[Ip-health] Big Pharma Can Be Beaten: This Union Just Proved It

Fran Quigley fwquigley at gmail.com
Sun Aug 20 10:19:35 PDT 2017



	No one in Nevada or elsewhere is claiming that these measures will alone fix the drug pricing crisis. But they are a historic first step toward doing so, especially since many observers believed that the powerful pharmaceutical lobby would easily block all reform efforts. Last April, the Wall Street brokerage and research firm Bernstein issued a report concluding that state-level drug pricing proposals are "a very modest risk to pharma, if at all." The industry "is very much on the ball" in opposing reform, Bernstein concluded. 
	That prediction was partly on target, as the industry was definitely on the ball in Nevada. It hired dozens of lobbyists in the state, launched an aggressive social media campaign, and threatened lawsuits to challenge any legislation. Yet the industry was beaten, and advocates across the world have taken note. 	

	How was this victory won, and what lessons can be learned by other patients, activists and lawmakers wanting to build on the Nevada success? Here are the highlights. 

Grassroots Organizing Works

	No clever slogan, ad campaign, or social media plea will singlehandedly beat Big Pharma, says Bethany Khan, communications director of the Culinary Union. “You have to organize, and you have to organize every day,” she says. 

	Fortunately, Khan and her colleagues were no strangers to that challenge. With 57,000 members, the Culinary Union is the largest local of UNITE HERE, and has a reputation for being unafraid of a fight. In the 1980s and 1990s, the union led multiple fiercely contested strikes at Las Vegas casinos, including a battle with the Frontier Hotel and Casino that lasted six-plus years, the longest successful hotel strike in history. The union that stands toe-to-toe every day with some of the richest casinos in the country was not fazed by Wall Street analysts concluding that the pharma industry was unbeatable.

	As the legislative session began, union workers and allies flooded each legislator’s district with door-to-door campaigning and thousands of phone calls supporting the insulin pricing bill. For those who think of labor struggles as focusing only on wages and collective bargaining, it may be surprising that the Culinary Union put its full strength behind a piece of drug pricing legislation. But the union’s Culinary Health Fund provides health insurance for over 140,000 Nevadans who are union members or their dependents. Diabetes care is the fund’s fastest-growing cost, rising over 20 percent in 2016 alone. 

Election Support for Progressive Candidates Pays Off
	It is an age-old debate among activists: Should resources and time be put solely into issue agendas, or should sympathetic political candidates be supported along with a policy fight?	The Nevada experience provides a compelling argument for activist engagement in winnable election contests, since the state’s new insulin law owes its existence to the Culinary Union’s deep dive into electoral politics. 

	In 2016, the union made the decision to allow 300 of its members to take two-month leaves of absence to engage in grassroots campaigning. Those members talked to tens of thousands of Nevada voters and delivered 54,000 early votes. Not coincidentally, the 2016 election caused Nevada’s State Senate and State Assembly to flip from Republican majorities to Democrat control. 


Popular Support Should Beat Pharma Money 

	Despite all the dollars and influence Big Pharma brought to bear in Nevada, Senator Cancela says the lobby does not intimidate her. “Of course the drug company lobbyists have a long reach, but when the conversation becomes about what the overwhelming majority of voters want to see happen, pharma should have no chance,” she says. 

	Cancela knew that there is one thing that lawmakers care more about than campaign donations and lobbyist pressure: their reelection. So she used some of her campaign funds to commission a poll on the drug pricing crisis. The plan was to show her colleagues that following the pharma agenda would put their political futures at risk.

	The results from Cancela’s poll made that case, and then some. In the weeks before the final votes on the insulin bill, 80 percent of a sampling of Nevadans told David Binder Research that they felt prescription drugs costs were too high. A strong majority blamed pharmaceutical companies. Cancela’s poll aimed at the heart of lawmakers’ self-interests, revealing that a plurality of Nevadans said they would be less likely to vote for their legislator if the legislator voted against controlling the price of insulin. If the dissenting legislator was revealed to have taken contributions from pharmaceutical companies, that vote-against number went up to a whopping 71 percent. 

	“That poll gave voice to the hundreds of thousands of people who could not come to the legislature in person, but who supported the change,” Cancela says. “When the conversation becomes about public support, pharma’s political power disappears.”

Odd-Bedfellow Coalitions Await


	The union knew it was not alone. Its Culinary Health Fund is a member of the Nevada Health Services Coalition, made up of 21 organizations that are similarly self-insured, including huge Nevada gaming corporations like Caesar’s and the Tropicana. After the union urged them to calculate their own spiraling diabetes and prescription drug costs, the companies came on board in support of the insulin legislation. They brought along political clout and a pro-business perspective that helped woo Republican legislators and the Republican governor.

	With the average employer’s health care costs increasing far faster than the rate of inflation, and drug prices a top driver of those increases, Nevada advocates say this type of labor-business alliance should be a viable strategy in every state.


	The Nevada law will not fix these problems overnight. The most ambitious portions of the original proposal, including a de facto price cap of mandatory rebates for prices that exceed inflation, were removed in the course of the legislative sausage-making. But Governor Sandoval said he would be open to revisiting the pricing problem, and advocates plan to take him up on that. 
In the meantime, mandatory disclosures of marketing and manufacturing costs begin the long-overdue process of regulating an industry that has managed to enjoy enormous public funding with no companion oversight of its pricing. 

	“Once we get the insulin pricing data over the next two years, then we can start to ask, ‘Why shouldn’t we do this with hepatitis C drugs, and why not with all drugs?’” Cancela says.


	Nevada’s new law does not include all that the Culinary Union and Senator Cancela wanted. And they expect the industry to file lawsuits to block what did pass, and to resist honest disclosure at every turn. But Cancela points to how the impact of the drug pricing crisis is so broad that it includes a personal reach up to and including the governor of her state. 

	That gives her confidence that the cause will ultimately prevail. “The stories are heartbreaking, and the numbers for changing this make sense,” she says. “Doing nothing is no longer an option.”

Fran Quigley
PFAM: People of Faith for Access to Medicines, www.pfamrx.org, (317) 750-4891
Also: Clinical Professor, Health & Human Rights Clinic, Indiana University McKinney School of Law

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