• 6 months ago
At a Senate Judiciary Committee hearing on Tuesday, Sen. Jon Ossoff (D-GA) spoke about the prices of prescription drugs.


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Transcript
00:00 Senator Ossoff.
00:02 Thank you, Mr. Chairman, and thank you to our panelists for joining us today, and Professor Mossoff.
00:07 We should perhaps determine whether we're distant cousins.
00:11 I am grateful to you all for your expertise.
00:14 Dr. Feldman, I want to discuss with you the prices that Georgians are paying for inhalers,
00:20 children on Medicaid, seniors on Medicare, and everybody in between.
00:25 First, I just want to note generally, the prices that Georgians are paying for prescriptions are outrageous.
00:33 The stories that come to me in my office are shocking.
00:38 From a constituent who right now is having difficulty making ends meet and affording cancer treatment,
00:45 who watched their own friend die from being unable to afford cancer treatment,
00:53 a veteran in Georgia who right now is having to scrape together thousands of dollars per month
00:59 in order to afford leukemia treatment,
01:03 kids and seniors with asthma or COPD who are having to pay exorbitant prices for inhalers,
01:13 medical devices across the board, and the tremendous lobbying power of the pharmaceutical industry
01:24 is a major driver of the outrageous prices that Americans pay.
01:30 And of course there's a balance that we have to strike between making sure that research and development
01:35 and innovation are rewarded and the interests of patients and consumers,
01:40 but this country is not getting the balance right.
01:43 We made big progress capping the cost of insulin for seniors on Medicare Part D at $35 a month,
01:49 finally empowering Medicare to undertake some negotiation with pharma over prices,
01:56 but we have a long way to go.
01:57 And let's talk for a moment, Dr. Feldman, about inhalers.
02:00 And I know that some voluntary caps are now in place, but Medicare, Medicaid,
02:06 still not participating in that.
02:08 You've seen countless patients. You're a pulmonologist, correct?
02:11 That's right.
02:12 And so you've seen countless patients dealing with serious life-threatening asthma and COPD, is that right?
02:18 That's correct.
02:19 How long have inhalers been on the market?
02:21 The first meter dose inhaler was approved by the FDA in 1956.
02:26 1956. In the last few decades, have the active ingredients in these devices substantially changed?
02:34 No. Since 1986, there have been no inhalers for asthma or COPD with a new mechanism of action.
02:42 That means of the dozens upon dozens of brand-name inhalers have been approved,
02:46 not a single one has an active ingredient that is fundamentally different
02:51 from other active ingredients in the same class.
02:54 For three and a half decades, you're saying, the active ingredients have been basically the same?
02:58 That's right. Some tweaks to the molecules where you get new active ingredients, but in the same class.
03:03 So fundamentally, no major breakthroughs in terms of managing these diseases from inhalers.
03:09 So why are so many Georgians and so many Americans still paying hundreds of dollars for these devices?
03:14 I think it comes back to really what we're focused on in this hearing today,
03:18 which is these problematic patenting practices, product hops,
03:22 where companies are taking decades-old active ingredients,
03:26 getting patent protection for the delivery devices, for other aspects of the products,
03:32 and it allows them to keep prices high by limiting generic competition.
03:37 So product hopping or device hopping, just for folks tuned in from Georgia, define that in a nutshell.
03:44 That's where you take the same ingredient or set of ingredients
03:49 and put them from an old delivery device into a new delivery device
03:53 that may be no better than the earlier one, but it does have new patents.
03:58 So it allows you to move people from an old device to a new device,
04:03 if you're a brand-name company, earn a lot more revenue by doing so,
04:08 but to no benefit for patients.
04:11 And so that patent based upon no innovation of the underlying medicine,
04:16 some nominal innovation of a device, then boxes out competitors, generics, and helps keep prices high, right?
04:22 That's exactly right.
04:24 I do want to note some manufacturers have agreed to cap out-of-pocket costs for inhalers.
04:28 Does that apply to Medicaid or Medicare?
04:30 It does not. Those caps do not apply to Medicare and Medicaid.
04:33 So for a kid on peach care in Georgia, for a senior, and I think according to my notes here,
04:38 one in nine Medicare beneficiaries have COPD. Those caps don't apply.
04:42 That's correct.
04:44 Where else do we see this practice of device hopping or product hopping?
04:48 We see it really for all drug device combinations.
04:51 What are drug device combinations? Those include products like insulin pens, inhalers,
04:57 EpiPens, GLP-1 receptor agonists that Senator Welsh was asking about.
05:02 So it seems like kind of a niche set of products, but in fact, if you look at the top 50 drugs by Medicare spending in 2022 by gross spending,
05:13 40% are actually drug device combinations.
05:16 Just about every family in Georgia has had to think at some point about,
05:21 do I need to carry around an EpiPen for my child who has an allergy?
05:27 Do I need to purchase an inhaler for my child with asthma or for a grandparent suffering from COPD?
05:34 And yet these abusive practices where there's not innovation on the underlying drug,
05:40 but there's some nominal change in the product is boxing out competition and keeping prices high.
05:45 This is, Mr. Chairman, a place where I hope we can achieve some bipartisan consensus to make progress for Georgians who are struggling for these basic medical products.
05:56 Thank you, Dr. Feldman.

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