For Issue 2, the Ohio Drug Price Relief Act

This one will be of interest mainly to Ohio readers.
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About a month ago, I had a post which discussed Ohio Issue 2, a.k.a. the Drug Price Relief Act, a citizen initiative which will appear on the November ballot.  Issue 2 would prohibit the state from paying more for any prescription drug than the lowest price paid for the same drug by the VA.  Ohio pays for drugs for approximately 4 million Medicaid recipients and state employees.

In that post, http://bustergammons.blogspot.com/2017/06/big-money-battle-over-ohios-drug-price.html , I said I'd be inclined to vote for Issue 2 because of scare-tactic advertising by its deep-pocket opponents in the drug industry.  That well-financed opposition has some heavy hitters, including the Pharmaceutical Research & Manufacturers of America (PhRMA), the huge drug-maker lobby.  Also opposed to Issue 2 are the predictably conservative Ohio Chamber of Commerce, various local Chambers, drug and medical trade associations, and the Buckeye Institute -- a far right-wing advocacy group, part of a network of of state pressure groups aligned with ALEC, the corporate-funded operation churning out business-wish-list legislation for state and local lawmakers.

In that June post, I held out the possibility that I could be persuaded to change my mind.  Dale Butland, spokesperson for the anti-Issue 2 group Ohioans Against the Deceptive Rx Ballot Issue, contacted me and offered to take me up on it.  He sent me a link to a radio interview and to his group's website.  We exchanged phone numbers and I promised to call, but I haven't.  Mr. Butland is a well-known Democrat, and the former press secretary and chief of staff for the late Senators Howard Metzenbaum and John Glenn.  He's also the former spokesman for Innovation Ohio.  I have great respect for him.  (If you're reading, Dale, sorry to wimp out on the call-back.  I did listen to the radio show and perused the websites of both sides.)  Here are the links to both sites:

For Issue 2:  Ohio Taxpayers For Lower Drug Prices, https://ohio4lowerdrugprices.com
Against Issue 2:  Ohioans Against the Deceptive RX Ballot Issue, www.deceptiverxissue.org

This morning I read the one-sided Columbus Dispatch editorial opposing Issue 2 and urging a no vote.  It could have been written by Ohioans Against the Deceptive Rx Ballot Issue.  Maybe it was.  It was filled with all the same FUD-inducing words:  might, could, unpredictable, potentially, unknown, higher costs, deceptive with little explanation of why and how.  After reading the other available info and today's editorial, I am convinced that voting for Issue 2 is the right thing to do.  I don't normally disagree with Mr. Butland, so call this the exception that proves the rule.

The arguments against Issue 2 are these, with counterpoints in red:

• It doesn't cover all Ohioans, only Medicaid recipients and state employees.  So what?  It covers 4 million Ohioans.
• The Medicaid drug prices for Ohio are already discounted 23%, which is almost the same as the VA's standard 24% discount.  So there's no real benefit.  But there's no harm either.  And importantly, if there's no benefit, no real price reduction, why is PhRMA spending a fortune to fight so hard against it? 
• The VA negotiates discounts deeper than the required 24%.  Those lower prices aren't published, and are subject to frequent change.  Opponents say this means Ohio can't find out the real VA price, which would make Issue 2 "functionally impossible to comply with."  Huh? You're saying the VA would just refuse to divulge its discounted price info if required by law to do so?  Why would they do that?  
• The claim of $400 million annually in drug cost savings is exaggerated.  Maybe, but opponents don't claim it won't save money, only that it might not, due to uncertainty.  And the drug makers are obviously not losing money at VA prices.
• Opponents paint a picture of a zero-sum game, where drug makers always maintain a steady margin, no matter what.  They claim that if Issue 2 forces a price cut here, drug companies will retaliate by jacking up their prices over there, meaning higher prices to the VA or across-the-board to all of us.  So we better let drug makers keep having it their way, or else they might/could/maybe would fuck us even worse.  Do you believe the pharmaceutical industry would take petty vengeance on Ohio for insisting on somewhat larger discounts for Medicaid recipients?  Do think the drug makers would find it wise to very publicly adopt the full-greed, screw-you posture of Mylan EpiPen or "Pharma Bro" Martin Shkreli?  Or might they more reasonably decide the mandated pricing isn't so bad after all, since they'd still be holding sufficient profit margins?

The anti-Issue 2 side is engaging in the sort of speculation, fear-mongering and negative ad messaging typically found in conservative political campaigning.  I understand that Issue 2 comes without guarantees, but for all their scare tactics about higher costs and what might happen or could happen, Issue 2 could just as easily trigger overall drug price reductions for Ohioans not directly involved with the state.  Whatever its consequences if passed, Issue 2 surely won't bring the apocalypse threatened by its opponents.

I also think its useful to consider the big-money interests fighting so hard and spending so freely to defeat Issue 2.  I cannot recall the PhRMA lobby, the Chamber of Commerce, the Buckeye Institute, or ALEC demonstrating a history of being consumer-friendly, and I seriously doubt these leopards have suddenly changed their spots.  Facing such opposition, Issue 2 faces a difficult uphill battle.

Issue 2 is supported and primarily funded by the AIDS Healthcare Foundation (AHF), a California non-profit.

It's David vs. Goliath.  Vote yes on Issue 2.