WASHINGTON — There were no Martin Shkreli moments.

Instead, Tuesday’s congressional hearing on high drug prices served mostly as a retreading of arguments that lawmakers and the drug industry have spent years fine-tuning.

“I’ve heard a lot of happy talk this morning,” said Sen. Ron Wyden (Ore.), the Senate Finance Committee’s top Democrat. “But what people are taking away from this hearing … well, no firm commitments have been made to lower list prices.”

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The hearing had all the makings of a high-profile Washington event, complete with lines snaking out the door, full of people paid by lobbyists to hold their place, and cameras flashing in executives’ faces.

But the executives from seven pharmaceutical manufacturers — Merck, Pfizer (PFE), AstraZeneca, Johnson & Johnson, AbbVie (ABBV), Sanofi (SNY), and Bristol-Myers Squibb — largely dodged the tougher lines of questioning from the panel’s mostly staid members. They pivoted, again and again, to well-worn lines of defense about the promise of innovation and new cures.

Drug executives slipped away from most attempts to shame them for perceived bad behavior. In one case, executives directly misled the panel: All seven insisted their companies had never blocked access to drug samples for generic manufacturers. An FDA database, in fact, shows that Pfizer and AstraZeneca — as well as Celgene (CELGZ), a company Bristol-Myers Squibb is working to acquire — have been accused of doing so.

The committee members offered less bombastic salvos than the diatribes that politicians like Sens. Bernie Sanders and Elizabeth Warren — to say nothing of President Trump — have frequently launched at drug makers. They barely batted an eye, for example, when the business leaders shifted blame for high prices to others in the supply chain — despite Chairman Chuck Grassley’s opening warning that such lines wouldn’t stick.

For the most part, both the senators and the panelists were respectful — perhaps disappointing those who expected a dressing-down in the style of Martin Shkreli or Mylan CEO Heather Bresch, or even the famous 1994 hearings in which tobacco executives were called to account for causing a public health crisis.

Even the hearing’s most intense moments didn’t quite hit the mark. In one memorable exchange, Sen. Bill Cassidy (R-La.) brandished two bottles of over-the-counter medication — Pepcid and ibuprofen. He then castigated a drug manufacturer for combining the two medications into a single drug that costs $2,300 for a 90-day supply.

“It is almost as if the taxpayer has stupid written across their face,” Cassidy said at one point. “Which they shouldn’t.”

The one hiccup: The medication, Duexis, is manufactured by the drug company Horizon — whose chief executive was not present.

One of the most confrontational moments wasn’t even about drug pricing at all. Sen. Maggie Hassan (D-N.H.), instead aggressively questioned Johnson & Johnson executive Jennifer Taubert regarding the company’s role in the opioid crisis.

Grassley, who warned at the outset that Americans are “tired of the blame game,” also reminded the executives that lying to Congress is illegal. Wyden, at one point, likened AbbVie’s protection of patents for its arthritis drug Humira to a Lord of the Rings character — “Gollum with his ring.”

On the issue of drug pricing itself, senators’ lines of questioning were scattered.

Grassley struggled to pronounce the names of the seven pharmaceutical executives called to testify. Sen. John Cornyn (R-Texas) aggressively went after AbbVie for its safeguarding Humira’s patent protection. Sen. Sherrod Brown (D-Ohio), a potential presidential candidate, highlighted his desire that Medicare negotiate drug prices directly.

Though both Democrats and Republicans had repeatedly warned pharmaceutical executives against shifting blame to other players in the supply chain, many of the drug industry executives did so anyway. After retreading arguments about heavy investments in research and development, several CEOs attempted to cast both insurers and pharmacy benefit managers as at least co-equal culprits in the high drug prices Americans have come to view as excessive.

Many of the companies also argued that while a drug’s list price often receives substantial attention from lawmakers, it has little bearing on patients. (Patients costs are often determined, in part, by a fraction of a drug’s list price.) Grassley and President Trump’s health secretary, Alex Azar, have repeatedly attempted to discredit that argument.

Executives from AbbVie, AstraZeneca, Bristol Myers-Squibb, and Pfizer also expressed support for the Trump administration’s proposed rule to ban rebates drug manufacturers pay to insurers — either hinting at approval or endorsing the proposal directly. Representatives of Johnson & Johnson, Merck, Sanofi also expressed, at length, a desire to reform the rebate system. Each of the seven CEOs, while expressing caution, indicated rebate reform would likely lead to lower list prices.

Four of the seven companies also endorsed a version of the CREATES Act — legislation that aims to prevent brand-name pharmaceutical manufacturers from refusing to sell drugs to generic companies, effectively increasing generic competition. The Congressional Budget Office has estimated that versions of the bill could save Medicare and Medicaid nearly $4 billion over the course of a decade.

Nicholas Florko contributed reporting.

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  • It’s not the FDA that stops patients from purchasing direct as you call it. States require medications to be dispensed by prescription from a licensed pharmacy. Pharmaceutical companies have and do own pharmacies (mail order or specialty). However, the payers/PBMs refuse to put the pharmacy in their network so patients with insurance coverage can’t access.

  • I watched what could be called a “Dog and Pony” Show. The most important set of culprits were not there. PBMs and Insurance companies who create the formularies. One has to pay to be on the formulary. Higher price ($100.00 per pill) from company “A” @ 20% rebate pays higher absolute dollar $20.00 rebate to PBM1 vs. lower price from company B ($80.00 per pill) @ 20% rebate pays $16.00. PBM will include company A on the formulary. Middleman wins and patient who cares in a mutually subsidized system.

    If patient can buy directly from the pharma companies and no middleman, we will or should see prices drop. However, Ms/r. FDA would prevent this to happen.

    If anything meaningful happens in the next 600 DAYS it would be a MIRACLE.

    Life will go on.

    • It’s not the FDA that stops patients from purchasing direct as you call it. States require medications to be dispensed by prescription from a licensed pharmacy. Pharmaceutical companies have and do own pharmacies (mail order or specialty). However, the payers/PBMs refuse to put the pharmacy in their network so patients with insurance coverage can’t access.

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