Friday, September 25, 2009

PhRMA Throws Bus Under the Bus

Remember the flap over candidates throwing allies, staff and pastors “under the bus?” It may seem like an eon; but it is only a little over a year ago that jettisoning a former supporter brought the phrase “throwing someone under the bus” into the common political parlance.

Now the phrase has true relevance to pharma politics. It creates the perfect metaphor to describe a change in tactics by the Pharmaceutical Research & Manufacturers of America (PhRMA), the trade association.

PhRMA is abandoning one of its high-visibility projects of the last four years, the patient assistance bus campaign in favor of a the larger goal of pushing through health care reform.

Ed Silverman writes about the trade association’s decision to put the bus back in the garage until the end of the health care reform effort in an article in “The Pink Sheet” Daily.

The association explains to Ed that it is too busy with health reform to take on budgeting issues like the cost of the bus campaign until the end of this legislative season.

That is clearly one reason. There is no question that PhRMA is busy with health reform and multiple mark-ups on Capitol Hill. And the association needs all of its resources to keep spending as heavily as it can (through partners like Families USA and the American Medical Association) to create the image of a strong consensus in support of overall health care reform.

From a strategic point of view, giving up the bus now makes perfect sense. The bus was just a vehicle (a big 18-wheel vehicle) for PhRMA to draw attention to its longer overriding objective: to get access for drug coverage to a good chunk of the 40-some million people who are insured and often can’t pay for drugs themselves. Offering assistance programs through the traveling bus was a good way for PhRMA to take charge of the issue of expanding drug coverage to the needy.

Health care reform moves that from a slow city-by-city or region-by-region effort to sign up people to the chance to legislate coverage to a large new market in one fell swoop. With that opportunity, it makes sense to change tactics.

It is worth noting as the bus goes back to the shop that it was also an effective way to counteract one of the most telling anti-industry metaphors of the last decade: the bus trips by seniors to Canada to buy cheaper drugs. PhRMA usurped the metaphor by sending a bus to the disadvantaged to sign them up for private assistance.

But now is the time for PhRMA to focus on opening the public pocketbook to drug coverage. The association and industry have been doing well at this effort: offering to pay $80 billion to pay for the cost of reform and stand with the White House has been a big plus.

PhRMA faces some big hurdles to the market expansion: take, for example, a recent change in the Senate Finance Committee mark (proposed legislation) that would remove the requirement for states to add drug benefits to all new Medicaid recipients. At first glance, this change would knock out a large proportion of the newly covered Medicaid beneficiaries in 2717 states from being assured of getting access to drugs.

That wouldn’t be good for PhRMA. The industry in this deal to get access to those Americans who cannot afford drugs now and to make sure that they get drugs without high out-of-pocket costs.

But getting coverage without a mandate on Medicaid to include drug programs for all beneficiaries won’t be the end of the road. PhRMA can always bring out the bus again to the states with coverage gaps and work at the state legislatures. The association should keep the tires inflated and the engine in tune while the bus is taking its break in the garage.

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