Probably the most controversial issue on the Nov. 7 ballot is the one proponents say could be a game changer in the skyrocketing costs of prescription drugs.
While proponents say the Drug Price Relief Act could save Ohio taxpayers up to $400 million a year, the opposition, funded by the nearly $100 billion annual marketing budget of the pharmaceutical manufacturing industry, are challenging that and other claims in a multi-million advertising campaign.
The advertising campaign funded by those who control drug prices makes use of thinly veiled threats that drug companies will pass any lost profits created by the bill off on veterans groups and individuals on private insurance.
That leaves voters facing a difficult decision going to the polls.
While acknowledging that drug prices are growing out of control, local doctors, pharmacists and public health officials, however, say the proposed legislation has too many negative repercussions to be useful.
The issue
Issue 2, as it will appear on the ballot, asks voters to bar state agencies from paying more for prescription drugs than the U.S. Department of Veterans Affairs.
The VA is the only government agency that negotiates drug prices with drug companies and proponents of the initiative say that the VA pays 20 to 24 percent less than the average price charged to the state for medications. It affects the approximately 3.7 million people who receive medicine from the state through programs such as Medicaid or via prisons or other institutions.
While it is only a fraction of Ohio’s total population, it could eventually spread to other states or government bodies to help drive down costs overall, proponents say.
Veterans groups, including the American Legion, are opposing the measure because they believe it could result in drug companies charging higher prices to the VA to make up for the losses.
While the proposed law may sound good on some levels, it has several flaws — including provisions that the petitioners who proposed the ballot initiative be paid legal fees to sue the state to enforce the law.
That means the individuals who put the measure on the ballot could stand to rake in millions in taxpayer money in legal fees.
Doctors
It’s for these reasons doctors, pharmacists and their professional organizations tend to agree that the ballot proposal is bad for average voters.
“We all know the costs of drugs are way too high,” Dr. Ryan Kauffman, of Hickory Medical Direct, said. “The government and people are all being taken advantage of, but this particular ballot issues, it’s not clear it is going to affect the problem as it is or that it’s going to reduce drug costs.”
Determining the amount the VA pays is difficult, too, as it is not publicly available and does not factor in distribution costs.
“It’s a deeply flawed policy and it’s not clear if it will really reduce drug prices,” said Dr. Kauffman, who is past president of the lone medical association that has come out in support of Issue 2.
The following statement is the official position of the Ohio Academy of Family Physicians, Dr. Kauffman said: “Multiple times every day family physicians encounter patients who are unable to afford the prescription medications needed to restore or maintain their health. Family physicians, being on the front lines of patient care, hear the horror stories about single pills that cost hundreds of dollars. The high cost of prescriptions is a critical issue for our patients, and therefore, for us — but it is an issue that the U.S. Congress and the Ohio General Assembly has failed to address.
“On Aug. 13, the OAFP voted to support Issue 2, the Drug Price Relief Act, because we know something must be done so that Ohioans can afford and have access to needed medications.
This initiated statute is far from perfect, simplistic, and flawed in many respects, and may not be the best approach for addressing high drug costs. But, because of the inaction of state and federal lawmakers, it is all we have. By supporting this issue, we hope to send a message to legislator — the exorbitant cost of medications and the negative impact those costs have on patients must be addressed.”
“They have come out in support of the issue, but it is faint support,” Dr. Kauffman said. He said lawmakers could address the issue without a ballot measure, but most are unwilling to do so because of the large amounts of money the pharmaceutical lobby contributes to political campaigns of both parties and the fact that voters rarely address drug prices as a major concern.
“It’s not a top issue for anybody because it isn’t going to change the way people vote,” Kauffman said. “If people don’t reach out to their legislators to tell them this is an issue that affects all of us, only when they hear that message will they make a change.”
Pharmacists
On the pharmaceutical side of the coin, small businesses are harmed by high prices, but Jeff Holycross, owner of the Aries Pharmacy at Russells Point, said he still cannot support Issue 2.
“I’m against it,” Holycross said. “There are too many things that don’t make sense from a pharmacy pricing standpoint.
“First, nobody can pin down what the VA is paying, and second, the drug manufacturers are likely to raise prices for them.”
He said lower drug prices would benefit pharmacies.
“We would all like to pass a law to curb the drug prices and pharmacists would love to because it affects our bottom line, but this isn’t the answer” he said. “If I thought that was going to work I would be all for it.”
Holycross said one way to address prescription drug costs under the radar of the pharmaceutical lobby is to address an unregulated middleman in pharmaceutical transactions called Pharmacy Benefits Managers.
“It’s been really hard for pharmacy groups to get much traction on this issue,” he said, noting that the benefit manager companies, which include CVS Caremark, Catamaran and Express Scripts, collect exorbitant fees for doing very little in the prescription drug distribution process.
“There seems to be some sort of a groundswell now as legislators recognize it affects government spending,” the pharmacist said.
“But we don’t need to pass legislation state by state on ways to purchase drugs that don’t affect all of us and have the potential to drive prices up more than anything.”
Public health officials
On the public health side, sheriffs departments that staff jails and buy medication for inmates could potentially benefit from passage of Issue 2, but it likely wouldn’t trickle down to county health districts.
Robert Cornwell, director of the Buckeye State Sheriff’s Association, said the group did not take a position on the issue.
While some county jails contract directly through the Ohio Department of Rehabilitation and Corrections and would benefit directly, other counties do not, Cornwell said.
“The price the big counties get versus the smaller counties is pretty comparable,” he said. “Even if it were to pass, there isn’t going to be a huge windfall to the counties.”
Logan County Sheriff Randy Dodds said the local jail does not have a contract with the prison system so his budget would not stand to benefit directly from passage of Issue 2.
Logan County Health Commissioner Boyd Hoddinott said because local health districts are not a state agency they would not be affected.
He said he is making his decision on the issue based on the general consensus of the medical community.
“I’ve tried to look at it, but it is as confusing to me as anyone else,” Dr. Hoddinott said. “Almost every organization is saying vote no and I can’t see any benefit to it. I’m basing my decision on what the organizations are saying.”
But if there is an up side to the issue, it is that it is bringing the conversation about drug prices up a notch on the scale of political importance, he said.
“I think it makes people think about whether we can negotiate these more,” the health commissioner said. “We are starting to ask why are they cheaper in Canada or some other place?
“Hopefully, it moves the conversation forward. Drug costs are a huge problem.”
See more on Ohio Issue 2 here: