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laying down their weapons. Would they try to raise VA prices? Would they try to make up the lost profits by raising prices in the uncapped parts of California’s healthcare markets? Opponents have exploited those uncertainties in their anti-Prop. 61 advertising, which the San Francisco Chronicle editorial board called an “industry-bankrolled disingenuous advertising blitz.” (The Chronicle recommended a “no” vote nonetheless.)
A few companies or executives have acknowledged the need to do something about prices; perhaps good intentions, or at least fear of a public-relations hit, would steer them toward some form of compliance. But other than a few test cases, such as Novartis and insurers inking “pay for performance” deals for a few products including the heart-failure drug sacubitril/valsartan (Entresto), ideas to change the way America pays for drugs have remained ideas. (And to be clear, just because a drug company might agree to be paid based on how much its drugs help patients doesn’t mean the transaction will be transparent.)
The Prop. 61 fight has now surpassed the dollar amount spent on another highly-contested California measure: Prop. 8, which aimed to ban same-sex marriage in 2008. The fight over same-sex marriage has also featured state-level maneuvering on both sides and threats of unintended consequences. Finally it was decided by the highest court in the land—the ultimate federal arbiter. Prop. 61, win or lose, is certainly contributing to the national conversation about drug pricing. But for big changes ultimately to come from Washington, DC, in the next few years, a few other races on next week’s ballot, including the one at the top of the ticket, will have to swing against the drug industry, too.