David Loebsack

Mr. LOEBSACK

Mr. LOEBSACK. Mr. Speaker, we have been able to find a consensus on this, too, among this bipartisan group of folks. As my good friend said: Pharmacists across the country serve as the first line, really, of healthcare 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 and hospitals, something we all want to see happen. I am 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. It is 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, community pharmacists face many challenges to compete and negotiate on a day-to-day basis with large entities in their business transactions. I frequently visit with community pharmacists in my district, and I have heard directly from them how hard they have to fight to compete on a level playing field that isn't always level for smaller pharmacies. So it is not really a level playing field. One pressing challenge facing many community pharmacists, as was already mentioned, is the ambiguity and the uncertainty surrounding the reimbursement of generic drugs. Of all things, it is the reimbursement of generic drugs. Generic prescription drugs account for the vast majority of drugs dispensed by pharmacists, making transparency in reimbursement absolutely critical to the financial health of small pharmacies. However, pharmacists are reimbursed for generic drugs through maximum allowable cost, or MAC, a price list that outlines the upper limit or the maximum amount that an insurance plan will pay for a generic drug. And these lists are created, as was mentioned, by none other than the pharmacy benefit managers, or PBMs, the drug middlemen, if you will. The methodology used to create these lists is not disclosed. Further, these lists are not updated on a regular basis, resulting in pharmacists being reimbursed below what it costs them actually to acquire the drugs. This is a major problem because, when PBMs aren't keeping the cost of generic drugs consistent, those price differentials can be a serious financial burden for pharmacies. Small pharmacy owners face even greater disadvantages than their larger counterparts because of the clear lack of leverage they have when negotiating the amount they will be reimbursed for filling prescriptions when dealing with the PBMs. When we talk about pharmacies closing because they can't keep up with the financial challenge, we are talking about the creation of an access problem also that directly affects patients. It is not just the pharmacies themselves closing down and those folks losing their jobs. It is the patients they serve. When we talk about reimbursement uncertainty for pharmacies, we are talking about uncertainty about patients' ability to get the medications they need at an affordable price. When we talked about a community pharmacist being put out of work, we are talking about taking away a familiar face that local folks trust with their healthcare concerns. To address this problem--and Representative Collins is going to talk about this, and others are--I partnered with him to introduce H.R. 244, the MAC Transparency Act. We have 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. This bipartisan bill would ensure Federal health plan reimbursements to pharmacies to keep pace with generic drug prices, which can skyrocket overnight. So specifically--and I know Mr. Collins is going to talk about this-- it will do three things. It will provide pricing updates at least once every 7 days. It will force disclosure of the sources used to update the maximum allowable cost, or MAC, prices. Again, it is about transparency. It will require PBMs to notify 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 I would like to highlight is the problem of direct and indirect remuneration, or DIR fees. The Centers for Medicare and Medicaid Services, CMS, originally coined DIR fees as a means of assessing the impact on Medicare part D medication costs of drug rebates and other price adjustments applied to prescription drug plans. However, DIR fees have increased greatly over the last year on pharmacies, and, if the pharmacy agrees to enter into a contract with a PBM or part D plan sponsor, it does not seem fair that these mediators can reduce the reimbursement rate since the contract has already been agreed to. This gets a little bit complicated. I know other Members are going to be talking about this later on as well. There is just basically no transparency regarding how the fees are calculated. There is another bill that I have signed on to. I applaud my colleagues, Representative Morgan Griffith, a Republican, and Peter Welch, a Democrat, for introducing the Improving Transparency and Accuracy in Medicare Part D Spending Act. It would prohibit PBMs and plan sponsors who own PBMs from retroactively reducing reimbursement on clean claims submitted by pharmacies after the contract has been submitted. This is a scam, and it shouldn't be happening. I urge everyone, leadership, to bring this to us and everyone to vote for this bill and for our other bill. I want to thank, again, Mr. Collins and the other Members who have been here tonight. It is a great opportunity for me to participate and highlight some problems that our community pharmacists are facing 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 serve while we are here in this Congress. I thank Mr. Collins very much.

Mr. LOEBSACK. Mr. Speaker, I thank the gentleman from Georgia (Mr. Collins) for inviting me to join him in leading this Special Order. I have been in this job long enough to know there are people you don't want to follow when you speak, and Doug Collins is one of those. The guy is absolutely inspired, but he is inspired for a lot of reasons. He has been a strong leader on pharmacy issues. He has been a great partner on the bills that we will discuss this evening. I am proud to say this is a bipartisan issue. Although, at the moment, I am the only Democrat over here, I can assure you there are others who are with us on this issue.

Mr. LOEBSACK

Mr. LOEBSACK. I thank my friend from Arizona. Mr. Speaker, I wasn't going to speak tonight; but after listening to so many folks, I decided to say just a few words. I do want to leave most of the time left for my friend, Mr. Murphy of Pennsylvania, who has been a leader on the mental health front. But I do want to say a couple of things on this issue. Mental health is a really, really important issue to me as it is to so many folks in this body and around the country. I often talk about my mom. She was a single parent with an 11th grade education who struggled with mental illness. Her whole adult life, she was in and out of institutions. This is personal for me. My wife Terry and I, we have two Marine children. My stepson, Terry's son, and his wife are Active Duty at Camp Pendleton. They have a couple of little kids. We do what we can to help them on that front. We had a recent suicide in Iowa City at the VA Medical Center, and we are struggling with how to deal with that as a community and I think as a country overall. The Office of the Inspector General is now looking into the circumstances of that suicide. On Sunday, on 9/11, we had an event that I was honored to attend in honor of Sergeant Ketchum and his family in an attempt to raise money so that we can deal with the issue of PTSD in the military. But it is a much broader issue, obviously--the issue of mental health--that affects all of our society in many, many ways; and Congressman Murphy can speak to that probably as well as anybody in this body. But the bottom line for me, folks--and I have often said this--is that if I accomplish little else while I am in this body other than doing what I can to remove the stigma of mental health, that is going to be one of my accomplishments. I am going to do that by talking about my personal story. I am going to do that by talking about veterans who have taken their own lives, folks who signed on the bottom line and were willing to make that ultimate sacrifice. There is no excuse for this. This should not happen in America. We have to find the resources on a bipartisan basis to make sure that this never happens again to any of our veterans under any circumstances. Mr. Speaker, I thank the gentlewoman for yielding. I really appreciate the opportunity to say a few words.

Mr. LOEBSACK

Mr. LOEBSACK. Mr. Speaker, after being in session for only 74 days so far this year, the Republican leadership has decided to send us home for 7\1/2\ weeks. That is thoroughly unacceptable to the American people. They expect us to do our job. That is not what we are going to be doing for the next 7\1/2\ weeks. We have a laundry list of things that we have to get done. We need comprehensive gun safety reform. We need comprehensive legislation to deal with Zika and other serious bio-threats. We have to deal with the Social Security COLA problem for our seniors, higher education reauthorization, comprehensive mental health reform--we passed some of that in the House, but we have to do more-- comprehensive job package, postal reform, campaign finance reform. You name it, we have to do it. We haven't done it yet. It is time for us to do our job. It is time for the Republicans to bring us back. After those conventions, we could come back in August, folks, and we could get the job done.

Mr. LOEBSACK

Mr. LOEBSACK. Mr. Speaker, I would like to extend my congratulations to Mr. D. Scott Welker on his retirement after 33 years of public service. As Executive Director of the U.S. Joint Munitions Command at the Rock Island Arsenal, Mr. Welker has dedicated his career to improving the safety and security of our Iowa communities and our nation as a whole. His work has directly contributed to the development and success of the Arsenal, the U.S. Army, and all of those privileged to work alongside him. I am proud to recognize Mr. Welker, thank him for everything he has done for our country, and wish him the best in his well-earned retirement.

Mr. LOEBSACK

Mr. LOEBSACK. Mr. Speaker, I yield myself the balance of my time. I thank Chairman Walden for working on this, once again. Thanks to our staffs, again, for working on this compromise. There is just one last thing. I would like to remind folks that transparency is a good thing, and the FCC has good intentions when they talk about transparency and making sure that consumers understand what they are getting for their money. So, as far as I am concerned, we have to continue to provide that transparency, but we have to make sure that we do it in the way that we are doing it in this particular legislation, to have that balance that those ISPs, those small-sized ISPs, can continue to provide that access in the first place, as I mentioned already in my remarks. I thank everyone who has worked on this. It is a great compromise. I wish that we could do this more often here in this body and over in the Senate. I am not such a Pollyanna to believe that this is the beginning of great things to happen, but I think we made real progress here. I again thank Chairman Walden, Ranking Member Eshoo, and our staffs for working on this. I yield back the balance of my time.

Mr. LOEBSACK. Mr. Speaker, I reserve the balance of my time.

Mr. LOEBSACK. Mr. Speaker, I reserve the balance of my time.

Mr. LOEBSACK. Mr. Speaker, I yield 1 minute to the gentlewoman from California (Ms. Eshoo), the ranking member of the Subcommittee on Communications and Technology.

Mr. LOEBSACK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, broadband development is a critical issue for my home State of Iowa, as it is for Congressman Walden's home State of Oregon, as it is for so many rural areas, in particular. We all know how important Internet access is for our constituents. Our students need access to the Internet to do their homework. Our businesses need the Internet to participate in the global economy and engage in the ever-growing world of e-commerce. Our healthcare providers need Internet access to serve patients with innovative telemedicine tools. Our constituents simply can't compete in the 21st century economy that we live in without access to the Internet. It is really that simple. Broadband deployment is especially important in our country's rural areas. Less than half--only 47 percent--of Americans living in rural areas have access to broadband. We as legislators need to do what we can to get these essential services to our constituents. This bill is a commonsense, bipartisan measure, and I thank Congressman Walden for working with me on this bill that will help small Internet service providers throughout the country deploy broadband and serve our constituents. In my home State of Iowa, we have 134--that is 134. We have 99 counties but 134 individual small ISPs. The smallest provider in our State is based in my district and serves only 100 subscribers. As a whole, these companies serve a median of only 750 subscribers. I am proud of the work done by these small businesses that serve the families and businesses that live on farms or in small towns that otherwise might not have any options. Small ISPs do not have the resources that the bigger guys do, and that is the important thing to remember with this bill. I support the FCC's enhanced transparency rules, and I think that it is important to make sure that consumers have the information they need to make informed decisions and to make sure they are protected. It is also important that we find a balance between providing consumers with technical information about their Internet and making sure that consumers have access in the first place. I have heard from small businesses in my district that these rules as proposed by the FCC will pose a significant burden and consume critical resources, potentially limiting their ability to invest in broadband development. For example, they have told me they would have to buy special equipment to measure things like packet loss on their networks. These are companies that may have only one technician on staff, so you can imagine the burden. To address these burdens, this bill would continue the FCC's exemption of small business from the enhanced transparency rules for 5 years. It also instructs the FCC to gather data to determine the impacts of these rules so that we can revisit this issue down the road. When we revisit the issue, we have the opportunity then to figure out the best way to implement these important consumer protections going forward. This short-term exemption gives small ISPs some much-needed certainty, allowing them to focus their resources on broadband deployment and thus serving their consumers. I am glad that Mr. Walden and I were able to work together on a bipartisan compromise, and I thank our respective staffs as well. They did a great job. While the original bill would have permanently exempted companies from the FCC's rule, this bill sunsets after 5 years, giving companies time to comply and giving the FCC time to report back to Congress on the real impact of these rules on consumers. The original bill would have also exempted companies with 500,000 subscribers and 1,500 employees. I and others on the subcommittee were concerned that this threshold was simply too high, and we were able to come to an agreement to exempt ISPs serving half that many subscribers. So this bill before us will give the certainty that small ISPs need, and it will help us achieve what I think we are all working for here, which is both expanded broadband access and the consumer protections that are needed by our constituents. Mr. Speaker, I reserve the balance of my time.

Mr. LOEBSACK

Mr. LOEBSACK. Mr. Speaker, I rise to recognize the Eighth Annual NACDS RxIMPACT Day on Capitol Hill. This is a special day where we recognize pharmacy's contribution to the American healthcare system. This year's event, organized by the National Association of Chain Drug Stores, takes place on March 16-17. Nearly 400 individuals from the pharmacy community--including practicing pharmacists, pharmacy school faculty and students, state pharmacy association representatives and pharmacy company leaders--will visit Capitol Hill. They will share their views with Congress about the importance of supporting legislation that protects access to community and neighborhood pharmacies and that utilizes pharmacists to improve the quality and reduce the costs of providing healthcare. Advocates from over 40 states have travelled to Washington to talk about the pharmacy community's contributions in over 40,000 community pharmacies nationwide. These important healthcare providers are here to educate Congress about the value of pharmacy and the important access provided by community pharmacies in the nation's healthcare delivery system. And just as these providers travelled to meet with us, Members of Congress and their staff have toured retail chain pharmacies in our own communities more than 400 times since 2009. Patients have always relied on their local pharmacist to meet their healthcare needs. The local pharmacist is a trusted, highly accessible healthcare provider deeply committed to providing the highest quality care in the most efficient manner possible. As demand for healthcare services continues to grow, pharmacists have expanded their role in healthcare delivery, partnering with physicians, nurses and other healthcare providers to meet their patients' needs. Innovative services provided by pharmacists do even more to improve patient healthcare. Pharmacists are highly valued by those that rely on them most--those in rural and underserved areas, as well as older Americans, and those struggling to manage chronic diseases. Pharmacy services improve patients' quality of life as well as healthcare affordability. By helping patients take their medications effectively and providing preventive services, pharmacists help avoid more costly forms of care. Pharmacists also help patients identify strategies to save money, such as through better understanding of their pharmacy benefits, using generic medications, and obtaining 90-day supplies of prescription drugs from local pharmacies. Pharmacists are the nation's most accessible healthcare providers. In many communities, especially in rural areas, the local pharmacist is a patient's most direct link to healthcare. Eighty-six percent of Americans reside within a five-mile radius of a community pharmacy. Pharmacists are one of our nation's most trusted healthcare professionals. Utilizing their specialized education, pharmacists play a major role in medication therapy management, disease-state management, immunizations, healthcare screenings, and other healthcare services designed to improve patient health and reduce overall healthcare costs. Pharmacists are also expanding their role into new models of care based on quality of services and outcomes, such as accountable care organizations (ACOs) and medical homes. The pharmacy advocates of NACDS RxIMPACT Day on Capitol Hill are promoting legislation, H.R. 592/S. 314, the Pharmacy and Medically Underserved Areas Enhancement Act, to allow Medicare Part B to utilize pharmacists to their full capability by providing underserved beneficiaries with services, subject to state scope of practice laws. They are also working to ensure that the TRICARE pharmacy program keeps prescription copays affordable for beneficiaries as well as preserving their ability to choose to fill their prescriptions at their community pharmacy. They also are promoting measures, such as H.R. 793/S. 1190, the Ensuring Seniors Access to Local Pharmacies Act of 2015 to guarantee Medicare Part D access and transparency. I believe Congress should look at every opportunity to make sure that pharmacists are allowed to utilize their training to the fullest to provide the services that can improve care, increase access and lower costs. In recognition of the Eighth Annual NACDS RxIMPACT Day on Capitol Hill, I would like to congratulate pharmacy leaders, pharmacists, students, and the entire pharmacy community represented by the National Association of Chain Drug Stores, for their contributions to the health and wellness of the American people.

Mr. LOEBSACK

Mr. LOEBSACK. Mr. Speaker, Mr. Young and I rise today to recognize and congratulate the community colleges of Iowa for 50 years of outstanding service to the state. The community colleges of Iowa have expanded to become our largest provider of postsecondary education. On June 7, 1965, Iowa Governor Harold Hughes signed the first bill into law allowing for the opening and operation of community colleges in the state of Iowa. The following institutions were officially designated the next year: Northeast Iowa, North Iowa Area, Iowa Lakes, Northwest Iowa, Iowa Central, Iowa Valley, Hawkeye, Eastern Iowa, Kirkwood, Des Moines Area, Western Iowa Tech, Iowa Western, Southwestern, Indian Hills, and Southeast Iowa. These fine institutions now provide accessible and affordable education, not only to Iowans, but to students across the country and the world. Their offerings include a wide-ranging, diverse curriculum that serves Iowa's specific workforce needs, including Iowa businesses competing in a global market. Iowa businesses in need of highly trained, specialized workers turn to our community colleges to fill the new, high-paying, high-skilled positions of tomorrow. Mr. Speaker, it is our honor to represent Iowa's community colleges in the United States Congress and it is with great pride that we recognize them today. We ask that our colleagues in the United States House of Representatives join us in congratulating Iowa's community colleges on celebrating their 50th year and for providing a high quality, affordable education for all Iowans. We wish them nothing but continued success in the years to come.

Mr. LOEBSACK

Mr. LOEBSACK. Mr. Speaker, I rise today to congratulate two of my constituents, Arizona Cardinals running back David Johnson and Denver Broncos center James Ferentz, on a remarkable 2015-2016 NFL season. David and James each helped lead their teams to the AFC and NFC conference championship games, and James now has the distinct honor of being called a Super Bowl champion. Having grown up in Clinton and Iowa City, David and James both know the meaning of hard work. This hard work ethic propelled them from the gridirons of the University of Northern Iowa and University of Iowa to the top of their profession. Currently in their rookie and sophomore NFL seasons, each has achieved so much in just a few short years. Their successes can be attributed to the family, friends, teachers, and coaches that continue to challenge the future David Johnsons and James Ferentzes of Iowa. I am honored to represent these men in Congress and look forward to seeing them achieve much more in their careers. The state of Iowa looks forward to watching these young men play on Sundays for years to come. Congratulations on a great season, David and congratulations on becoming Iowa's Super Bowl champion, James.

Mr. LOEBSACK

Mr. LOEBSACK. Mr. Speaker, we celebrate America Recycles Day on November 15. I rise today to pay tribute to the aluminum industry, which has a prominent role in my district, indeed throughout Iowa, and which probably does more than any sector of our economy to advance the cause of recycling. Before recounting the many ways in which aluminum, perhaps more than any other material, contributes to the success of recycling programs across the country, let me make clear why we in Iowa benefit so much from the aluminum industry and its hard-working employees. The aluminum industry is an integral part of the economy of Iowa. The industry operates over 20 facilities, handling all aspects of aluminum manufacturing, throughout Iowa. All told, these facilities employ thousands of workers, and thousands more indirectly and through suppliers. Estimates are that the economic output, between the manufacturing and wholesaling operations in the aluminum industry in Iowa, are around $2.0 billion. Over one billion dollars more in economic impact in the state derives from suppliers and other indirect contributions to the aluminum industry. Thankfully, these are good-paying jobs. Estimates are that wages paid are close to $800 million annually in Iowa as a result of the aluminum industry's footprint in Iowa, taking into account direct and indirect employment. And the state and local governments as a whole benefit, to the tune of well over $100 million in revenue from the aluminum industry. With that backdrop, I am pleased to salute the impact of the aluminum industry on recycling. The list of ways in which recycling pays huge dividends to our nation is long. First, recycling aluminum saves more than 90 percent of the energy that would be needed to create a comparable amount of the metal from raw materials. Think of it this way: by recycling a single aluminum can, you are saving enough energy to power a large screen television for more than 2 hours. Rather than the expense and energy consumption associated with mining and processing raw materials to make aluminum products, recycling used aluminum can be done at a tiny fraction of the energy utilization. That is why recycling is a core business of the aluminum industry. In the U.S., the industry collects nearly 12 billion pounds of aluminum each year for recycling, almost all of which goes back into North American supply. In fact, more than 70 percent of U.S. aluminum production today is in recycled metal--an exact reversal of the trend in 1980. What's more nearly 75% of all aluminum ever produced around the world is still in use today. A used aluminum can is recycled and back on the shelf as a new can in as few as 60 days--something that happens over and over again. And last year, the domestic aluminum industry recycled nearly 60 billion cans-- that saved the equivalent energy of taking 1 million cars off the road for a year. Aluminum saves energy in other ways as well. It can be a tremendous factor in enabling buildings to achieve modem energy efficiency standards. The first LEED-certified building in California, for instance, received this recognition in part because of creative uses of aluminum that cools the building naturally. But energy savings are only part of the story. Companies across the country are incorporating environmental and sustainability objectives into corporate commitments, and aluminum is a major piece of their ability to meet their goals. Perhaps the best aspect of aluminum's recycling story is its role in job creation. No matter our political persuasion, Mr. Speaker, each of us is committed to the creation of U.S. jobs, and aluminum has a wonderful story to tell here. The collection of aluminum at the curb or in the alley creates thousands of jobs around the country, as does the sorting of aluminum at processing centers. Even more jobs are created at plants that receive recycled aluminum, and turn it into new product. More than 157,000 workers are directly employed in the industry, and for each aluminum industry job, an additional 3.3 employment positions are created elsewhere. This story will be enhanced by the commitment of car and truck manufacturers to the widespread use of aluminum in vehicle bodies and parts in the interest of increasing fuel economy by lightweighting vehicles. As these vehicles are no longer in use, rather than being thrown on the scrap heap, they too can be recycled, thereby creating even more jobs. The aluminum industry is a major economic driver in my state and district. In recognition of America Recycles Day, it is appropriate to tip our hat to an industry that has such a positive influence on our nation's economy, and its people.

Mr. LOEBSACK

Mr. LOEBSACK. Mr. Speaker, today, over eighty Iowa veterans of World War II, the Korean War, and the Vietnam War will travel to our nation's capital. Together, they will visit the monuments that were built in their honor by a grateful nation. For many, today will be the first time they will see the National World War II Memorial, the Korean War Veterans Memorial, the Vietnam War Memorial, and Arlington National Cemetery. I can think of no greater honor than to be able to thank Iowa's and our nation's heroes for their service to our country. We owe these heroes a debt of gratitude, and the Honor Flight demonstrates that we as a state and as a country will never forget the debt we owe those who have worn our nation's uniform. As a reminder of the service and sacrifice of the Greatest Generation, I am proud to have a piece of marble in my office from the quarry that was used to build the World War II Memorial. Our World War II, Korean War, and Vietnam War veterans rose to defend not just our nation, but the freedoms, democracy, and values that make our country the greatest nation on earth. They did so as one people and one country. Their sacrifices and determination in the face of great threats to our way of life are both humbling and inspiring. I am tremendously proud to welcome the Eastern Iowa Honor Flight and Iowa's veterans of World War II, the Korean War, and the Vietnam War to our nation's capital today. On behalf of every Iowan I represent, I thank them for their service to our country.

Mr. LOEBSACK

Mr. LOEBSACK. Thank you, Mr. Collins. It is great to be here. I know that you folks have a lot of things going on on your side of the aisle, and it is a testament to your commitment to this issue that you have gotten a number of your colleagues here tonight to speak to this issue, to speak to the importance of independent and community pharmacists. It is really, really important for America that we talk about this. And as Mr. Collins said--and Mr. Carter, I appreciate your invitation as well--it is really important that we speak to how important these folks are for our communities, for health care, for their patients. Mr. Blum, thank you for being here tonight as well. Mr. Blum represents the district that borders me to the north, and he mentioned the Hartig pharmacy. They have a pharmacy in Iowa City, and I took a little bit of time out of my schedule a couple years ago to visit there and to hear the problems that they have when it comes to all kinds of issues. This month, of course, is American Pharmacists Month. It is a month during which we recognize the important role that pharmacies play in our communities. Pharmacists are, in fact, frontline healthcare providers, and they are counselors for many patients who consistently depend on their training and expertise to stay informed, to stay healthy, and to stay out of the hospital. They also play an incredibly important role in strengthening the economies of the areas they serve, particularly in rural counties like so many of those that I represent of the 24 counties I have. It is also crucial that these pharmacies have a level playing field, as was already mentioned by the gentleman from Iowa (Mr. Blum), when trying to run a successful business in a challenging and complex environment. Like most small-business owners, community pharmacists face many challenges to compete and negotiate on a day-to-day basis with large entities on their business transactions. I have personally visited, as I have said, many of these pharmacies in my district, the Second District. I have learned firsthand how they often struggle to compete. One problem I have heard, for example, from many pharmacists is that the reimbursement system--and I am sure we are going to hear more from folks about that tonight--for generic drugs is largely unregulated; and it is, in fact, a mystery to many folks. Generic prescription drugs account for the vast majority of drugs dispensed, so it is critical for pharmacists' bottom line that their reimbursement is transparent. However, pharmacists are reimbursed for generics via the maximum allowable cost, or MAC, lists created by pharmacy benefits managers, PBMs--the drug plan middleman, something we have heard so much about. But the methodology used to create these lists is not disclosed. It is a secret. It shouldn't be a secret. It should be open. We need to have transparency on this front. Also, the lists aren't updated on a regular basis, resulting in pharmacists often being reimbursed below what it costs them to actually acquire the drugs. That makes no sense whatsoever. So to address the problem, I partnered with the gentleman from Georgia (Mr. Collins) to introduce H.R. 244, the MAC Transparency Act. We have a lot of folks onboard on this. It is a bipartisan bill at a time when, as Mr. Collins said, there is not a lot of bipartisanship in this body at the moment. Basically, what this bill would do is it would ensure that Federal health plan reimbursements to pharmacies keep pace with generic drug prices, which can skyrocket overnight, as we know. I am not going to go into great detail at the moment. We have got time to talk about this a little bit more. There are other things we can talk about tonight. But I just wanted to say a few things at the outset and to just thank you again, Mr. Collins and Mr. Carter, for setting this particular time aside so we can really educate our colleagues, as much as anything, about the problems facing independent community pharmacists.

Mr. LOEBSACK. Oh, my gosh. First of all, I want to thank Mr. Carter. It is testimonials like his that I have been hearing for the last 10 years, since I have been in Congress, since I first went to an independent community pharmacist, and you spoke with such great passion. You are not alone, as you know. Every single person like you in my district can tell me the same things that you have told me. That is why I am on these bills. That is why I am talking tonight about these issues. I don't have the firsthand experience that you have as a pharmacist. The closest I ever got to a pharmacy, other than picking up my prescription drugs, before I got into Congress was when I was 16 and 17 years old. I was a delivery boy for Greenville Pharmacy in Sioux City, Iowa, which, by the way, still exists, since 1969. Actually, longer ago than that it was established. But I would deliver prescription drugs to folks, especially to the elderly who couldn't get out of their home, who couldn't get to the pharmacy. That is what this is about, as you said. It is about making sure ultimately. And as a Member of Congress, my job is to make sure that folks have access to affordable quality health care. And that is where pharmacists play such an important role, whether it is with medication therapy management or just simply consulting on an informal basis with someone who comes in and has a lot of different prescriptions and is confused by what to take and when to take them. You folks really do such a wonderful job. And if we lost that service, as you said, because of unfair business practices, because of being squeezed by the big guys--and it doesn't make any sense at all for that to happen--then patients would suffer in the end. That is why I support both of these pieces of legislation, two of these that have been mentioned already. 244, which Mr. Collins just mentioned again, to make sure that everyone understands what it is about, it is a measure that will increase transparency of generic drug payment rates in Medicare part D and the Federal Employees Health Benefits program, which serves a lot of folks, as we know, millions of folks, and in the TRICARE pharmacy program by requiring those PBMs, one, to provide pricing updates at least once every 7 days. That doesn't seem like a lot to ask, to me, and I am sure it doesn't seem like a lot to ask for you; number two, disclose the sources used to update that MAC list and to notify pharmacies of any changes in individual drug prices before these prices can be used as a basis of reimbursement. This is complete common sense. That is why there are Republicans and Democrats alike on this bill, and I hope we can move this bill forward. In Iowa, the State legislature did pass something not quite this comprehensive, but something similar to this, because in Iowa folks understand what these PBMs are doing and what those independent community pharmacists are up against. And the second piece of legislation, H.R. 592 that was already referenced, again, a bipartisan piece of legislation, has got 218 cosponsors. If memory serves me, that is exactly the number we need, if everybody votes, to pass a piece of legislation in this body. We could get it done. If we brought it to the floor, we could get it done. Maybe we ought to do a discharge petition. Sorry. I don't mean to create too many anxieties there with you folks. But, nonetheless, we have got to get this thing done. It is about making sure that our pharmacists are able to continue to deliver the kind of quality health care. Look, whatever we decide at the Federal level when it comes to utilizing pharmacists to their full potential, this legislation does stipulate that nothing will override State scope of practice laws as well. Because I know that a lot of folks in other professions have concerns about that, that pharmacists are going to go too far. Well, they are not going to. If States have laws in place about scope of practice, this legislation will not override that. But it is about making sure, as Mr. Carter said and as Mr. Collins would agree and others who have been so active on these issues would agree--it is about making sure that folks get the quality care that they need. If we close down these pharmacies in these rural areas--95 percent of the folks in Iowa are within 5 miles of an independent community pharmacist--if they close down those pharmacies, those folks in my district who depend upon those pharmacies and those pharmacists are going to suffer. That is unacceptable to me. Thanks again for giving me the time to speak on this.

Mr. LOEBSACK. I just want to say one thing. Pharmacists are among the most respected folks in all of America, and there is a reason for that. Now, Mr. Carter, I realize you went from being a pharmacist to being a Congressman.

Mr. LOEBSACK. We might question your judgment about that kind of a transition, and you are finding out about that; but, nonetheless, every single time I go to a pharmacist, it is the same thing--they care. They care about their patients. Again, I have so many stories, but it would take forever for me to recount all the stories of all of the pharmacies I have gone to in my congressional district over the last 9 years. I have 24 counties. I have a lot of local pharmacies, as you might imagine, and those pharmacists are among the most respected folks in the community. They are right up there with the clergymen; so that tells you something about them and about their profession and about how folks look up to them and about how folks depend upon them. As you just said, they are the folks who get called when they are worried about their prescriptions. They are the folks who can be reached the most easily. Other professionals can be reached, but pharmacists are right there at the ready, and that is very important.

Mr. LOEBSACK. It doesn't serve any of us. It certainly doesn't serve any of us in the end, because those folks are the ones who are serving us, and if they are suppressed--if their voices cannot be heard--that stifles competition. It goes back to the market. It stifles competition, and that is not good for any of us in the end.

Mr. LOEBSACK. Yes. Thank you, Mr. Collins. Thanks again for inviting me and Mr. Carter. I really do appreciate this. As always, Mr. Carter, I have learned something tonight from a pharmacist--I always do--and I really appreciate your comments. I just want to touch upon sort of the issue of the city square. That is so important for so many of our rural districts, as you folks know all too well. It is kind of hard to explain that to our more urban colleagues, but we have to do the best that we can. A pharmacy is so absolutely critical for the economy of a small community. Yes, it is absolutely critical and necessary to serve the population in the area, but it is important for the economy as well. We have a pharmacy--Mahaska Drug in Oskaloosa, Iowa. It is off the square a little bit, but it is such an important institution in its own right. Every Christmas, they have wonderful decorations, and they have things to sell for Christmas. I mean, people come to depend upon them to do the kinds of things they have done in providing not just the pharmacy services but other things as well. If they were to go under as a pharmacy, I am not at all sure that they would survive, and that community would suffer as a result. Folks' choices would be lessened. Their tradition would be hurt. It would be a disaster in many ways for so many of our local communities if those pharmacies were to close down. I, for one, am with you. I am not willing to accept that. I am going to fight as hard as I possibly can with you, and we are going to do it together, holding hands across the aisle, which, as you know, doesn't get done a lot around here; but when we can come together, I think it is important for us to do that. So thanks again for organizing this tonight. I appreciate it.

Mr. LOEBSACK

Mr. LOEBSACK. Mr. Speaker, I rise today to express my strong support for the wind energy industry, the workers that it employs, and the clean energy it produces. My home State of Iowa leads the Nation in the amount of electricity consumers get from wind, with around 30 percent of our electric power coming from wind. It also supports some 80,000 jobs across the country and over 6,000 in Iowa alone. My district is a manufacturing powerhouse, with several major manufacturing facilities, including Siemens, TPI Composites and Trinity Structural Towers. I was happy today to be able to meet with representatives from these companies to discuss the need for Federal policy stability, specifically an extension of the production tax credit. It is my hope that this body will take up a tax extenders bill soon which includes an extension of the renewable energy production tax credit. Please join me in supporting these American manufacturing companies and all the hard-working Americans that they employ.

Mr. LOEBSACK

Mr. LOEBSACK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I rise today in support of S. 1359, the E-Warranty Act of 2015. I am pleased the House is considering this bipartisan, bicameral legislation. S. 1359 is identical to H.R. 3154, the E- Warranty Act of 2015, which I was very, very happy to introduce with my good friend, the gentleman from Oklahoma (Mr. Mullin). This commonsense legislation will bring product warranties into the 21st century by allowing warranty information to be posted online. This solution makes sense for both manufacturers and consumers, as many of which prefer the option of providing or receiving warranty information in electronic rather than paper form. Not only will this bill reduce waste, it will make it easier for consumers to find warranty information quickly and easily, without worrying that it will be lost or discarded. I thank the committee for bringing this bill forward, and I urge support for this bill. I reserve the balance of my time.

Mr. LOEBSACK. Mr. Speaker, it appears that I have no further speakers, so I yield back the balance of my time.

Mr. LOEBSACK

Mr. LOEBSACK. I thank the ranking member for yielding. Mr. Chairman, this legislation, I believe, as Mr. Lance stated, is proof that we can accomplish great things when we put aside partisanship and unite around a common goal. To that end, I want to thank all of my wonderful colleagues here today who have worked on this thing for so long. I am new to the committee, and coming into this and being able to be a part of this is really a great honor for me. I want to thank the chair and the ranking member also for my provision to extend and expand the prior authorization program for prior mobility devices in this bill, providing certainty to Medicare beneficiaries that these critical devices will, in fact, be covered. I am also excited about the NIH innovation fund, which entails mandatory funding, as was mentioned earlier, and will support scientists like those working at the University of Iowa. As a result, we will have more groundbreaking advances like the University of Iowa researchers' discovery of a biomarker that could lead to early detection for the risk of preeclampsia in pregnant women, a discovery that could save countless lives. While I am disappointed that the NIH funding was cut from $10 billion to $8.75 billion, I am hopeful that we can restore this amount as the process moves forward. Finally, I am really happy that we finally have gotten to a point in this body, at least on this legislation, where we can think longer term and not just short term, not just about the costs for this program this year or even for the next 5 years, but think about all the savings that this will entail down the road as well, something that really happens far too often, I think, in this body and over in the Senate as well. I thank my colleagues for their work on this issue. I am really very pleased to be a part of the process. Thank you for having me as a member of that committee and to be a part of the process.