Seven top pharma executives testified before Congress on Tuesday about the rising cost of medications in what some had predicted to be a watershed moment for the pharmaceutical industry. They were grilled about their pricing process, profit margins, and even their own salaries as lawmakers expressed outrage about high drug prices, including those for the lifesaving, necessary medications that so many Americans are now struggling to afford.

But that conversation, and the lawmakers’ outrage, centered around a specific group of Americans: those with health insurance. Senate Finance Committee Chairman Sen. Chuck Grassley (R-Iowa) opened the hearing by describing how high list prices hurt “those with high deductibles” and “taxpayers,” but not once did he mention the uninsured. Not only were the uninsured ignored, they were talked about as if they didn’t exist or were at best an afterthought.

In fact, the uninsured very much exist. Today, there are 27 million Americans without insurance — about 1 in 12 people — and that number is growing.

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I know this group well. These are the people who come to the 1,400 free and charitable clinics managed by my organization, the National Association of Free & Charitable Clinics. These clinics, which span the United States, rely on the time and charity of more than 200,000 volunteers. As CEO of the association, I was one of 50 people allowed into the hearing room as the pharma executives testified. While I applaud Congress for finally getting these executives to speak, I noticed some significant gaps in the lines of questioning.

The needs of the millions of uninsured Americans were mentioned only once during the 3.5 hours of testimony when Sen. Steve Daines (R-Mont.) asked the seven executives, “Who pays list price?” Merck CEO Ken Frazier responded by saying, “There’s a small percentage of people who have no insurance who could actually be charged the list price.” He also said that in our current system, “the poorest and the sickest are subsidizing others.” Daines summarized the issue this way: “So the people who can afford it the least, arguably, are paying the list price?”

List prices came up again and again throughout the testimony. The general consensus during the hearing appeared to be that no one actually pays the list price. Here’s how a columnist for MedPage Today explained how drug pricing works: “The manufacturer sets a ‘list price’ which, like the chargemaster in a hospital, is a bargaining position — no one actually pays it (except the unfortunate uninsured patient).”

Lying within those parentheses are 27 million people.

Many of the individuals who attend our clinics are not insured, and even $10 for medication is a lot of money, let alone the minimum $150 needed to buy a single vial of insulin. Some of them have no choice but to ration medications, taking lower doses of them or stopping them altogether. There’s no shortage of such stories, from young adults starving themselves to reduce the amount of insulin they need to use to parents starving themselves to afford insulin for their children. In our network of clinics, this is a lived reality.

The pharmaceutical industry and Congress seem to have forgotten the uninsured and the people who come to our clinics for health care.

In a time when few issues are truly bipartisan, and health care becomes ever more divisive, the exponential growth of drug prices is a rare issue that crosses the aisle. Needing insulin isn’t red or blue, nor is using an EpiPen or depending on an inhaler to breathe. No one should feel their health and well-being is subject to a CEO’s whims to double the price of a medication overnight. We need to harness this rare moment of unity and push for true progress.

Our democratically elected lawmakers have a responsibility to all of their constituents — insured and uninsured — to make sure they can access the medications they need to stay alive. This isn’t the first time we’ve had this conversation. It’s been 60 years since pharma first testified before Congress, but nothing has changed.

I know that lawmakers realize how important it is to have the conversation about unaffordable drug prices once and for all, so we can fix this broken system. I want to make sure we get it right this time around. America’s free and charitable clinics try to catch the people who slip through the cracks. But if we don’t stop this unchecked rise in the cost of medications, I fear these cracks will widen until they threaten the foundation of our health care system.

Nicole Lamoureux is CEO of the National Association of Free & Charitable Clinics.

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  • This is also the way treatment at doctors offices and hospitals work. Those among us who have the least, pay the most. The business of healthcare is beyond broken in this country, and why would a CEO making $27m a year care?

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