Merck, Biogen boost lobbying to defy Obama’s drug comparisons
Already the biggest spender on influencing policy, the drug industry is hiring well-known individuals, some with stories of personal battles against disease. They include Tony Coelho, a former House Democratic leader who has epilepsy; Andrea LaRue, counsel to Tom Daschle when he was Senate Democratic leader; and the firm of Democratic fundraiser Tony Podesta, brother of Obama adviser John Podesta.
The firepower shows the drug industry’s resolve to stop Obama from using comparisons of medical treatments to force cuts in health costs. More than half of medical care may be based on insufficient evidence of effectiveness, the Congressional Budget Office said in March. Meantime, the Health and Human Services Department says all medical spending will probably rise this year to $2.5 trillion, or 18 percent of the economy.
“The companies fear that older generic drugs might very well turn out to be better than the newer advertised drugs, which bring in much more of a profit,” said Julian Zelizer, a history and public affairs professor at Princeton University in Princeton, New Jersey. “In difficult economic times, the drug companies don’t want to take any risks, so they are bringing out the biggest lobbyists in the business.”
Lobbying vs. Studying
The economic stimulus package includes $1.1 billion for studies showing which medical treatments work best -- less than the $1.6 billion the drug industry spent on lobbying from 1998 to 2008, according to the Center for Responsive Politics, a Washington-based research group.
Drug companies “are concerned that there is a potential to come down with pronouncements about what should and shouldn’t be covered,” said Jane Horvath, senior director for public policy at Merck, based in Whitehouse Station, New Jersey.
Opponents cite the U.K.’s National Institute for Health and Clinical Excellence, or NICE, which looks at the cost and benefit of medical treatments in deciding what should be covered by national health insurance. The agency said March 5 that Tykerb, sold by GlaxoSmithKline Plc of London, is too expensive for routine use in women with advanced breast cancer. Given with chemotherapy, Tykerb costs about $35,000 a year for each patient, the agency said.
Insurers Push Back
Indianapolis-based WellPoint Inc., the second-largest health insurer by revenue, and Philadelphia-based Cigna Corp. are backing Obama with a lobbying push of their own through their Washington-based organization, America’s Health Insurance Plans.
“We need more information about which drugs, treatments and technology are more effective and we need to put that information in the hands of consumers and providers,” said Robert Zirkelbach, a spokesman for the trade group. “That will go a long way to improve the quality of care and bring down health-care costs across the board.”
The drug industry outspent all others in the last decade for lobbying. Health insurers, which back Obama in support of comparative effectiveness, spent $246 million from 1998 to 2008.
The companies successfully pushed a 2003 Medicare prescription law that kept the government from negotiating lower prices and blocked repeated efforts to allow the importation of less-expensive drugs from Canada.
Drugmaker Victory
Drugmakers notched an early victory this year against comparative effectiveness. The $787 billion economic stimulus law, signed by Obama in February, dropped cost as a consideration in comparative effectiveness studies.
Merck and Schering-Plough Corp.’s cholesterol pill Vytorin may face tougher competition from generic simvastatin if federally funded studies show it no more effective at unclogging arteries. Vytorin prescriptions dropped by a third last year after a study found the pill, a combination of simvastatin and Kenilworth, New Jersey-based Schering-Plough’s Zetia, worked no better than the generic pill alone. Vytorin costs about four times as much as simvastatin.
Obama said during the presidential campaign that studying medical treatments side by side is essential to saving money for expanded health coverage.
The president’s Federal Coordinating Council for Comparative Effectiveness Research, formed last month, includes Ezekiel Emanuel, brother of White House Chief of Staff Rahm Emanuel, to oversee the studies. The council’s first report to Obama and Congress, containing recommendations of what treatments should be studied, is due June 30.
Advancing Cost?
“We need to compare whether some of these new ideas are really advances or more costly alternatives to what we know will work,” said Henry Waxman, a California Democrat and chairman of the House Energy and Commerce Committee, in an interview.
Drug companies fought earlier comparative effectiveness efforts for a decade through their trade group, the Pharmaceutical Research and Manufacturers of America, known as Phrma. Merck and Wyeth, of Madison, New Jersey, also hired lobbyists to work on the issue.
Soon after Obama won November’s election, Phrma helped create another group, the Partnership to Improve Patient Care, which last month hired Coelho, 66, who was chairman of Al Gore’s unsuccessful presidential bid and helped win passage of the 1990 Americans With Disabilities Act.
Coelho’s group also includes the American College of Cardiology, a Washington-based trade group for heart doctors, and Easter Seals, the 90-year-old advocacy group for disabled people. The organization, based in Chicago, claims a million members.
Calling Lawmakers
Those organizations’ members will be encouraged to call lawmakers to oppose using comparative effectiveness to deny access to specific drugs or treatments.
“I have no problem with research determining what is bad, what is good,” Coelho said. “But all of us have different bodies and all of us react differently to different types of medication. Don’t make it into a cookie-cutter process.”
Easter Seals will use its newsletter, Web site and annual convention in October to mobilize supporters, said Katy Neas, a lobbyist for the organization.
“As the debate goes forward, and after this much- anticipated research, things are going to start heating up,” Neas said.
Another Coelho ally is Phrma President Billy Tauzin, 65, a former Republican chairman of the House Energy and Commerce Committee.
Cancer, Epilepsy
Tauzin had intestinal cancer. He and Coelho use personal stories to argue that Obama’s plan runs the risk of stopping government health plans and insurers from paying for lifesaving treatments deemed more expensive than alternatives that may not work as well for everyone.
Coelho said he’s worried that government studies will lead to restrictions on antiseizure drugs. He said he needed four drugs, though some plans would only pay for two. And substituting lower-cost generics can hurt patients, Coelho said.
“On a lot of us, if you do that switch, you can cause me to have seizures,” Coelho said. “It’s criticism from my point of view as a patient.”
Tauzin said he used an experimental drug to cure his cancer, a medicine he might not have gotten if insurers consider cost to determine coverage.
“They’ll show medicines work better for some people on average,” Tauzin said. “You may not be average. Suppose you’re the patient for whom Drug B doesn’t work.
‘‘The irony is science is taking us in the direction of precision medicine, where we can figure out from your genetic code exactly what medicine works for you.”
Advancing Personal Medicine
Backers of comparative research say there’s no conflict.
“It’s not whether it works or not, but in whom it is working or not,” said Marcus Wilson, president of HealthCore, a WellPoint subsidiary that conducts comparisons and is seeking federal money for research, in an interview. “We look at it as helping us get much closer to personalized medicine than we are today.”
Individual drug companies also are readying for Obama’s challenge. Tokyo-based Eisai Co., which developed the Alzheimer’s drug Aricept, hired the Podesta Group in January.
Biogen Idec Inc., the Cambridge, Massachusetts, seller of drugs for multiple sclerosis and non-Hodgkin’s lymphoma, hired the Washington firm NVG LLC, including lobbyist LaRue, former counsel to Daschle, a South Dakota Democrat. Calls to Biogen weren’t returned.
Comparative effectiveness “should not be used by the public or private payers as a reason to deny access to specific therapies to specific patients,” said Lynn Kenney, an Eisai spokeswoman.
Bloomberg.com
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