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OPA urges opposition to Issue 2, the deceptive drug pricing ballot initiative

The Ohio Pharmacists Association (OPA) has joined a growing coalition of stakeholders, experts, and patients in opposition to Issue 2 the so-called “Ohio Drug Price Relief Act” - a proposal (referred to as an initiated statute) that will be on the November 2017 ballot in Ohio.

Stop the deceptive Rx ballot issueAs part of the Ohioans Against the Deceptive Rx Ballot Issue coalition, OPA will be working hard to defeat a measure that could have serious negative consequences for pharmacies, payers, employers, veterans, and patients.

The "Ohio Drug Price Relief Act" is being pushed by controversial California activist Michael Weinstein, and would prohibit Ohio’s state government from paying any more for prescription drugs than the lowest price paid by the United States Department of Veterans Affairs. 

A very similar proposal, “Proposition 61,” was soundly defeated in California last year, and was opposed by more than 100 different health organizations, civic organizations, veterans groups, taxpayer organizations, business groups, and unions. It was also opposed by nearly every major newspaper—liberal, conservative and moderate alike—in the state of California.

It's no secret that OPA has been very outspoken about the problems with prescription drug pricing (see here, here, here, and here). We've spent a great deal of time working with reporters and lawmakers across the country to reform a broken system that rewards big supply chain middlemen and results in higher drug costs for employers, taxpayers, and patients. We continue to advocate for legislation to bring about increased transparency and competition into a system that is incredibly secretive and anti-competitive.

Unfortunately, the inaccurately dubbed "Ohio Drug Price Relief Act" will not only fail to accomplish its intended goals, but if approved, the measure could actually result in major price increases for millions of Ohioans.

Specifically for pharmacists, this measure is extremely concerning due to its bad wording and seemingly poor understanding of how prescription drugs are bought and sold. While Issue 2 would prohibit government programs from paying any more than VA prices for prescription drugs, there is no requirement that pharmacies be able to buy those drugs at the VA rates as well. So pharmacies would be buying drugs at their current commercial rates from their wholesaler, but only receive a fraction of the reimbursement that they would normally receive.

Even if the measure were workable (which it likely isn't, due to VA prices being confidential), pharmacies could ultimately be the biggest losers in the equation, as they would ultimately shoulder the burden of the cuts. And while pharmacies would be getting dramatically under-reimbursed, pharmaceutical companies and pharmacy benefit managers (PBMs) would be largely unaffected and free to perpetuate the current model that has resulted in the enormous price hikes we are seeing today.

Furthermore, there is no guarantee that the VA rates will remain what they are today. Currently, pharmaceutical companies give steep rebates and discounts to the VA program. If all of a sudden, those VA rates are used as a benchmark for other programs, then pharmaceutical companies could just end the discounts for the VA, and charge everyone higher prices.

Additionally, this initiative could restrict access to medication. The VA program has its own unique formulary, with special rebates given in return for preferential treatment or exclusion of certain drugs from that formulary. The nature of these rebate agreements for the VA would mean that patients could have decreased access to medications if a particular medication is not included within the VA’s formulary.

There is also no requirement that pharmaceutical companies charge the same prices to all. So if the government and VA were to enjoy all the major discounts that are being sought by this ballot measure, pharmaceutical companies could just raise the prices for everyone else to offset those losses. This would mean that the government would get the benefit, but working Ohioans would be stuck with the bill.

A bit more simply, imagine if the government required Starbucks to give a 25% discount to a third of their customers. What would Starbucks likely do? They could refuse to sell coffee to the people who are mandated to get the discount. They could raise the cost of coffee for two-thirds of their customers who don't get the discount. They could just raise the list prices of their coffee entirely so that the 25% discount meant nothing to their overall bottom line. Keep in mind, that under this scenario, all of these premises would apply to pharmacies and prescription drugs. Building on this example, nothing actually lowers the overall price of coffee— just like under Issue 2, nothing actually lowers the overall price of prescription drugs. In fact, the likely outcome is either a loss of access, or the elevation of prices for a majority of consumers. No matter how you slice it, Issue 2 is fundamentally flawed and incredibly reckless.

For a complete set of fact sheets on this measure, click here. For a comprehensive analysis of the proposal from Vorys Health Care advisors, click here.

“The members of the Ohio Pharmacists Association know all too well of the struggles patients have in affording their medications," said OPA Executive Director Ernest Boyd. "As an organization, we have spent years trying to address and change an outdated, opaque drug pricing model that incentivizes members of the medication supply chain to drive up the cost of prescription drugs. Through our work, we know there is a critical and immediate need to implement responsible solutions to lower drug costs – unfortunately, this initiated statute not only misses the mark; but it actually could end up raising drug prices. Ultimately, despite the stated intentions of its proponents, the proposal is ill-conceived, poorly crafted, unworkable, and could result in less access and increased costs for millions of Ohioans – including the very patients the proponents claim to want to help. We strongly urge Ohioans to vote against this proposal.”

Lastly, another provision would give the ballot issue’s four named co-sponsors an unprecedented right to intervene—at taxpayer expense—in any post-election legal challenges that may be filed against the initiative or its implementation. This means that if there's a lawsuit — which is highly likely — taxpayers would have to foot the bill for the proponent's legal fees.

To read through the summary and full text of the proposal from the Ohio Secretary of State's Office, click here. To learn more about the language itself, visit

OPA is proud to join the Ohio State Medical Association, Ohio Nurses Association, Ohio Osteopathic Association, Equitas Health, National Alliance on Mental Illness of Ohio, Drug Free Action Alliance, Ohio Chamber of Commerce, Ohio Manufacturers’ Association, Veterans of Foreign Wars, National Community Pharmacists Association, and many other trusted organizations in opposition to the ballot proposal. Check out a recent campaign ad featuring OPA among three core health care associations opposing Issue 2:

There are better ways to resolve our state's woes when it comes to affording prescription drugs. The "Ohio Drug Price Relief Act" should be wholly rejected by voters, and OPA urges a NO vote on the measure.

Find out the facts at


Additional coverage and resources:

Cleveland Clinic files 'cease and desist' order against Yes on Issue 2 group - Cleveland Plain Dealer, 10/5/17

Who is Michael Weinstein, the man behind Issue 2? - Dayton Daily News, 10/2/17

Your questions answered about Issue 2 - Dayton Daily News, 10/2/17

Face The State with Scott Light and OPA's Antonio Ciaccia - 10TV Columbus, 10/1/17

Issue 2 pits emotion against complex drug pricing system - Dayton Daily News, 9/28/17

Why Ohio employers should care about Issue 2 - Dayton Business Journal, 9/27/17

Ohio's prescription ballot issue: Get your questions answered - WCPO Cincinnati, 9/26/17

Editorial: Issue 2 sounds good, but isn’t - Wheeling News-Register, 9/25/17

Editorial: Vote ‘no’ on Ohio’s Issue 2 - Canton Repository, 9/24/17

Editorial: Reject Issue 2, the drug pricing proposal - Cleveland Plain Dealer, 9/15/17

How truthful is the EpiPen ad put out by the Yes on Issue 2 campaign? - Cleveland 19 News, 9/13/17

America's Work Force Radio show with OPA's Antonio Ciaccia - America's Work Force, 9/12/17

Editorial: Issue 2, all message and too little detail - Akron Beacon Journal, 9/11/17

Outside experts assess Ohio’s ballot issue on prescription-drug prices - Columbus Dispatch, 9/5/17

Foes of Ohio drug-pricing initiative see many side effects for state - Ohio Watchdog, 9/5/17

Who is the controversial man behind Ohio's drug price ballot initiative? - Cleveland Plain Dealer, 8/24/17

Drug-price ballot failure in California could mean bad prognosis in Ohio - Toledo Blade, 8/20/17

Ohio “Drug Price Relief Act” Ballot Update - Policy & Medicine, 8/17/17

Opposing the Ohio Drug Price Relief Act - Equitas Health, 8/12/17

Ohio Issue 2 opponent Dale Butland on drug price initiative - This Week in Cincinnati - WCPO, 8/8/17

Side Affects: The Ohio Drug Price Relief Act - Side Affects podcast, 7/27/17

Television ads clash over Ohio Drug Price Relief Act - Toledo Blade, 7/24/17

Editorial: Drug-price measure carries terrible side effects - Columbus Dispatch, 7/23/17

Prescription drug issue on ballot draws criticism - Findlay Courier, 7/18/17

Which side should we believe in battle over Ohio drug prices? - Columbus Dispatch, 6/18/17

Ohio’s drug price ballot issue: What’s really going on? - Dayton Daily News, 6/14/17

Ohio Chamber of Commerce slams Drug Price Relief Act - Columbus Dispatch, 6/6/17

Ohio Drug Price Relief Act: Who is telling the truth? - 10TV Columbus, 5/25/17

Former Ohio Medicaid directors oppose drug price ballot issue - Cleveland Plain Dealer, 5/23/17

Broad coalition anchored by drug makers opposes Ohio ballot issue - Columbus Dispatch, 5/23/17

Drug Price Relief Act sent to Ohio lawmakers for review despite petition fraud concerns - Cleveland Plain Dealer, 2/4/16

Drugmakers gearing up for fight on Ohio ballot issue - Columbus Dispatch, 1/17/16

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