To my fellow congressman, tim murphy, who is a psychologist and serves the navy and helps veterans, helps veterans at walter reed. Congressman murphy, we have been talking about your bill this evening of which we are strongly supportive. We thank you for that work and thank you for joining this evening. I yield you so much time as you would like. Mr. Murphy thank you. I thank the gentlelady for sponsoring this special order tonight. This bill since the house passed and i sure hope the senate takes it up. And the senate thinks they may not have time but i dont know how to tell a family, whether a civilian or a soldier that the senate didnt have time and they went home. Since september 1, the national day of Suicide Prevention month, mrp americans have died, 24078 veterans. 118 people a day, 22 veterans a day. But it means that every 12 minutes a person dice by suicide , but one every hour, a veteran, but also means every hour a new family is grieving or 13 minutes a new family is grieving on something we could have prep vepted. Ar we could prevent many deaths. I want to read a story of one veteran to convey the struggle he had. Sergeant daniel summers. He had ptsd and depression. He was 30 years old. His parents gave me permission to shave his letter. Im sorry it has come to this. As long as i can remember, my motivation for getting up is so you would not have to bury me. As things have continued to get worse it has become clear, this isnt a sufficient reason to carry on. Im not going to get better and i deteriorate further. From a logical stand point it is to end things quickly than to drag things out. My body has become nothing but a cage, a source of pain and constant problems. Nothing short of torture. My mind is a wasteland filled with incredible horror and depression and krimming anxiety. He lost hope. It doesnt have to be that way. And whether you are a citizen or a Family Member or a soldier listening tonight, mr. Speaker, i want them to know there is hope that depression is something we can treat. That anxiety is something we can treat. That people can and do get better. Now i myself have never seen the horrors of war through the scope on a combat rifle. I had the opportunity to treat heroes at walter reed. They are a source of inspiration to me, particularly when i see them get better and when they come to grips with the horror they are faced and their hearts turn to understand it is not their fault, they are not to blame. Life is tortureous but there is tremendous positives that can come out of this. Whether it is a sense of god or finally realizing they have a choice between being a victim forever or becoming a survivor and moving forward and being strong despite what happened to them or a third choice, to become a thrifere. Saying i will take my adversity and turn it into a source of strength instead of turning away from it and a course of depression. Mr. Speaker, my colleagues have spoken eloquently tonight about what we can do. It doesnt have to be that day. I hope whether there is a Family Member or whatever the situation is, convey to them there are places they can get help. Our job as congressmen and levels of state government, too, s to make sure those resources e well fubbeded and get more departments that can treat them. And the best message is where there is hope, there is hope. With that, i hope the Senate Passes this bill before the week is out. Ms. Sinema thank you to my colleagues. I fought with the families who lost a loved one. But our veterans. We are committed to continuing this fight to ensure that our veterans always know they have a to turn. We who enjoy freedom, thanks to the sacrifices must all step up to end the to turn. Epidemic of suicide. Hank you, mr. Speaker. The speaker pro tempore the gentlelady yields. Under the speaker atissue the speakers announced policy of january 6, 2015, the gentleman from georgia, mr. Collins is recognized for 60 minutes as the designee of the majority leader. Mr. Collins i ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous material on the topic of the special order. The speaker pro tempore without objection. Mr. Collins were going to be going at a subject ive been down here before on and will continue to come down here on until frankly i leave we are moving forward with an issue that affects pretty much every hometown of every congressman here. Its amazing, though, how much we dont know about it. Its amazing how much it goes unreported. How much it gets looked over. And in the sake of the shiny object of savings, our Community Pharmacists, independent pharmacists are being basically run out of business. Mechanic, i dont tell you anything new and to my friends who join me here tonight, this is about hometown america. This is about the Health Care Chain we all talk about and a forgotten element of that Health Care Chain is something that we need to focus on because Community Pharmacists fill an important nearby in our Health Care System, serving as the primary Health Care Provider for over 62 million americans. They dispense roughly 40 of the prescriptions nationwide and a higher percentage in rural areas, especially mine in georgia. Community pharmacists play an Important Role in our Health Care System by being that accessible voice at the other end of the phone. Just being there sometimes to answer those simple questions that are very important to somebody. Or the difficult questions that could frankly mean life or death. For that patient. Knowing how to taker that medication. Knowing what to get and how to be there and be part of the community. Not just at the pharmacy but at the ballfield and the community, employing some of the best Small Business employees we have in our communities. Are found in our Community Pharmacists. When we look at the relationship that communities have with their pharmacies and especially Community Pharmacists, the facetoface counseling, the work that goes in to our Community Pharmacists, and pharmacists meaning in general, is something that is just something that we need to continue to focus on. Patients failure to properly take medication regimes costs 320 billion and contributes to 125,000 deaths each year. The facetoface counseling our community fample cysts give is the most important and most effective way to ensure our patients take the right medicine, know what theyre take and why they take it. As i stated before and i state it here again on the floor tonight, there is a group that believes that our Community Pharmacists really frankly if you just look at it, shouldnt exist. Because everything theyre doing, the pharmacy benefit manager, the pbm, that middle person, i want to show you this. Were going to talk about this chart more, but p. B. M. Controls the pharmacy system right now. If you take the p. B. M. In the middle and look at employers, look at pharmaceutical companies and look at pharmacies, they form a circle around here. Were going to talk about this, quote, savings issue, and look at it, is it actually saving employers . Sit actually helping pharmaceutical companies . Is it actually more importantly is it actually helping the patient . I think tonight youre going to find out theres a lot of questions to be had here. Well talk about that as we go forward. As we look at this, weve had a lot of things that my friends tonight are here to talk about. Were going to talk about transparency, generics, the way this goes, but were also going to talk about really what i believe is the unfair tactics used by p. B. M. That are constantly forcing our pharmacies and our Community Pharmacists out of business. I mean, i think at some point in time, many of the p. B. M. s ought to changer that mission in life into, quote, and say, our job is to run Community Pharmacists out of a job. Theyre the best ive ever seen at doing that. In one of my small towns 0 minutes from my house, in the past year, three Community Pharmacists have closed. Three. Theyre now in smaller town being forced in choices they didnt want to have to make. Into p. B. M. Control pharmacies. You see, p. B. M. s when they first started had a good idea. How do we make sure we get drugs and medications to pharmacists to cheaper prices so patients can save money, employers can save money. Then they decided they wanted to be part of all the system. They wanted to start owning pharmacies, wanted to start owning the supply chain. Wanned to be part of it all. When they did that, everybody else was competition. Ive said it before from here. The problems that we have in georgia pharmacists and have talked about and weve talked about as well is when you have your competitors who are able to come in and audit you and theyre able to fine you for clerical errors and for things, and keep you out of systems and out of pames and things that they give their own pharmacies, thats just wrong. When they only come in and audit the name brands and leave the generics behind and for some of you if youre watch, thinking about it, hearing my voice for the first time you may think, thats ok. Theyre making sure the system is safe. P. B. M. s are not auditing pharmacies to make sure the system is safe. Theyre auditing pharmacists to make money because theyre going to withhold the cost of the drug from the pharmacist. If they make a clerical error and the drug costs, lets say 100 they dont take the profit. They dont take the margin thafle take the entire 100 back. I wish i had a racket set up that good. You know, the sad part about that whole statement right there is, at the end of the day, joe or suze or bob or bill or whoever came and got their prescription knew nothing about this. All they knew is the pharmacist filled the prescription that the doctor had ordered. They went home and took their medicine and got better. But yet on the other end, p. B. M. s are trying to destroy an industry and a group of people who mean so much to our community. So tonight were going to talk about it. Were going to talk about it some more. Were going to keep bringing attention until the light is fully shined on this. Tonight as we get ready to find a friend who has been such a friend to us as weve been doing these, Dave Loebsack is here tonight, hes going to talk. Weve shared this before. Its good to share the stage again with you. This is something that needs to be discussed, needs to be hammered home until every member of the house an senate understand this and we find a workable solution. With that, i yield as much time as the gentleman may need. Mr. Loebsack i want to thank my friend, mr. Collins, for inviting me to join him in this special order. Ive been in this job long enough to know there are people you dont want to follow when you speak, doug collins is one of those. Hes absolutely inspired but he is inspeared for a lot of good reasons. Hes been a strong leader on pharmacy issues, hes been a great partner on the bills well discuss this evening. Im proud to say this is a bipartisan issue although at the moment im the only democrat over here, i can assure you there are others. And look, weve been able to find consensus on this, among this bipartisan group. As my good friend said, farm sirses across the country serb as the first line, really, of Health Care Services for many patients. Especially in small towns in iowa and around the country. People count on pharmacists training and expertise to stay healthy and informed and maybe most importantly, to stay out of Urgent Care Centers at hospitals, something we all want to see happen. Im proud to stand here today with my colleagues to recognize the quality, affordable, and personal care that pharmacists provide every day. Community pharmacists and their pharmacies are also a great source of Economic Growth in Rural Communities like those in my district in iowa. I have 24 counties. Its a big area. And when a pharmacy is under pressure economically the Community Knows it and hears about it. And if they have to close, the community suffers as a result. As a member of the Small Business caucus i recognize how challenging it can be for some small pharmacists to compete with bigger companies. I appreciate their hard work to serve our communities every day. Like most Small Business owners, pharmacists face pressure to compete. I appreciately visit with Community Pharmacists in my district and ive heard directly from them how hard they have to fight to compete on a level Playing Field that isnt always level for smaller pharmacies, so its not really a level Playing Field. One pressing challenge facing many Community Pharmacists, as was already mentioned, is the ambiguities and uncertainties surrounding reimbursement of generic drugs of all things. Generic Prescription Drugs account for the vast majority of drugs dispensed by pharmacists, making transparency and reimbursement critical to the Financial Health of small pharmacies. However, pharmacists are reimbursed for generic drugs through maximum allowable costs. A price list that outlines the upper limit or maximum amount that insurance plans will pay for a generic drug and these lists are created as was mentioned by none other than the pharmacy benefit managers or p. B. M. s, the drug middlemen if you will. But the methodology used to create the lists is not disclosed. These lists are not updated on a regular basis, resulting in pharmacists being reimbursed below what it cost them to acquire the drugs this this is a major problem. When p. B. M. s arent keeping the cost of generic drugs consistent, those price differentials can be a serious burden for local pharmacies. Small pharmacy owners Face Even Greater disadvantage than larger counterparts because of the clear lack of leverage they have when negotiating the amount theyll be reimbursed for filling prescriptions when dealing with p. B. M. When we talk about pharmacies closing because they cant keep up with the challenge, were talking about access challenge that affects patients. Its not just pharmacies closing down and those folks losing their jobs, its the patients they serve. When we talk about reimbursement uncertainty for farm sis, were talking about uncertainty about patients ability to get thed meation cases they need at an affordable price. When we talk about a Community Farm sis being put out of work were talking about taking away a familiar face. To address this problem, mr. Collins is going to talk about this and others are, i partnered with him to introduce h. R. 244, the transparency act. Weve had actions along this line in the state of iowa as well. We can do it at the federal level if we can do it at the state level, folks. This bipartisan bill would ensure that federal health plan reimbursements to pharmacies to keep pace with generic drug prices which can skyrocket overnight. Specifically, i know mr. Collins will talk about this, it will do three things prosmvide pricing updates at least once every seven days. It will well force disclosure of sources used to update the maximum allowable cost or max price. Again its about transparency. And itll require notified pharmacies of any changes in individual drug prices before these prices can be used as the basis for reimbursement. This is a commonsense bill, folks. It is about access. It is about making sure folks have access to their pharmaceuticals, to their drugs and generic drugs in particular. Another issue id like to highlight is the problem of direct and indirect remuneration or d. R. I. Or d. I. R. Fees. The centers for medicare and medicaid services, c. M. S. , originally pointed to d. I. R. Fees as a means of assessing the impact on Medicare Part d drugs, cost of drug rebates and other costs applied to Prescription Drug plan. However, d. I. R. Fees have increased greatly over the last year on pharmacies and if the pharmacy agrees to enter into a contract with a p. B. M. Or part b plan spon part d plan sponsor it doesnt seem fair that mediators can reduce the reimbursement rate since the contract was agreed to. This gets corm kated, i know youll be talking about this later on as well. Theres no transparency regarding how the fees are calculated there is another bill ive signed onto. Ive i applaud my colleagues, representative Morgan Griffith a republican, peter welch, a democrat, for introducing the improving transparency and accuracy in Medicare Part d spending act. It would prohibit p. B. M. s from anned sponsors who want to retroactively reduce reimbursements on claims submitted by pharmacies after the contract has been submitted. This is a scam and shouldnt be happening. I urge everyone, leadership, to bring this to us and everyone to vote on this for this bill and our other bill. I want to thank mr. Collins and other members for being here tonight. Great opportunity for me to participate and highlight some problems with our Community Pharmacists are fatesing and then ultimately their patients, the folks they serve as well. Those are the folks we are trying to look out for as best we can and trying to serb while were here in this congress. Thanks very much, mr. Collins, and i yield back. Mr. Collins that was dead on. This is about the patient. This is about serving that patient who is used to that, who understands it and a part of that Health Care System that has been provided along that is at riffing of going away. It is not too strong to say. Some say this is a free market. Government is one of the biggest payers of this and this is something in fact, as i was listening to you talk, there was a study at tricare and i will introduce mr. Scott here, Armed Services from georgia, but ricare did a study if it