Drug politics

April 27, 2004

FORTRESS PHARMACEUTICAL, the drug industry's mighty resistance to cutting consumers a break on medicine costs, took a bad hit last week.

After 14 months of foot-dragging, the Bush administration reluctantly granted approval for five states to form a purchasing cooperative to negotiate discounts for Medicaid patients. Maryland was among the first of what is likely to be a rash of states seeking to join in.

This is only another milestone marking what is expected to remain a protracted battle to inject some fairness and rationality into drug pricing. But it may well be viewed in hindsight as a watershed moment.

But only if voters keep the pressure on.

The Bush administration and state officials throughout the nation are responding to both voter demand for lower drug costs - particularly among those without health insurance - and the huge holes paying top dollar for brand-name pharmaceuticals has created in budgets already ravaged by recession. They'd rather fight the drug lobby than raise taxes.

Similar pressures have produced initiatives in several states and cities - and been supported by half or more members of Congress - to buy pharmaceuticals from Canada, where the government is already using its buying power to score deep discounts.

In Maine, where busloads of elderly residents headed regularly to Canadian pharmacies, state officials created a program to dicker on their own for cheap drugs on behalf of uninsured Maine residents and last year won a landmark Supreme Court decision that rejected the drugmakers' claims that they had no right to do so.

Progress should now come more swiftly. If most or all of the states use their combined leverage to get a better deal for Medicaid recipients, why not for state employees as well? Maryland also has its eye on a bargain for HIV/AIDS medications, which could mean substantial savings and expanded treatment.

With baby boomers looking to cash in soon on that Medicare prescription drug benefit, shrewd bargaining for discounts offers the only responsible plan for meeting that demand.

The drug lobby is defending its turf with heavy artillery, warning that the result will be HMO-like drug programs that put cost concerns above patient needs.

That would be a nightmare for the pharmaceutical industry, which maintains its huge profits in part through lavish advertising that sends customers to their doctors demanding the latest miracle potions they've seen on TV.

For most patients, though, a lot more discipline applied to the way drugs are prescribed and administered - favoring generics and over-the-counter alternatives to the latest designer drug - would be healthy.

If patients and taxpayers keep hurling rocks at the ramparts of Fortress Pharmaceutical, sooner or later the unsustainable price structure will finally collapse.

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