the government in this chamber, we are responsible for protecting you from it. I want to apologize, i want to apologize because ive only been here for seven months but not at my watch. I will not be able to not humanizing the impact and push it back against corporate greed. I want you to know that it is not just us, it is congresswoman kelly and all of us in this room and many of us now. We really truly and sincerely care about your life. A woman came up to me at a coffee hour and said rashida, i dont understand that they are saying that insulin is not preventative care. You dont understand, insulin prevents death. I said absolutely and she said her company, her big company, said they decided to change the system so now she would have to literally sit for months before she can go pick up her sons insulin at 2800. She had a put together 2800. I said no, i cant wait for a bill to pass. I cant wait for people to wake up here. I am going to put it on my letterhead. So on my letterhead, i said, what are you doing. You are a corporation and i took the Mission Statement of the corporation and said, you are supposed to be about people. Right. What about and without telling them who it was, i said what you doing, you are allowing people to die. To die in your health insurance. She told me she went in last week to go pick up her sons insulin, she got together 2800 and i know where she lives, it was hard for her to raise the money. She would in and she said i dont know what you did but it is 244 now. That is still too much. But, that means there is a well, they are waiting for us to tell them to stop. Moms know this. When there is bad behavior, we subsidize, weve done the research and development and we have done everything we are supposed to do. We can say to them that you are supposed to give the American People access forum to live. Continue to be bold. Continue to ask for more. Even when folks say, we all agree. Thats great, but actions speak louder. So i only have and i want each of you to tell me why we you think we havent enacted in congress. We will start with you. Drug companies are monopolies. They have monopoly Pricing Powers. And by definition they have unlimited resources to defend their monopolies with political country can Campaign Contributions and lobbyist. There is 1. 5 lobbyists for every one of you in the United States congress. 1. 5. Thats like daunting odds as my dad wouldve said. So i think its both a fact that the use of the monopoly Pricing Power to maintain the power and to stop reform from happening. I dont know the answer. But i think this hearing is like you said putting a human face to the issue i think theres a lot of donations that happen. Maybe it gets pushed back to the back of the shelf. I can definitely tell sitting here today that you guys are going to do something about it. My disease is really treatable. Its not so treatable for these people. Thats not okay. The question why you havent you acted. I think its an interesting question because im going to say think congress has acted. I think because of congress, my son is participating in a Clinical Trial that i believe is helping him. I believe that patients are accessing Treatment Center and i think that everyone in this room and everyone listening, and is acting right now and i think thats what we need to focus on. I think lets not dwell on why we havent solved this yet, lets keep doing the next right thing. This figured out and lets do that. Thank you very much. I would say from a patient perspective, not really knowing, i dont really know how all of this works but it seems like the people up top benefit from this. And they are not acting. I dont know if its in a Financial Way or whatever way but it just seems like you get a piece of the pie some way and somehow. Thank you. Im just a retired teacher from indiana. But to me, its money. I think its money. Its the lobbyist. Its the pressure put on people to do things according to the money rather than the good. I also see a lot of bipartisan fighting that i think is in cons consequential when it comes down to peoples lives. There needs to be more cooperation. I do think, i am 70 years old and i am hoping things will change before i die. I am hopeful in meetings like this that things are finally happening. I started coming to washington dc two years ago, to help the crates bill and i am frustrated that it is still not passed. I am excited that it is making progress. I am learning how the Government Works and how slow it is. For me that is frustrating. I am excited to see progress being made. Thanks. Thank you very much. Thank you for having me back. I too want to thank all of you for being here. Its not easy to tell your story in front of congress, cameras, people in the audience so i truly truly appreciate all of you being here. Mr. Kaman i appreciate you for having this and i am proud to serve on this committee but i am also proud to be a member of energy and commerce. It makes me feel good to hear that you say we are moving along and what we are doing and its meaningful and we are really working in a bipartisan way which is good for here. There are so many other ways that we are not but we definitely are in energy and commerce. When i came to congress which ive been here, i am in my seventh year. My district had the highest rate of foreclosure in the state of illinois and some of it, people lost their jobs, some of it people went for how okeydoke mortgage but also some of it was because of medical reasons and they couldnt afford to keep their homes. I think we are in the rebound and things are getting a little better for the other reasons but not for the medical reasons. I also am in the chair for the black hawk range brain trust and of the top ten diseases that people buy from, africanamericans are number one in eight of them. Some escape are, we work a lot with your issue. The other thing, in that capacity i am responsible for two conferences a year and one conference someone chair that they had asthma and their asthma inhaler is 325 in the United States. She left her inhaler at home and she was in south africa. Same exact inhaler and company and everything exactly the same in the inhaler was 25. Coming to congress, ive got more aware of the issues that every day people, my nextdoor neighbor who ever have to go through this fight with Prescription Drugs. They have to choose between paying bills and buying the drugs or eating. I promise you that i will continue to work really really hard in this area on both of these committees. One question i dont know if you know the answer my colleague ocasiocortez always have maybe some of the answers but the money that company spent in advertising, you cant open an magazine without seeing pages and pages of advertising. I dont know if you know the cost. A billion dollars a year and we subsidize it. We are the only other country there are only two of countries in the world. As and new zealand. We give a tax break to these companies to send those advertisements are way. The only reason they do it, is to make more money. Its encouraging people in some cases to use drugs they dont necessarily need. Im one of the last people to ask you a question, is there anything more that you didnt already say anything at all . I do want to say ms. Miss kelly that i would love to come visit with you and talk about the sicklecell cure that in age is bringing forward soon. Im going to make sure that that drug is developed inside the walls of nih, they are running Clinical Trials right now. Its been at least a half a billion dollars. We make sure that that drug comes to market at a price that is affordable and accessible. I am willing to meet people 2416, come visit anytime. [inaudible conversation] i just wanted to followup on this question about advertising, i havent thought of that before. Thank you mr. Mitchell for telling us that its only us and new zealand. Are you suggesting that you think that should band or that the cost of those ads should not be tax deductible for the businesses as ordinary business expenses . Have you done work on this. The courts have ruled that the companies have a right to advertise but the National Society of engineering came forward with a report 18 months ago recommend that they do eliminate the text indicts that double for the advertising. That would reduce it by large amount. That would be good i dont know why we are subsidizing it. Thank you. Mr. To sonia thank you mr. Chairman,. Thank you for having us here and for being nonpartisan. I just want to follow up on the earlier discussion. I would recommend to anybody books our daily meds is a book by a former New York Times reporter. Mr. Mitchell you have read it. Its called how the pharmaceutical companies transform themselves into slick Marketing Companies and hook the American Public. This is not some new phenomenon. If you read that book and do research, we took pharmaceutical companies being driven by research to ceos were read usually researchers. They became the ceos. At a reasonable rate of return for their investments. For a variety of reasons, not just the pharmaceutical mystery but towards the financing industry. This book will tell you they didnt extensive focusing groups, 15 to 20 years ago and they looked at professions and industries that americans trusted and it turned out that we trust people with white smocks. We trust doctors and pharmacists and researchers. So they went in, but of controlling shares and they turned them into Marketing Companies. So to act like this is something that just happened is just become so bad. We finally have gotten attention and it needs to be stopped. I do my colleagues have heard this before but sometimes you repeat things lots of times in this building. I know this because i have a bill in my pocket that sold by Johnson Johnson and it keeps me alive. I have a forum of leukemia and i am thankful for this bill. It is 500 bucks. Open it up here. Its the most expensive thing on me. Until 3 00 oclock in the afternoon and most of the research for that bill came from darpa in the department of defense. If you are in the study blood cancers, it started because sailors and soldiers getting mustard gas during world war i. We spent a lot of research trying to help soldiers to be inoculated. We found out about how these in our blood systems were covered. This bill, that cost 500 here in the United States of america and im lucky enough that i signed on to the public option that was in the company i was a county server to visor for four years ago and eventually dont do it. Youll have to get your medical service at the county hospital. My kids and i went to the clinic and we got great service. It is a classic option public option and it does work in some instances. So they help so that i dont have the kind of cost that you have. Because thats my supplemental. That pill cost 400 a year ago and then they change the formula now it is 500. This bill in australia cost 6. 37. With subsidies fully loaded it because 37. Where does the rest of the many go to. It doesnt go to research. So mr. Mitchell, a study oxford journal of law and bio scientists, just 27 percent of new drugs in 2005 and 2015, were new drugs. Rather than creating new medicines, pharmaceutical companies are largely recycling old ones. According to a gao study Innovative Products accounted for only 13 percent of fda approvals each year from 2002 and 22016. So therein lies the problem. Another hearing, we had a pharmaceutical executive here and i said we want investment. We want to get a reasonable rate of a return. It was supposed week highs risk high return. They gain the system so its a very low risk and a high return. In the meantime, people are going bankrupt, losing their lives, when my 2 cents named jordan, sort of relates to me on multiple levels. This is outrageous. Its outrageous and it is a crime. These people should not be executives they should be in prison in my view. Wind Drug Companies do what you just described. File new patents on all drugs. 78 percent do it the other way all of them are filed on existing drugs. If they are filing patents on existing drugs to extend their monopoly on those old drugs, they are not doing what they what we all want. We need to invest in research and development to bring a cure. To make sure take care my cancer before i die. You guys have really got to stop this abuse that allows them to milk old drugs by gaining the system instead of doing what we need to them to do which is an best innovation and new development. We gotta keep in mind that a lot of that is often subsidized by the ugly. You have to give them back focused on new drugs. Instead of just milking the old drugs. Thank you mr. Mitchell. I want to thank you all once again. Your testimony is really important and people need to hear our stories. Thank you. Thank you mr. Chairman, thank you for your leadership, thank you to all of you for sharing your stories, for being so vulnerable for sharing something that is so personal and for your courage in doing that to help our country move forward. I appreciate mr. Your here not just as an academic exercise you want to see some action. One of the things that we have been talking about as a country for the longest time, but dont do anything is medicare for all. Medicare for all would finally give the government the ability to go to negotiate and lower these drug prices. Lyndon johnson, when he first passed medicare anticipated that we would eventually have medicare for all. The 25 years ago, senator moynihan at 25 hearings in the Senate Finance committee, all of these experts in it at the end of it he said well, theres one solution, lets extend medicare. President trump in 2000, in his book, said why dont we have a single care Healthcare System. Its better than anything we have. Yet we keep talking about this and keep coming folks like you testify, and nothing is done. So i want to ask each of you starting with mr. Mitchell, do you think medicare for all would help . Affordable drugs only focuses on drug prices. We want very much for people to have access to affordable accessible care. But we dont have a position on medicare for all. Or any of the steps you can take to ensure that people get access to coverage. I apologize. Was your personal opinion question mark see neck im not going to express one because i am here on the behalf of the organization. I say and i stay in my lane. I respect that. Sorry but i think us the question a little bit over my head. I dont really have an opinion on that and i am only telling you my experience with my issue about a drug that cost 1100 a month with insurance. I have respect that. Does anyone have an opinion on that. As i previously stated, i dont know all of the ins and outs of everything but i can say this. Being the face of an affordable now campaign, i go down my Instagram Newsfeed and i see people from other countries who are just completely outraged that i have to pay for insulin at all. So if that is what medicare for all leads to than that is something i definitely support for someone with fibromyalgia or anything like that it doesnt have to pay hundreds and thousands for something that they need to live, then, yes, i would support that. I may be the only one on this panel that is on medicare right now. Medicare for me, involves medicare plus a supplement. Even with that, my drug prices are skyhigh. So if that does not change, then no i am not in favor of medicare for all. Is a very fair. And part of that is because the medicare hasnt been able to negotiate for drug prices, which some of us have wanted to do and part of that is because we dont have a generic competition. Let me ask a second question. The president came on the state of the Union American should not be paying more for our drugs than people in britain and france and germany, and folks there and we can start with mr. Mitchell and anyone else who wants to answer it, support the idea that if an American Drug is priced higher than the drugs in these five leading countries germany france britain japan, then americans should pay the same price as people in other countries or we should open it up to generic up competition. We strongly support direct medicare price negotiations. Direct to the secretary to negotiate the drug prices praise trade theres absolutely no reason why we should be paying two to three times that other countries are paying. You can fix it if we can pass that direct negotiation pricing. I would agree with mr. Mitchell. The founder of t1 International Actually moved from her from the United States to london, to be able to afford her insulin. I know there are probably more like her who have had to leave the country in order to live. To afford to live. Thank you. Thank you very much. Ms. Maloney. Thank you mr. Chairman for this really incredibly important hearing and all of our panelists for helping to build a case and putting really the misery that americans are facing with these unAffordable Drugs. I believe its a National Scandal that they are able to charge these prices without any accountability for how they are raising and why they are raising it. I want to mention four ways that congress could act tomorrow. To combat this based on your testimony today. First of all, competition. The competitors are literally paid not to come forward with a generic or other ways that they delay the process moving forward. Ive heard from your testimony also the gaining of the system where they say they delay and delay when you should have a generic. They filed patents from old drugs so that the time is longer. This also hurting people. Mr. Oconnor just pointed out, the fact that they can be so much cheaper overseas is an absolute outrage. That we pay for the production, the research, and yet when it goes overseas, its affordable but not here in america. I think your story really on insulin is so moving. This was discovered well over a hundred years ago and the scientists gave it to the American People, he didnt want people to make money off of his invention. Yet now, its unaffordable or not even affordable in many places in america to the. That americans are dying. We need to change this and want to make it happen and i want to follow up with ms. Craig, on your story. We talked about your inflammatory condition, can you describe what its like with this condition is like and what your drug that you received that is now unaffordable to tell us what you merit does for you and what its like if you dont have this drug that you cannot afford now. Zero man, thats opening up a can of worms. Well, epidermis is your largest organ so when i am at a full flareup, the last one was two years ago and it lasted ten months. I was literally covered from head to toe and what somewhat cold lesions on top of that all of my joints eight and i am selfemployed i am a hairstylist and infected my business, i had to wait six months to go through three and helmet processes knowing i would not be able to afford the drug once i got approved. There is no generic available. This started has been out since 2002. It is crazy. Its 80 percent cheaper overseas. The science is there. Its a scandal. The science is there. In your testimony, you said your written testimony your successful hairdresser, you make a very good salary under the most americans. Yet to the cost of your drug was more than your car payment, more than your business insurance, more than what you spent for food in a month. Yet, and not having it has totally impacted your health. Can you still work without the driver . I can and its got a 40 percent. Ive been basically and remission for two months. Im a little drug. You also wrote that this filed over 250 patents additional patents on whom era effectively made generic drug and any competition for decades. That is manipulating the system to not allow americans to afford it. We should stop that and the band that immediately. I like to say that those 247 patents, that was only last year. What is the total due no question mark. I believe they filed 247 patents, pretty short you are close enough. And now i understand that you also take enbrel now manufacturing. Sumac ive not taking it now, the cost of that was just under 1200 a month so i dont take it. I just want to say that i am distressed beyond belief that they have manipulated the system. To run the price up so that you cant afford the drugs that you need, and i am sorry that you have had to face this challenge for your health, and it is something that we as a Congress Need to act on as soon as possible and all of you have helped make the case and i want to thank you. Mr. Goes mans. Thank you mr. Chairman this is an issue that unfortunately has been going on for decades. I was curious about price gouging when it i did a quick Google Search one day and i found a lawsuit from 1940 and believe 1941. Basically, accusing the companies of price gouging. This is not anything new. It has been going on for decad decades. The question is what are we going to do about it. A lot of times, its difficult but weve got to keep pushing and coming up with some new ideas. I think there is more of a camera than ever. That doesnt mean it always translates to legislative victories. I was in california legislator and we did push through some of the reform there and it was still difficult but we got it done. I always say that we need to continuously highlight people stories to make it a powerful impact. Thats why let all of you are here and i want people to really hear your story and empathize. One of the things i waste realizes that the impacts vary from person to person. Its definitely something that people should be able to feel even if they are not directly impacted. Ms. Skipper, you mentioned in years testimony that you and your sister shared insulin. In order to manager type one diabetes. How long did you guys share your insulin for. Were still sharing. You are still sharing. When you and your sisters first decide to share insulin. I dont think it was more or los a decision to do it, i think it was something that we were forced to do. How long would you say about seven years. What kind of impact does it have on your health to share insulin . To summon up, i dont know what a good day is. I dont know what a day to feel okay is. I dont know what that feels like. There hasnt been a day where i dont have a high blood sugar reading, there hasnt been a day where i dont have aches and pains, there hasnt been a day where ive been completely exhausted, so to explain it, the best way i can, i dont know what a good day feels like. So we do know that because you dont know of what a good day feels like because of your symptoms, that there is probably an underlying and chronic impact on your health. That will probably im not a drs not good. We need to make sure that you and your sister get the support and the insulin that you need. What were you feeling while your sister was in the hospital . Angry, i was very angry. I was angry and for some reason i had and i felt guilty too. I dont know why have felt guilty because i know that i dont control the prices of this drug, i just didnt understand why im giving this corporation 40 hours a week and i cant afford what i need and my sister has basically put her life on the line to ensure that i am alive. I was very angry and also like i said guilt and very shameful because very shameful because it was just hard to see my sister fighting for her life. I was ashamed that i couldnt get what i needed so that she did not have to be in that position. I feel your anger, i think the American People should also feel your anger. I grew up without health insurance. Ive seen and i know what its like to see her parents worry about you. If you get sick, what does that mean. Are you going to get better can you get back what you need. We have positives in our Healthcare System but we have a lot of negatives that week and got to Work Together. I think that sharing your story and making sure people know about it especially with the t1 International Organization to make sure that we share the stories. Some folks here that have four or 5 million twitter followers they can help us out. [laughter] i dont have that many [laughter] but i think that at least adding our voice over and over could help make a difference. I think you for all of you for being here for sharing your stories. Its important. Thank you so much. Just one thing mr. Mitchell. Has nearly tripled the price of a cancer drug that witnesses are taken. Is that right . More than tripled. That is since it was launched in 2005. The yearly supply of this drug is almost 225 or 250,000 per year. Selden sold about in 2018 alone. Why did holden do with all of the money. Well percy gave it the ceo a pay raise, his compensation was worth 16. 2 million. That was in 2018. 3 million more was added to that in the previous months and 3 million more than the previous year. Salaries, tell me about that. These drug manufacturing ceos salaries. Definitely hamza role. I think that the issue that was raised about stock buybacks in the short term focus of the Drug Companies is one of the things not getting us what we want because theyre running a prices in order to drive up their stock price in order to get higher bonuses and do more stock buybacks and not enough focus is being paid on the innovation that we all and every one of us wants. You take an old drug, in one year i think it was 19 or 2018, they ran up the price 19. 8 percent in 112 month peri period. One of the reasons they didnt they had a failed drug Crohns Disease trial they had to take a 700 million charge so they increased the price in order to get the stock price up. These are the games they play. I want to thank all of you for being here today. But before i conclude todays hearing, i would like to enter into the record to letters that the committee has received in recent days. One from initiative for medicine access and knowledge and one from the National Hispanic medical association. These letters discuss the acute impact that Drug Companies actions hide. Certain high drug prices in some communities all across the country. I ask that these letters be entered into record. Let me again thank all of you for being here. It is not easy to on national tv by the way, to talk about your pain. You talking about some of the things that are so very very personal. A lot of times you know when people are suffering, its almost like they are suffering alone. They feel like they or society, nobody knows what they are going through. I can tell you that there are a lot of people who feel the same way that you feel. They may not be going through what you are going through exactly, and thats why we in the congress, we have to move. We dont have any choice. I saw something here today i am so proud to be the camera of this committee. I watch members cry. I watch you will cry. Its because there is a tremendous pain that comes with hearing your stories. I think for most of us your pain is our pain. Your dreams are our dreams your hopes are our hopes. I just wanted to encourage you to keep forging on. I heard you talk about mr. Mitchell, how there will come a day when your options run out. When your options run out, i am sure that you worry about going into a dr. And the dr. Telling you sorry, your options have run out. But when there are options, when they are at our fingertips, but because of cost, and greed, some of what you are reaching for an option in you just cant get there and it would be one thing if it would be if it would debilitate you for a minute but when your life is going to end, as i often say you when you are dead, you are dead. So, it reminds me of one of the greatest hospitals in the world hopkins, doing a lot of great things that was the hospital of the saved my life. I know there are a lot of people outside of the hospital who just want to get in the door. They know the cure in the treatment is there, they just cant get in the door. So, to all of you, i want you to keep forging ahead. Keep in mind the words i said and i want you to put them on the dna of every cell of your brain. Pain and caption and purpose. Pain passion and purpose. All of you are giving other people help. You really are. But we have a responsibility to. We appear. We have a responsibility to make sure we give life to your hope. Give life to your hope. That little boy who was racing and i just watch you as you talk about that hug and how precious that hug is and what it means to you. Im sure you can hardly wait to get back to him. When you come in here mr. Glennon ms. Skipper and all of you, and you talk about what you are going through you are still forging on and that you are trying to have some videos. I lay, keep in mind, its not just you. That you are sticking up for in this the thing that i love about all of you. You said that no matter what, i am going to make life better for somebody else to. We are going to do everything in our power. To help you get to where youve got to go. Life is precious. As i listen to you and you talked about sometimes feeling you get the impression that some of you felt the life was spiraling downwards. That is not a good feeling. Its not a good feeling when you have given so much of your life over and over again and taking care of you are a schoolteacher and doing everything you are supposed to do. You are doing everything you were supposed to do it all you want to do is be able to hug your grandchildren. You want to be able to go to the park sometimes. Be able to do you do texting, do texting. You and i are about the same age. [laughter] i am challenged when it comes to texting. Dont mind admitting it but the fact is that those are they basic things. So you want to be able to go down maybe with your daughter when she gets married going to go down that aisle and you want to see her where her dressing helper with what kind to steward all of that. It goes to the quality of life. Its not just living, its about living a quality life. A life of quality. So again, i think all of you for being here. I want to tell you enemy just make you feel some hope. We are going to have the drug company folks sitting in the same seats as soon as we come back. And were going to try to understand some of why they are doing what they are doing. I do believe that and by the way as i close, the first conversation that i had with president trump, was something that he said and i will never forget. The Drug Companies are getting away with murder. Thats what he said. They are getting away with murder. In his right. Because every time someone cannot afford their medication, every time they cant and they have to share insulin, and all of the things that you talk about, they are. Im not putting it all on the Drug Companies, but this is the United States of america. This is the greatest country out here. We ought to be able to resolve these issues. I want to thank the members for being here. I cannot in this year without saying this because its really been bothering me. We get a lot of complaints, a lot of dialogue about our members. Ive got to tell you the refreshment members on our committee mr. Garcia has, this fillets ms. Presley, are some of the hardest working members of the congress and i told somebody the other day that as i listen to them i am inspired. I realize i to know they are there, that they will take up this fight and they will carry this ball down the field, and get over their lines excuse me a football metaphor. I am a football fan. That means something to me. Its important to me. So thank you very much and with that, without objection, all members have five legislative days in which to submit questions to the witnesses. It will be forwarded to them for their response and please response respond is you are able to. This meeting is adjourned. [inaudible conversation] tonight on cspans cspan industry changes on the news. Reporter describes what its like to be the first to break news in todays immediate loose cycle. On the flipside it can also be detrimental. We dont have with the news as the fact checking. With the program shooting and running a story and is moving very quickly. Its what some teens have told us. All that kid and that track and field photo. That looks like, okay yeah, its not that kid. That was something that ive learned is to in breaking news a lot of trying to be first. Two setback and take a deep breath. Question and ask and have them verify and especially like now with the pace of news. Its very important that i take a breath. See the entire discussion tonight at nine is turn on cspan. How media is changing. And the impact of the changes in news coverage. Weeknights this month we are featuring book tv program showcasing whats available every weekend on cspan two. Tie same as science. Journalist andrew explores the resources and Technology Used to develop a daily weather report. Nobel prizewinning biologist becky breaks dna down to the molecule. Science journalist john burkert explores the history of ice on greenland. Watch it tonight beginning at 830 eastern on cspan two. Enjoy book tv this weekend every weekend on cspan two. [inaudible] watch book tv saturday august 31st, starting at 10 00 a. M. Eastern. Our coverage includes author interviews with justice ruth berti on her book my own words. David, his book is the heartbeat of wounded knee. Sharon robinson talks about her book child of the dream. Rick atkinson author of the british are coming. And thomas malone, founding director of the mit center for elective intelligence. He discusses his book super mines. The National Book festival festival. Life saturday august 31st at 10 00 a. M. Eastern. Book tv cspan two. Up next, students on issues impacting their communities. Gun violence, Mental Health the environment and other topics. These are winners of the National Public speaking competition called soapbox nation. Hosted by the Facebook Education at the museum in washington dc. Hello everyone. Good evening and thank you for joining us today you are joining us here with make the challenge. We are committed to developing young peopleal to be good and active citizens to create a just and equitable world. Named afterr two great leaders. We believe in the power of these voices that are here with us today. We believe in helping people to take civic action to improve the world. Im going to turn it over to a great colleague nicole. Its on Facebook Education. [applause] hi everyone. My name is nicole and i work on education team. Focus on leadership. Our mission is to provide young