Alexandra robbins talks about the issues teachers are facing in the classroom today. She is interviewed by a staff writer. Logical tv every sunday on cspan and find a full schedule online or your channel guide. Listening to programs on cspan radio just got easier. Important trend congressional hearings. Catch washington today. Listen to cspan anytime. Tell your smart speaker, play cspan radio. Cspan, powered by cable. Pharmaceutical majors for being here. Onto think eli lilly i want to thank eli lilly announcing ac stencil reduction in list prices for some of their prices. Announcing a substantial reduction in list prices for some of their products. All over this country, people are saying enough is enough. They are sick and tired of paying outrageously high prices not only for insulin before other products as well. They want action and this committee will do what it can to respond to their needs. We need the help of the people on the panel to do that. As we gather today, i know we have some advocates fighting, we thank them for what they do. It is important to acknowledge the too Many Americans who died because they rationed their insulin. Alex smith was 24 years old and he dreamed of opening a sports bar. He is dead because he could not afford insulin. A 22yearold worked two jobs to support herself. She is dead because she could not afford insulin. A 20yearold already lost his home because of insulin, this young man is also dead. These are just a few of Many Americans who have needlessly lost their lives because of the outrageous costs of insulin. We further acknowledge the thousands who have ended up in Emergency Rooms or hospital beds suffering from diabetic ketoacidosis, a very serious medical condition as a result of rationing insulin. 1. 3 million americans in the richest country on earth cannot afford insulin. The committee today is convening for two major issues, one is personal. A couple years ago i took a trip to ontario with the busload of people. Windsor is a bootable town but that is not why i went. I went in order to purchase insulin in canada, which they were able to do for 1 10th of the price they were paying for the exact same product. I will never forget the tears coming out of a mothers eyes because she can suddenly afford insulin. What i promise them is they will not have to go to canada or other countries to purchase a lifesaving product. This committee is not only going to be dealing with the crisis in insulin but will do everything we can to end the outrage in which americans pay by far the highest prices in the world for every brand name Prescription Drug on the market. We end up paying the highest prices in the world. I want to know why there are americans who are dying or becoming much sicker than they should because they cannot afford the medicine that they need. These are the questions the members of our panel will have to answer today and in the future. 1 out of 4 americans cannot afford the medication is prescribed to them. The high cost of Prescription Drugs not only impacts the health of individual americans but the budget. If we paid the same prices, we could save over 1 trillion in 10 years. I know many of my republican friends are concerned. I share the same concern. 1 trillion over 10 years. Let us not forget that a vial of insulin costs less then 10 to manufacture. Someone correct me if im wrong. Meanwhile, we have increased the price 34 times from 21 to 200 and 75 275. No one has stopped them. They can charge any price they want. A company that has increased the product in every instance it is the exact same product. Lets be clear. This is a problem that is unique to the United States. Pbm has signed secret deals not with the lowest list price, but the ones that gave pbms the most generous rebates. As a result of a lot of public pressure, we have seen Major Drug Companies substantially reduce prices. That is good news. And we have got to ask some hard questions. If they can lower their prices, why are there still charging the American People 2000 for a drug to treat stomach cancer 200,000 for a drug to treat stomach cancer were in germany it is less . If a drug price can be lowered 75 , why are there still draw charging American People 12,000 . If they can reduce, wire they still charging over 200,000 for a drug purchased in japan for 37,000 . These are the questions the American People are asking. Why nearly half of all the new drugs now cost over 150,000. What world are you living in . Why does that happen with cancer drugs where it only costs a few dollars to manufacture, they are charging for thousands of dollars . Really . Do not have any values . We have a lot of work to do. Onto think the work being done on insulin. Want to make sure americans can afford. I went to medical school for a portion of my life. Diabetes was a constant but also the ability to afford the drug was a constant as well. These medicines are more convenient to take and have made it easier for the diabetic to manage diabetes. One i tip of the hat to you. The ability to afford insulin that may have occurred because if you cannot afford it it has never occurred. 100 years ago, diabetes was a death sentence. Not only do we have medical breakthrough. But we have had you come up with products that have made it easier for the diabetic to manage. We have had remarkable increase in the quality of life. Significantly reduces life sentences. Even with modern insulins and devices, two thirds of People Struggle to keep their disease under control. Not only with diabetes, cancer, alzheimers and other serious conditions. Lily invest 25 of our revenue which enables us to introduce new medicines. 19 alone with an and of with an antibody for covid. Just last week we shared results from a new study which followed billions of dollars in investment, decades of work and several failures that preceded it. Medicines do note good if people cannot access them. We have led the industry in helping people access them. We have brought insulin down to 20 a month. That was before recent announcements which will drive them lower. Lily has not raised prices since 2017, the year i became ceo. We have only cut them. In addition to the original brand, we launched a large branding when ursula when insurance was not working, we were the first to cap our insurance costs. I believe we are still the only company that will cap all of our insulins at 30 per month. This essay people with diabetes 185 million and nearly 100,000 people per month are saving. We have led the way inaffordability against the headwinds of Health Care System that can incentivize others for hire list prices. This allows for higher fees and rebate which can increase patients outofpocket costs while benefiting employers, Insurance Companies and people who do not use medicine. Even though it is identical to another drug and cost less. I brought both here. Not everyone has access to the lowerpriced drug. The list price for insulin over time gets a lot of attention. Even before recently announced price decrease, what we take home was about the same as when launched in 1986, accounting for inflation. Last year 80 went to pay fees for companies who did not invent , did not develop nor manufactured the medicine. This also supports about 4000 highpaying jobs with full benefits and pensions. We also contribute 25 back into rnd for newer and better medicines, including insulin. New and better methods are needed. Reforms must help people at the pharmacy counter while also incentivizing u. S. Companies to continue investing which leads to americans having more and newer americans than any other country in the world. We are ready to do our part and we are confident our solutions are simple and achievable. Thank you for having me. Thank you our next witness is the chief executive officer of the snow b. Senobi. Thank you for having me. This is an opportunity to dispel some misconceptions insulin is sometimes described as a 100yearold drug period much like the cars that bear little resemblance to the model t, there has been significant improvements. Senobi it is our imperative. Shirley after i arrived, we are able to focus our research and with best in class treatments. Today im very proud to announce we have positive results in c pod. If approved, it will be the first for those suffering from the disease in over a decade. With this immunization, the burden of rsv on providers and families may never happen again. Finally, we recently launched the first medicine proven to delay the onset of type one diabetes. And next 15 months, we will learn about other clinical studies. Each with the potential to become a first in class medicine or vaccine. This is why i am equally proud of the longstanding commitment to affordability. It will make medicines affordable through assistance programs, capping outofpocket costs by 35 to the uninsured and launching lowpriced versions of our insulins. This is not the first time we have offered a lowpriced medicine to the system. Each time these medicines have received very little coverage resulting in limited benefits to patients. The system is largely driven by the Financial Sector that adds rebates and fees to the list price. The list price is not the amount the system pays. In 2022, 80 4 of our gross insulin sales were returned to the system is rebates and fees. 84 cents on the dollar. Outofpocket costs have increased by 45 . The average amount is lower than when it launched in 2001. While competition is working to drive down insulin prices for the system, their savings are not reaching many patients. Why are patients not benefiting . There are three players in the system the cover 80 . These consolidated agencies, health insurance, pharmacies and Group Purchasing organizations. It gives these corporations near total control over products that patients have access to and the prices they have to pay third rebates and fee for receive are calculated. It is a percentage of the list price. And of the committee is actively looking at solutions. We welcome changes that will make the system work better at protecting the ecosystem that allows numericals to be developed. We have contributed in the past and are willing to do so again. It starts with a holistic approach that drives the systems preference over hire list prices. It requires rebates to be used to lower Prescription Drug costs of the pharmacy. Otherwise, i am worried the policy reforms will do little to help patients. Thank you, again. Thank you. Our next witness is the president and ceo of novook he will be speaking to us virtually from a belief denmark. Chairman sanders, ranking member, thank you for the opportunity to speak today. Our mission is to pioneer significant good pioneer scientific breakthroughs. We hope todays conversation will lead to meaningful action. I like to begin by briefly introducing myself. I grew up in a small town in denmark. My sisters and i help run the family farm. It taught me to take responsibility and work hard, not only for myself but others. Almost 32 years ago i went to work for a company in the netherlands and japan, thought to return to headquarters in 2004 period 2004. I know the deceased both personally and professionally. We are a company that keeps the patient at the center of everything we do. Our company was born between two danish scientists. When marie developed diabetes, the company embarked on a path to find a cure. Today, we have comprised of more than 50,000 colleagues worldwide. Just last year the Foundation Awarded almost 1 billion worldwide. Some of these projects are between industry and academia here in the United States. We are proud of our companys Financial Success and that it fuels the foundations of work. As we have worked to treat and cure diabetes for over a century, our lifework is often of repeated nothing further from the truth. 100 years ago patients were provided with little glass syringes to keep the needle sharp. Insulin had to be detected in and throughout the night. It saved lives but was eez easier to use. It may seem minor and insignificant to those of us with diabetes for many have meaningfully improve their lives. No matter how a drop may be, it can only help patients when it is affordable. No one should have to go without it because they cannot afford it. That should not be the case. We have worked hard to fill the gaps but we know that a lot of problems remain. We know there is often a misaligned system. A system where more and more dollars flow not to patients. We pay on average . 75 on every dollar of medicine to ensure that our medicines remain available to patients. Everyday we ask yourselves, what can we do more for patients . We can try to fill the gaps of a system that has left people behind. We provide a free lifetime supply of insulin, a longterm supply to those under the poverty line. That is 120,000 for a family. We supply insulin for patients to walmart and other pharmacies that are sold for 25 at one vial. We work hard to ensure that our programs help as many patients as possible. Now is the time for all participants to work for solutions that put patients first. Thank you. Thank you. We have heard from representatives of the three Major Drug Companies and now we will hear from the three major pbms. Our next witness is the executive Vice President , president of Pharmacy Services for cvs health. Thank you for joining us. Thank you. Thank you for the opportunity to discuss our work ok, thank you for an opportunity to discuss the work. We make things more affordable to help improve the outcomes heard our goal is to remove many of the challenges for our members. When people cannot afford their when people can afford their medications it means Better Outcomes and less hospitalizations. In order to make medications more affordable, our job is to go ahead with the manufacturers to discuss the lowest prices. The last few years have been challenging because of constrained household budgets. Over the last five years prices have increased at a rate of 7. 4 . Over the same time, the pbm industry has helped clients hold to 7 and member at 1. 4 . We have reduced patient costs with outofpocket costs below nine dollars. Today it is important to note that nearly 95 95 are generic. By using competition and generic prices, they have been deflationary over the last decade. Now we are securing affordability for the last 10 of namebrand drugs and that is our focused. We use competition to deliver discounts to our customers. By negotiating rebates and discounts, we lower prices where competition exists. I, many drugs without competition are many of the high list rices and account for must much of our client spending. We encourage the committee to focus its efforts and we support the three bills that the committee will consider in this market. Drug manufacturers complained that rebates are the reason but the facts show otherwise. Study after study show that price increases are not the result of rebates or discounts. We know there are questions about the level of transparency we provide to our clients the trust of our clients is important to us and is built on transparency. Transparency starts at the beginning of our process and is a cornerstone of our approach throughout the period clients negotiate transparent contact contracts in detail to understand how things are spent. We understand what transparency brings to the marketplace and we surpassed nearly 90 we passed nearly 98 back to our clients. We also provide them detailed updates. Our clients choose how to use those discounts or rebates by either reducing outofpocket costs and or delivering lower overall premiums at the pointofsale for the medications. I begin by highlighting the importance of adherence and reducing complications. This is why we create and maintain preventative drug list. This allows our clients to offer members zero dollar copays including insulin and many other educations medications. We want our to the 200,000 employees to stay healthy period we have made tremendous progress by inducing competition and encouraging the lowering of outofpocket costs for members. We have reduced the insulin cost on average 7 for the last few years. At cvs caremark, the average cost for a 38 supply was less than 25. For those using the preventative drug list it is zero. Weve also launched a program for uninsured and underinsured patients providing insulin at just 25 vial. We provide pharmacy benefits to over 110 Million People and are improving their health every day. We will continue to improve and innovate on our model to help clients provide affordable coverage for members that need to stay healthy. I look forward to answering your questions. Thank you very much. Our next witness is president of express scripts period scripts. Thank you for inviting me to testify today. My name is adam. I grew up in missouri outside of st. Louis and began my career at a regional pharmaceutical. Im proud of our work to deliver Affordable Access to lifesaving medications. I was diagnosed with stage iv melanoma in my early 30s. That experience strongly shaped how i approach our work to advance pharmacy care and lower drug costs for patients and employers. As a Business Leader i am guided by my experience as a father, cancer survivor, american. We believe all patients should have access to the medication they need at affordable prices. For decades we have taken on one of the toughest challenges, negotiating manufacturers or lower costs. We exist to help solve the challenges you are exploring here today. Our company has been at the forefront of introducing solutions to address the insulin crisis. We announced a program to capping insulin costs at 25 or less. These lifesaving medications have also been extended for Additional Savings for cardiovascular diseases as well. We are constantly evolving and improving our services, this includes working to shield patients from high costs and provide multiple transparent contracting options to ensure our clients have control and flexibility to choose their benefit design, network and pricing structure and are provided robust disclosures. Our solutions were driving lower drug spending are working. Each year express groups saves more than 30 billion for employers, the