 I'm Jen Taylor. I'm the senior director of federal relations at families USA. It is my honor to kick us off. As we all know, last week, the Biden administration announced the first 10 drugs that the secretary of HHS will negotiate for for fair prices as part of the new Medicare Negotiation Authority provided under the Inflation Reduction Act. These drugs are going to be the very first drugs that Medicare has ever had the authority to negotiate for. So this is a monumental step towards lowering drug costs, certainly for the millions of older adults and people with disabilities that rely on Medicare and hopefully really taking us in a new direction for the entire country and achieving affordable prescription drug pricing. These are drugs that we're going to be talking about today that so many of us and our families and friends rely upon to treat chronic conditions. They cost people who rely on Medicare thousands upon thousands of dollars for just routine treatment. Among these drugs are blood thinners, diabetes medication, treatments for heart failure, cancer drugs taken all together. These drugs cost the Medicare program $50 billion over the last year, representing 20% of total part D drug spending over that time. So perhaps it's not surprising then that we see that seven drug companies, the U.S. Chamber of Commerce and the National Infusion Center Association have all filed suits against Medicare negotiation in order to protect these profits. But as it's so clear that drug pricing negotiation is going to have tangible, meaningful benefits, both for the Medicare program at large and most importantly for the millions of people who rely on Medicare for their prescription drugs. We have to also be clear that any company seeking to upends negotiation is seeking to protect their profits at the expense of people who rely on these medications for their health and their livelihoods. So you didn't come here today to hear from me. We've got three incredible advocates for prescription drug pricing reform who can speak from their different perspectives on the critical importance of this new step of Medicare negotiation and what's at stake in getting this right. So first up is a man who perhaps needs no introduction, but I'm giving him one anyways. Senator Painter Welch from the Great State of Vermont is elected to serve in the U.S. Senate in 2022. And so while he may be a relatively new member of the upper chamber, he's certainly not new to Congress or to work on prescription drug pricing as a longtime member of the House of Representatives and a senior member of the House Committee on Energy and Commerce. He's been at the table for the better part of two decades on federal drug pricing reform work. He was a champion of the IRA when he voted for it in the House of Representatives. And now in the Senate, while he's accomplished much, he's still not resting on his laurels. He's introduced the Strengthening Medicare and Reducing Taxpayer or Smart Prices Act, which would build on the success of the IRA and give HHS enhanced authority to negotiate for drug prices in Part D. So we are beyond honored and thrilled to spend this time with you today. Sir, I know you have votes, so we're going to kick it over to you. I appreciate you making it all work. And with that, I turn it over to the senator from Vermont. Thank you very much. And I want to thank Families USA. I want to thank my partners in crime, Sarah DeSilvi and David Mitchell. And Bailey, you're there. I really appreciate it. It's a big day. But here's the question, okay? What is more important to any country than to have a healthcare system that takes care affordably of the healthcare needs of its citizens? That's the question. That's much more important than the particulars of what a procedure costs or who does it or whether it's private, whether it's public. It's about a country coming together to do its best to have a healthcare system that delivers affordable and accessible care. And that is to every citizen, whether they're poor or rich, whether they have a job where the employer provides healthcare or it doesn't. That's the ongoing challenge. What has happened, of course, in healthcare is that medications have become more and more important in the treatment in the pain relief for our citizens. And we have a situation here that's unique to America where the pharmaceutical companies who do good things. So all of us here, either personally or a loved one has had the benefit of pharmaceuticals that have extended life for relief pain. But what is happening where this country is unique in that it's the only country where the government that is to represent the objective of affordable and accessible healthcare stands on the sidelines and seeds to the pharmaceutical companies. Total pricing power. And of course, it starts out with the patent where by law, the inventor of the medication can charge whatever they want. And none of us here oppose that. That's to protect the incentive. But what has happened is that our drug companies have essentially abused the patent system. And then when there was the passage of the Medicare Part D, stopped the government on behalf of people from doing what every other government does. When it buys wholesale, it wants to pay wholesale. We're the only government where we buy wholesale and we have to pay retail. I mean, it's really that simple. So it's why isn't if you ask a person that embryo, just as an example, if you need it in the U.S., it costs $5,000. We're right. Sarah, you and I, we're right on the Canadian border. We cross the line. We pay $1,000 in Canada. And why is that? It's because the U.S. essentially says to the pharma companies charge what you want. We'll pay it at the expense of taxpayers, at the expense of our employers who want their employees to have access to healthcare, but are constantly dealing with these premium increases that then mean lower pay increases for people who need to pay the bills. And it doesn't have to be that way. Now, the Medicaid price negotiation essentially brings us the United States of America through the Medicare program into the same situation that the Pentagon's in, and that every other country is in. If you're buying huge quantities, whether it's aspirin or emerald, you get to negotiate a bulk price discount. It's as simple as that. That's what's called capitalism in the market system. But we had a law here that we had to overcome that says we're going to be the suckers. The government is just going to go to the taxpayers and stick it to the employers whose premiums are going to go up and we'll just stand by and let the pharma charge whatever it wants. And what's heartbreaking to me about that, we all have our stories of people who are in these horrible situations and it's always more severe when it's not about you, it's about your child, it's about your partner, where they need this and it's right within reach, but they literally can't, they literally can't afford it. And they start cutting the pills in half, they start missing, taking the doses. That is a result of public policy. It's not necessary. And the reason I'm so upbeat about this is that this law more than anything else recognizes that the government that is for the people has an obligation to stand up and defend when there's been really an abuse, in this case of the patent system. We've got to make healthcare accessible. That means it has to be affordable. Now the big pushback from pharma is the standard one. This will decrease innovation and the logic that they have is that let us charge whatever we want no matter how much it bankrupts an employer or government because we won't innovate unless we can rip you off. That's literally what it comes down to. But you know what? It doesn't have to be that way. Why is it that we pay $5,000 and in Canada it's $1,000 for that drug, emerald. So the business model of pharma is to just stick it to American taxpayers and American consumers and the American medical system. You know what? Even out, let the folks share the cost of the research and development. So this is significant because we do have to bring the cost down in service of making healthcare affordable to every single person. And we're seeing the big pushback. If I were a pharma executive making $20 million a year and to deliver to the shareholders, I'd probably be a little bit nervous too because now I'm actually going to have to earn my salary, but earn it by actually coming up with innovation and having to find a business model that doesn't stick it to American taxpayers and consumers and folks who are in desperate need of healthcare. So this is very affirming because I see this is fundamentally about making healthcare affordable and in no way do I see this as a threat to innovation. So it's been a long and tough battle and the effort goes on. There's a lot of litigation and basically the litigation premise is that we should be, it's uninstitutional for us to have to negotiate the price. And I think they're going to lose the litigation and I think as people start seeing the benefits of this is going to be embedded and I hope we can deal with this in addressing other cost issues in healthcare to make it more accessible and affordable. So thank you all very much for your leadership and the fight continues. It does indeed and we are very, very lucky to be able to have you as a champion and a partner in that fight. So thank you Senator for joining us today. I know you're going to try to stick around for some questions if you don't get pulled away to vote. So with that I'm going to kick over to Sarah DeSilvi. Thank you again for joining us literally during your clinic hours up in Vermont. So I will keep this brief. Sarah is a Vermont based nurse practitioner working at Georgia Health Center for the last decade. She practices full-factor rural family practice, pediatrics to geriatrics, taking care of many four generation families. She went back to school to get her doctorate in health systems leadership and quality and loves taking care of patients and working to take care of patients better. I think we all can agree we would love to have a provider just like you. When she is not at the health center she leads a national collective charged with developing language and data standards to address social determinants of health. So she is well versed both in the day-to-day impacts of what we're talking about today and what it looks like from a policy perspective. So Sarah with that I give you the floor. Thank you so much. First off I want to say I'm just grateful to be here speaking on this very, very important topic. It's one of those that's mission driven for me. So if there's ever an opportunity to speak to it you know I'll be there. I'm going to build off what the senator well to speaking of and lean into a topic that I think is very near and dear when it comes to this area is called moral distress. There's this term that we have in healthcare which is when you know the right thing to do the ethical thing to do but you're constrained from doing it. And it's such a crucial concern that we name it and talk about it and there's very clear applications of that feeling of moral distress when it comes to the conversations that we have to have on a regular basis with patients who have Medicare coverage regarding the difference between what we know we should be doing for them the medications that they should be on and the medications that they can afford. The list this first which I hope the first of many medications that are on this list for negotiations are the best in class recommended medications or some of the highest risk concerns that I see on a daily basis. My patients with heart failure my patients with diabetes my patients with different kinds of inflammatory arthritis and each of these medications has a very clear space on the guidelines for what I am supposed to do for you right but I sit with patients every day and I say I know we're supposed to give you this medication I tried it's too expensive for you so what do we do next right even simple insulin right is on this list as well so I just want to hold that up that what we're really talking about is like an ethical problem that is not necessary right in order to address that it's very simple do we just need to be able to negotiate on these and many more medications to come because this is what we should be doing for patients it's what the evidence says we should be doing these are the patients that we're trying to keep well and living their lives and out of the hospital but simply we cannot afford to do it and that's an ethical problem and I think that's really the heart of it for me I can go on and on about different patient stories but it really what that's what comes down to and it just needs to be addressed and we need to stop and just do better and be more like other countries as we focus on this approach thank you so much Sarah and they may just have some questions for you when it comes to patient stories in just a moment so before we get to questions I do last you want to introduce last but certainly not least David Mitchell who has joined us today in his role both as president and founder of patients for affordable drugs which we may all know him speaking from but also as a patient and I think that's why David is such an extraordinary champion for affordable drugs as you probably know patients for affordable drugs is the only national patient advocacy organization exclusively focused on lowering prescription drug pricing they have a very clear vision which is just simply that every person in the United States can get the prescription drugs they need at prices they can afford again he's been an extraordinary champion for affordable drug pricing as an expert with more than 40 years of experience working on health care and public health but also as a patient with an incurable but treatable form of blood cancer and depending himself on drugs costing hundreds of thousands of dollars a year for his survival so I'm not sure there's anyone who could speak to this issue more passionately and eloquently than David and we really appreciate you being here today well thank you very much for having me and uh Sarah it's a pleasure to hear from you Senator Walsh good to see you and always good to hear you lay things out so clearly and so powerfully and thanks to families USA for uh pulling this together you know the drug provisions in the inflation reduction act are historic over time they're going to save money for millions of Americans by allowing Medicare to negotiate directly on prices by curbing annual price increases by holding the line on premiums and finally finally putting in place an annual out of pocket cap in Medicare Part D as the congressional budget office points out the reforms are going to improve both the financial well-being and the health of people more of whom are going to be able to afford to buy and take the drugs they need as to negotiation specifically it's really important to know the history back in 2003 when Medicare when the Medicare prescription drug benefit was enacted into law big pharma bought a sweetheart deal the chairman of the key committee Billy Towson inserted into the bill a prohibition on Medicare negotiating directly with drug companies for lower prices now shortly thereafter Towson left Congress and went to work for the powerful industry trade association pharma for a salary of two million dollars a year now for almost 20 years after that pharma fought successfully to keep that sweetheart deal drug companies could dictate a price and the american government could not negotiate directly for a better deal now that changed last year with the passage of the inflation reduction act but of course the drug corporations and their trade associations are not having it they filed nine lawsuits apparently one was withdrawn today so maybe there are eight there could still be nine to block the new law and to thwart the will of the american people more than 80 of whom support Medicare negotiation now the fact is Medicare sets prices for everything else it pays for in healthcare doctors hospitals tests but pharma says no they won't even negotiate pharma says it has to have the power to set prices for the brand name drugs we buy now as a patient with as as was pointed out in curable blood cancer whose drugs carry a list price of almost a million dollars a year before cancer drugs i have to take i can tell you it's wrong just one of my cancer drugs an oral drug under part d called palmless costs about a thousand dollars per capsule but it costs less than a dollar a capsule to make and i have to pay my out of pocket currently based on that one thousand dollar per capsule price and that list price means i'm paying more than seventeen thousand dollars per year out of pocket for that one drug eloquous a blood thinner i have to take that maybe one of the first drugs is going to be one of the first drugs negotiated as a list price of almost seven thousand dollars in the us because it's maker bristol meyer squib has blocked competition in canada where there's a generic the price is less than seventeen hundred dollars now the drug companies also claim as the senator pointed out that negotiation leading to lower price going to kill innovation and new drug development but this is a red herring that just doesn't hold up in fact the new drug law is going to spur innovation because drug companies won't be able to generate huge profits by extending monopolies and raising prices at will on old drugs that we're going to negotiate over they're going to need to innovate what's more the negotiating process under law requires that medicare gives central weight to the clinical value of the drug whether it represents a therapeutic advancement and the extent to which it meets an unmet need in other words drug companies are going to get higher prices for high quality innovative drugs the law maintains the incentives for innovation that already exists in the us by allowing drug makers to be rewarded for investment and risk by setting their launch prices and maintaining that fda awarded period of exclusivity exempting all medications from negotiated prices for a nine to thirteen year period so we can't let the drug companies overcome the will of the american people and restore their sweetheart deal we're supporting the legal fight against big pharma we've always already signed on to uh one amicus brief opposing a preliminary injunction in ohio to stop implementation of the law and we are going to keep working doing everything we can to make sure the courts understand how patients are going to be harmed if the laws delayed or overturned thank you so much thank you to all three of you for your comments today i'm going to open it up to any questions that books in the call may have for either the senator uh sarah or david uh we do have a question in the chat uh since kennedy warlock and collin shagene insulin bells don't address the high list prices and only bush sanders bill insulin act for all 2023 addresses the high list prices do you think provisions from the bush sanders bill should be included in the insulin bill that might be included in a senate drug price and package since it addresses the root of the problem or do you think it will be difficult to include the provisions of the bush sanders bill there i'm going to say you don't have to answer that question that's probably i'm not going to kick it straight to you um i don't know senator welch if you had a position on the bill from your colleagues or david if patients for affordable drugs has a position on that issue sorry the long question so we can also repeat it if that's helpful it would be helpful to repeat it bailey you're breaking up a little bit apologies and i can also talk a little slower is that better yeah great so uh essentially the kennedy warlock and call collins shagene insulin bills don't directly address high list prices whereas the bush sanders bill insulin for all act of 2023 does address list prices do you think that provisions from the bush sanders bill that addresses list prices should be included in any insulin bill that could be included in the senate drug pricing package but not just capping out of pocket for insulin but also addressing insulin less price the crux of the question i we're firm believers that we really should be trying to do both uh that you can't really lower out of pocket without lowering price otherwise patients just wind up paying in other ways with higher premiums they get less money in their paycheck if they're getting their their health care from their employer uh so we believe that lowering out of pocket needs to be coupled with lower prices however you know things happen in steps uh and we took a huge step last year uh in uh winning the drug pricing provisions in the inflation reduction act and we will begin to negotiate now 10 drugs to begin with then 15 and 15 20 and 20 in the ensuing years so uh we need to always remember that we have to reach for what is the best we can achieve and if it isn't one bill exactly the way it was written or another bill the exactly exactly the way it's written that's not nearly as important is making sure we get the best possible result uh that we can achieve that will help the greatest number of people thank you so much bailey do we have any other questions in the chat um at this time there are not any questions in the chat if folks want to feel free to use the q&a chat or the regular chat to some of the questions i can read them aloud in the interim i know we did have a question for the senator some reflections on the moment we're in bailey do you want to go ahead enough yes thank you uh we did get a question for the senator which is uh given this moment i'm sorry let me pull it up real quick uh all right uh given this moment what does it mean to see the law that you fought to pass in the house uh go into effect with the announcement of the first 10 drugs there's two things one uh it's been like a 20 year battle and it's about addressing affordability issues uh and we've got those across the economy that really affect working families but there's nothing more poignant than when you can't afford the medication your child needs or your partner needs so the fact that we've got government standing up for fairness and affordability it's really a thrill second not a moment to lose we've got to keep at it the fight never stops you know the challenges that we face to make health care affordable those are going to continue so i feel good but um i don't feel so i don't i feel good but nervous we've got to keep at it 100 as we give just another moment or two for questions in the chat sarah i am coming to you now you didn't have to answer the wonky legislative question but i am going to come to you for that personal touch that you talked about i know you've seen a lot of stories in terms of firsthand impacting your patients is there anything you'd want to lift up today um that you really want people to sort of keep in mind as we move forward and how we're working on this um i guess the thing i want to stress is that in our work you know in taking care of people we think about negotiable things like and things that are must-haves right and so for patients that live on the margin and many and most of my patients in rural vermont live on the margin they have a small social security allotment they have a you know fixed price rental you know they're getting by as best they can these prices affect everything right so if they choose to go forward in the medication that's required in their pink sense of out of pocket it becomes like the gas they can't buy or the foods they can't afford to eat that drives the diabetes that is uncontrolled or the heart failure admission that we could have prevented right there is not like in the lives of many of the people that will be most drastically affected by the the reduction in prices out of pocket and negotiations everything's interconnected it's housing it's food and the medications are things that if they can't afford them if they actually make the choice to go forward and they're paying those prices they're living on the margin with everything else right they're they're scrimping and saving they're you know you know not doing things that they should be doing in other areas because they're making this the thing that they do and we have to solve all of that for them right so solving the price problem is solving like a general wellness problem that that shouldn't be there in the first place looks like we didn't get any more questions in the chat uh anybody else have last comments they wanted to leave folks on the call with david or senator welch if there's anything else you wanted to leave us with now i just want to take a second to thank senator welch for his uh leadership and um you know it the fight goes on and this is not a man who rests on his laurels so we're really glad he's there thank you senator well you know the hard way you're kind of do that but oh it's really really hard uh you know sarah you have patients that come in and you see the anxiety that they have and the shame they have if they can't afford something there's no way they can afford because they regard it just their obligation to take care of the person they love no matter what and it's like you've seen people if they can get a second mortgage they'll do it they can go into the retirement they'll do it yeah do we really want to be a society where we impose that anxiety and uncertainty on people when we really don't have to so this is a a righteous cause for a health care system is affordable and accessible and we can have it with the innovators and the creative efforts to create new viewers we can continue to support that and maintain our position of doing that but it's got to be affordable and i think that was perfectly thank you all so much for joining us your extraordinary advocates and really extraordinary humans and i appreciate both the thoughtfulness and the human compassion and empathy that you approach this work all three of you so thank you so much for the time today and to all the reporters who joined um i know this is a story that is going to be ongoing you're going to continue to have questions and want to make connections i know families usa is available to you at any time um and certainly while these are some very busy folks on the phone i am sure that they will be available for follow-up questions you may have as you continue to really bring um this story to the public and keep reminding folks why it's so important thank you all for your time we'll let you get back to your busy days and keep up the good bye take care