[Ip-health] California Drug Price Plan Is Criticized by Patient Advocates

Claire Cassedy claire.cassedy at keionline.org
Wed Aug 3 12:47:44 PDT 2016


http://www.nytimes.com/2016/07/05/business/california-drug-price-plan-is-criticized-by-patient-advocates.html?rref=collection/sectioncollection/health&_r=0

California Drug Price Plan Is Criticized by Patient Advocates

By ANDREW POLLACK  JULY 4, 2016

LOS ANGELES — A state ballot initiative meant to lower prescription drug
prices for California faces an expected opponent: the pharmaceutical
industry, which has spent almost $70 million to defeat it.

But concerns are also coming from a more curious source: some patient
advocacy groups.

Called the Drug Price Relief Act, or Proposition 61, the proposal would
prohibit state programs, such as California’s Medicaid, from paying more
for a drug than the lowest price paid by the federal Department of Veterans
Affairs, which typically receives big discounts.

It promises to be the most prominent measure in November’s election to deal
directly with pharmaceutical prices. And because the effort is happening in
California, the most populous state and a trendsetter, the approach could
quickly spread to other states if it is approved.

Yet how much, if any, money would be saved is a matter of hot debate,
highlighting the complicated world of drug pricing. In recent weeks, there
has even been a nasty spat between some AIDS activists — who say the
proposal might inadvertently lead to price increases — and Senator Bernie
Sanders, the Democratic presidential hopeful, who supports the measure.

“We agree with the proponents that we need to do something, but we just
don’t think this is it,” said Anne Donnelly, director of health care policy
at Project Inform, an advocacy group based in California for people with
H.I.V. and hepatitis C. “It doesn’t appear to save the State of California
perhaps any money, and it could have some negative effects.”

Drug prices have become a big public concern and an issue in the
presidential campaign, in part because of huge price increases on
decades-old drugs by Valeant Pharmaceuticals and Turing Pharmaceuticals,
the company founded by Martin Shkreli. A furor also arose over the $1,000 a
pill that Gilead Sciences charged for its hepatitis C drug Sovaldi, which
strained health care budgets. And list prices for a huge number of drugs to
treat various conditions increase 10 percent or more each year.

Still, federal legislation to address drug prices is considered unlikely in
an election year. So some proponents of greater action have turned to
states.

In June, Vermont enacted the nation’s first so-called pharmaceutical cost
transparency bill, which will require drug companies to justify certain big
price increases.

Last Tuesday, the California Assembly’s health committee approved a bill,
already passed by the State Senate, that would require drug makers to give
advance notice of big price increases and to justify them. Several other
states have cost transparency bills, though most have not gotten very far.

In Ohio, a voter initiative similar to the one in California has been
caught up in litigation filed by the pharmaceutical industry and other
business groups and might not make it to the ballot in November.

Supporters of the California proposal, including the California Nurses
Association and the California branch of AARP, say it could save the state
several hundred million dollars a year on the more than $4 billion it now
spends on medicines for about five million to seven million people.

Proponents also say it might spur private insurers to seek bigger discounts
as well.

“We believe it will have an overall effect of lowering prices across the
board for all payers,” said Michael Weinstein, president of the AIDS
Healthcare Foundation, which sponsored the initiatives in California and
Ohio.

Pharmaceutical companies, worried about a precedent being set, have
contributed $68.5 million to the opposition campaign, which calls itself
Californians Against the Misleading Rx Measure. That swamps the $4.4
million contributed in support of the measure, virtually all from the AIDS
Healthcare Foundation.

“It’s a fairly straightforward expansion of price controls,” said Stephen
J. Ubl, president of the Pharmaceutical Research and Manufacturers of
America, the industry’s main lobbying group.

Concerns about the measure center on how it would actually work and whether
it could even be put into practice.

The California Public Employees’ Retirement System, which spends nearly $2
billion a year on drugs and would be affected by the measure, said the
proposal “might possibly provide cost savings” but could disrupt the
contracts the group already had with pharmacy benefit managers and would be
hard to administer.

The California Medical Association, which represents doctors, called it
“deeply flawed and unworkable.”

One concern is that if drug companies are forced to lower prices for state
programs, they might try to raise the prices they charge Veterans Affairs
and commercial health plans.

“Veterans are special,” Mr. Ubl, of the pharmaceutical trade organization,
said. “To the degree the veterans population becomes a larger population, I
think it undermines the economics of the situation.”

Another issue is that the rebates and discounts offered by drug companies
are typically confidential, making it difficult to determine whether a
state agency is paying less than Veterans Affairs. The state Legislative
Analyst’s Office said the impact of the proposal was “highly uncertain,” in
part because of the opacity of drug prices.

“You’re taking one set of numbers where there’s no transparency and another
set of numbers where there’s no transparency and trying to compare them,”
said Tim Horn, H.I.V. project director for the Treatment Action Group, an
advocacy organization.

Veterans Affairs tends to pay the lowest prices for drugs, in part because
it gets mandatory discounts under federal law. A report by the
Congressional Budget Office in 2005 said the department was paying on
average 42 percent of list price for name-brand drugs while Medicaid was
paying 51 percent. The gap between Veterans Affairs and Medicare or private
insurers is even bigger.

Proponents of the measure have filed Freedom of Information requests to
bolster their case that price information can be obtained. They also say
that it would be difficult for pharmaceutical companies to raise the prices
they charge Veterans Affairs, and vindictive if they were to do so.

Sniping over the California measure intensified after Senator Sanders met
with 19 AIDS activists in San Bernardino in late May and then issued a news
release praising the initiative. The activists said Mr. Sanders had falsely
implied that they endorsed the measure when they had reservations about it.
The campaign in favor of the ballot initiative then accused the AIDS
activists of “shilling for Big Pharma.”

Mr. Weinstein and the AIDS Healthcare Foundation have long been at odds
with other AIDS advocacy groups. For instance, he has run almost a one-man
campaign against use of a Gilead drug to prevent H.I.V. infection,
something some other activists support.

The nonprofit AIDS Healthcare Foundation runs treatment centers in many
states and countries. It had about $1 billion in revenue last year, $800
million of which came from pharmacies it operates, which can mark up prices
on the drugs they provide to patients.

Mr. Weinstein is a vocal critic of Gilead, the leading supplier of drugs
for H.I.V. and hepatitis C. He recently had a caravan of vehicles,
including a hearse, pass by an investor conference where Gilead was making
a presentation. A plane flew overhead towing a banner that read “Gilead
Greed Kills.”

Calling attention to pharmaceutical industry “greed” is a crucial strategy
of the campaign in favor of the proposition, as illustrated by its website,
StopPharmaGreed.com.

It also points out that many opponents of the measure — including some
politicians and doctors, and the AIDS advocacy groups that raised questions
— receive money from the industry.

Ms. Donnelly of Project Inform, the AIDS advocacy organization, said the
accusation was “an unfair attack designed to obfuscate poor policy.” She
says that while her organization receives some money from drug companies,
it often takes positions unfavorable to the industry.

Public opinion polls by third parties have not yet been taken on the
initiative. Early polls often mean little in any case. Generally,
industries have succeeded when they have spent huge amounts to defeat
ballot initiatives in California.

In 2005, drug companies beat back a measure that would have essentially
required discounts on medicines for some Californians.



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