Two very different systems
The VA and the various state programs impacted by Issue 2 are very different in how they purchase drugs — a distinction that isn’t taken into account in the wording of Issue 2, opponents say.
“Unlike the VA, Medicaid does not buy drugs in bulk or otherwise directly buy from wholesalers and then distribute or dispense drugs through its own pharmacy system. So Medicaid has additional costs in its net cost paid for drugs that are associated with getting prescriptions filled by a retail pharmacy — costs that are not reflected in the benchmark VA price,” the consultant report says.
Issue 2 would not change the amount the pharmacy pays for the drug, but would restrict the amount a statefunded health plan like Medicaid could reimburse the pharmacy. This is why the Ohio Pharmacists Association is against the measure. It fears pharmacists will lose money on many prescriptions filled for Medicaid patients, a situation that is already happening and forcing community pharmacies to close, the association says.
Because its patient population is older, the VA doesn’t purchase as many different types of drugs as programs like Medicaid. If the VA does not purchase a drug — like a medicine used on infants for example — Issue 2’s rules would not apply to that drug. Supporters say the state would continue to pay the prices it does now for those drugs. But opponents say there is ambiguity in the proposed law.
“Because Issue 2 lacks any operational guidelines regarding how drugs not on the VA formulary are to be handled, whether the state could continue to purchase those life-saving drugs — and at what price — are open to question,” the Ohio Chapter of the American Academy of Pediatrics said.
Issue 2 proponents say it would be up to the legislature to work out those details.
“(Big pharma) wouldn’t be spending $50 million if this didn’t hurt them,” said Weinstein, using a figure he claims the opposition will spend by Nov. 7. He said the ballot language allows Ohio to figure out how to make the law work after it’s passed.