California voters will decide tomorrow the fate of a drug price control initiative, ending a contentious and expensive campaign that, according to the latest poll, has the state evenly split. At issue is whether to require that pharmaceutical prices for state programs such as Medi-Cal and the state’s prison system be the same as what the Veterans Administration pays. The initiative’s actual impact on overall drug prices is unclear, according to a nonpartisan legislative analysis, but for both supporters and opponents it is likely to be a measurement of just how upset voters are about pharmaceutical prices and whether the industry can convince them that price controls are the wrong way to go. As is typical in California – consultant Bob Shrum once said that in the state “a campaign rally is three people around a television set” – the campaign is being fought out mostly on the television airwaves.


The “Yes” campaign is backed by AIDS Healthcare Foundation chief Michael Weinstein and has the support of Democratic Sen. Bernie Sanders of Vermont, whose failed presidential campaign energized much of the left-leaning primary electorate in California. The California Nurses Association is the most prominent healthcare-oriented group to back the measure, though it also has the support of other high-profile progressive activists. The lead consultant is Garry South, a prominent political adviser who helped engineer Gray Davis’ 1998 gubernatorial win. The campaign focuses its message not on the initiative’s pricing details but on attacking the pharmaceutical industry – its website features unflattering photos of pharma CEOs in FBI-like “Wanted” posters.

The “No” campaign is, unsurprisingly, backed by the pharmaceutical industry, but many medical groups in the state, including the California Medical Association and the California Pharmacists Association, also oppose the measure. Veterans groups, who have expressed concern that the measure might actually lead to increased costs for prescriptions at the VA, are also lined up with the “No” campaign. Television ads against the initiative have featured doctors and veterans.


Much of the coverage about the initiative – in the state as well nationally – has focused on the money pharma companies have put into the campaign to defeat it. Sanders did receive significant coverage for his endorsement of the initiative and his recent visit to the state, but otherwise, much of the coverage focuses either on the politics of the campaign or the television advertisements.


California’s major newspaper editorial boards, despite their varying ideological views, are united against Prop 61. Many cite the unknown consequences of the measure’s passage.


A new public poll released last Friday showed a virtual deadlock for the ballot initiative, with 47 percent saying they would vote for the initiative, 47 percent against and 6 percent undecided. That’s a change from earlier polls, even from earlier last week, when a different public poll showed 51 percent backing Prop 61. In August and September, public polls showed much stronger support for the measure, but those came before the onslaught of commercials, videos and direct mail pieces


The topic of Proposition 61 came up on this week’s earnings calls for at least two manufacturers, Merck and Eli Lilly.

Ken Frazier, Merck

I will say, as an overall comment, we have very serious concerns about this measure and its potential impact on patients. And that’s why we’re part of a growing coalition of groups that are actively opposing that ballot measure in California, because we think it will negatively impact millions of California patients.

John Lechleiter, Eli Lilly

Prop 61, we’re fighting that tooth-and-nail in California. It’s not only bad legislation, it’s bad for your health. And we’re trying to impress that on the voters. What we’ve found is that the more people become aware of what’s at stake here and what’s the likely outcomes of Proposition 61, the more they’re prone to vote against it and vote it down.


If drug prices are the number one health issue in the election (see Kaiser poll below in “Pricing Politics” section), and California is the no. 1 battleground for drug pricing legislation, it would stand to reason that Proposition 61 has galvanized California doctors, right?

Not quite. We queried our proprietary MDigitalLife system, looking at verified doctors with Twitter accounts, to see the extent of the conversation. The volume was underwhelming: just 160 tweets about Prop 61 from docs in the past 90 days. And only eight physicians who practice in California have tweeted on the topic.

But physicians are hardly politically disengaged. For context, Donald Trump turns up in 190,000 tweets over the same time period, and Hillary Clinton figured in 111,000 tweets from physicians. And, for the record, @HillaryClinton is getting more retweets from doctors than @realDonaldTrump: 3,000 to 1,400.

Why these engaged physicians are disengaged about the year’s most prominent drug pricing battle isn’t clear. The issue is complex for 140 characters. Also, many who are sympathetic to price regulation have said the initiative is the wrong way to go (see editorials above.) Or it could be, in a presidential contest with the madcap pacing of a Benny Hill episode, physicians have simply been too distracted by bad hombres, nasty women, and baskets of deplorables to focus on down-ballot measures.