Drug company CEOs were in the hot seat Thursday, as Sen. Bernie Sanders (I-Vt.) sought to harness the anger over high drug prices into action.  

During a showy Senate Health Committee hearing, Sanders pressed the CEOs of Merck, Johnson & Johnson and Bristol Myers Squibb about why their medicines cost so much more in the U.S. compared to other countries.  

“The overwhelming beneficiary of high drug prices in America is the pharmaceutical industry,” Sanders said Thursday. “The United States government does not regulate drug companies. With a few exceptions, the drug companies regulate the United States government.” 

He focused on several widely used drugs, including blood thinner Eliquis from Bristol Myers Squibb, Merck’s cancer drug Keytruda, and Johnson & Johnson’s arthritis drug Stelara. 

The Vermont senator has long criticized pharmaceutical companies for their pricing tactics. In a similar hearing last year, he extracted a promise of no insulin price hikes from the CEO of Eli Lilly and Co.

But he received no such guarantees from any of the executives testifying Thursday, and the panel’s top Republican said Sanders was wasting people’s time with a show trial. 

“I wish this were a genuine exercise. I am willing to do the work, my colleagues are too,” Sen. Bill Cassidy (R-La.) said. “This committee has devolved into CEO whack-a-mole with little to show … if this is just to get social media clips of members taking it to a quote unquote greedy CEO, then I suppose that is what some people want to accomplish.” 

Responding to questions from Sanders and other Democrats, the CEOs largely stuck to familiar talking points and blamed the U.S. health system for the substantial differences in list prices.  

Larry Levitt, executive vice president for health policy at the research group KFF, said nobody should have realistically expected the CEOs to promise anything.  

“I would not expect the CEO of a drug company to stand before Congress and just all of a sudden give up millions of dollars in revenues and profits by committing to lowering prices,” Levitt said.  

Any change would have to be driven by Congress, a tall order especially in an election year.  

The executives acknowledged that list prices have increased, but they countered that revenues have not, and more money is going toward paying rebates to pharmacy benefit managers (PBMs). 

“Will you commit today at Bristol Myers Squibb to reduce the list price of Eliquis in the United States to the price that you charge in Canada, where you make a profit?” Sanders asked Chris Boerner, CEO of Bristol Myers Squibb. 

“Senator, we can’t make that commitment primarily because the prices in these two countries have very different systems,” Boerner responded, adding that the company has paid “billions of dollars in rebates” to intermediates that “unfortunately do not go to lowering the price of medicines.” 

Other countries typically pay far less for prescription drugs than the U.S., in large part because their governments control the cost.  

PBMs, which negotiate manufacturer discounts for health plans, do play a role in higher prices, and there are bipartisan bills aimed at modest regulations for the PBM industry.  

But Sanders sought to push back on the PBM angle at the hearing’s outset. 

He noted that Bristol Myers Squibb made $34.6 billion selling Eliquis in the U.S. compared to $22.5 billion in the rest of the world combined. 

“In other words, the U.S. accounts for nearly two-thirds of all global sales of Eliquis. Not a single dollar of this revenue is going to PBMs,” Sanders said.   

Similarly, Johnson & Johnson made more than $30 billion in revenue selling Stelara in the United States since 2016 — more than twice as much as the rest of the world combined, and Sanders noted none that money went to PBMs.  

The hearing came at a pivotal moment as Medicare is allowed for the first time to negotiate the prices of 10 of the most expensive drugs, and each of the three companies has at least one medication that is subject to negotiation. The Biden administration sent out initial offers to manufacturers earlier this month.  

The three companies are all suing the White House over it. 

In the run up to the hearing, Johnson & Johnson CEO Joaquin Duato and Merck CEO Robert Davis initially declined to testify, saying they were not experts on drug pricing. They also accused Sanders of holding the hearing as retribution for the lawsuits. They voluntarily agreed to testify under threat of a subpoena.  

The White House is leaning hard into drug pricing as a campaign pitch for President Biden’s reelection. But Levitt said he was surprised Democratic lawmakers didn’t make a bigger deal about major policy wins. 

“Democrats passed this historic legislation to require Medicare to negotiate prices, and that barely came up in this high-profile hearing on drug prices,” Levitt said.  

The CEOs admitted the companies were still making profits selling their drugs abroad despite the much lower prices, but all three said patient access to drugs in the U.S. is much easier than in other countries.  

“Those drugs mean nothing to anybody who cannot afford it,” Sanders countered.