CEOs from leading pharmaceutical companies and pharmacy benefit managers spent three hours before a leading Senate committee pointing fingers at one another as the party responsible for high insulin prices.
Chief executives from pharmaceutical manufacturers Eli Lilly, Sanofi, and Novo Nordisk and top pharmacy benefit managers testified Wednesday before the Senate Health, Education, Labor, and Pensions Committee about the industry's inability or unwillingness to offer insulin and other lifesaving drugs at reasonable prices. The execs found little solace from the group of lawmakers, many of whom demanded structural changes to how the pricing system operates.
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Only Eli Lilly CEO Dave Ricks agreed to one of Senate HELP Committee Chairman Bernie Sanders's (I-VT) numerous requests of the chief executives, pledging his company would not raise the prices of any insulin drugs currently on the market. He joined the other CEOs in declining Sanders's other pleas, such as lowering list prices on other drugs that cost less in Europe and Canada.
The PBM executives faced the brunt of lawmakers' ire over the systemic pricing issues, especially after the drugmakers testified that their companies had tried to push lower-cost medicines to no avail. The drugmakers had also all committed ahead of Wednesday's hearing that each would cap insulin prices, including for the uninsured. The move served as a victory for HELP members on both sides of the aisle who had been pushing for such price caps.
Sen. Mike Braun (R-IN), who is leaving the body to run for governor, lamented the broken state of the healthcare system overall, noting how insurance was "disproportionately more impactful in terms of keeping the whole system glued together the way it is."
"You pile all that up here," he said of the problems in the pharmaceutical and healthcare industries, "To where Sen. Sanders is, people are getting fed up with it. I got fed up with it 15 years ago. The rest of the world can buy drugs for one-quarter the price."
Braun warned that if the industry did not self-correct, the United States would likely go the way of Europe, as the current system is not sustainable.
"Obviously, you're covering your variable costs. Why are we as Americans paying the bill, even though it is only 15% of our GDP?" he said in an exchange with Ricks. "If it's not working here? How are we going to get the rest of the system to work?"
Sanders also made the budgetary impacts of high drug costs a focus of his remarks and questioning, saying early on in the hearing, "The high cost of prescription drugs not only impacts the health of individual Americans but the budget of the United States. If we paid the same prices for prescription drugs as major countries around the rest of the world were paying, we could save over a trillion dollars over 10 years."
A number of the senators, including Sens. Tim Kaine (D-VA) and Susan Collins (R-ME), questioned the PBM executives on their pricing preferences, pointing out concerns the other CEOs had raised about rejecting lower-cost drugs. The executives consistently replied that they would prefer drugmakers lower the list prices of medicines that are already available rather than introducing new options.
Sen. Markwayne Mullin (R-OK) called out Express Scripts CEO Tim Wentworth for being a PBM owned by Cigna, a pharmaceutical giant. As a result of the company's ownership, Mullin noted that both the PBM and pharmaceutical company were profiting from a business model that funnels rebates to one another that should be going to the patients.
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"If we're talking about bringing down prices, what have you all done to bring down prices?" Mullin said. "That was the whole reason why you guys were created, to bring down prices; we've seen nothing but an increase. It's not going with the pharmaceutical companies that are making it; it's not going to the pharmacist unless you own them."
"And you wonder why you're here? Are you actually serving your purpose? Heck no. You're not," he continued. "And as I said before, it's like the fox guarding the hen house. You've literally forced us to make the changes. And in my private company, if I have an entity that's not being effective for what their intended purpose is, I would shut them down."