Prop D Targets Drug Prices
San Francisco voters will have a chance on Election Day, November 5, to weigh in on a ballot measure that would make it city policy for officials to continue to directly negotiate with drug manufacturers for cheaper prescription drug prices, including those used to treat HIV and AIDS.
The city purchases prescription drugs for medical programs it runs and spends over $23 million a year on the medications. Current law authorizes the health department to use outside companies to negotiate in order to ensure that the city gets the lowest possible prices.
If voters pass Proposition D, it would be city policy to "use all available opportunities to reduce the city's cost of prescription drugs and to ask state and federal representatives to sponsor legislation to reduce drug prices paid by the government," according to the ballot pamphlet. The measure requires a simple majority to pass.
AIDS Healthcare Foundation, which is based in Los Angeles but does work in Oakland and San Francisco, including its Out of the Closet thrift stores, is spearheading the Prop D campaign.
Officials with the nonprofit have said the measure was spurred by Gilead Sciences pricing Stribild, its recent four-in-one AIDS treatment, at $28,500 per patient, per year, more than the annual income of many people living with the disease. Requests for comment from Gilead weren't immediately returned.
In a Friday, September 27 meeting with the Bay Area Reporter editorial board, Yes on D campaign manager John Baldo referred to "skyrocketing" drug prices.
Asked about what teeth the measure, which is a policy declaration, has, Baldo said, "This is not by any means a symbolic policy declaration."
"We wanted the city to have a mandate from voters" that residents want city officials, including the Board of Supervisors, to fight the high costs, he added. The hope is such a mandate would send a clearer message to drug companies than complaints from city government alone would.
Baldo said Prop D's supporters are aware that pharmaceutical companies have to have money to pay for research and development and other costs, but "We want price controls to be talked about and discussed," he said.
AHF had to gather more than 9,000 valid signatures to get its measure on the ballot. Officials with the agency announced plans for the measure with a November 2012 news conference on the steps of City Hall. The nonprofit launched the action with little, if any, input from local elected officials.
Dale Gluth, AHF's associate regional director for the Bay Area, said at the time that he hadn't contacted any San Francisco supervisors specifically on this issue.
Tim Boyd, director of domestic policy for AHF, said last week that backers had approached city officials early, but "everyone told us, 'Come back when it's certified.'"
Ten of the city's 11 supervisors are now signed on as supporters of the measure. Baldo said proponents weren't able to get District 11 Supervisor John Avalos's signature in time.
AHF is spending hundreds of thousands of dollars on the campaign, which comes from AHF's advocacy general fund. That resource is separate from the nonprofit's budget for "providing medical services for clients through its pharmacies and care centers," according to Baldo. No paid arguments against Prop D were submitted to the city's elections department.
No Support from AIDS Orgs
While a big part of the Prop D campaign centers around the high cost of HIV/AIDS medications, AHF has been unable to persuade any other San Francisco HIV/AIDS service organization to publicly support it.
Asked about buy-in from other AIDS organizations, Baldo said they "have not taken a position."
"There's a difference of opinion on how this should be addressed," he said, adding that it's not that the other agencies are against Prop D.
Among the local agencies that Baldo said that he talked to was Project Inform, which does advocacy and other work for people living with HIV/AIDS and hepatitis C.
In an email to the B.A.R., Project Inform Executive Director Dana Van Gorder said his agency has taken no final position on Prop D.
"However," Van Gorder said, "We founded or have worked closely with the Fair Pricing Coalition and [AIDS Drug Assistance Program] Crisis Work Group, which have been doing the heavy lifting on drug pricing negotiations for many years. Because of the very small amount of drug purchasing done by San Francisco, we see Prop D as being largely symbolic in comparison to other efforts."
Baldo also said he communicated with AIDS Housing Alliance-San Francisco.
AHA director Brian Basinger said in an interview this week that he supports the measure "in principle," but "I don't think I have enough information about the ins and outs of how the contracting with the Department of Public Health works, and what they can and cannot do." He said Public Health Director Barbara Garcia is "a fabulous leader, and I trust her leadership on it."
Basinger also said, "In general, yes, the pharmaceutical industry is overly aggressive in its pricing structures in the United States." He added that San Francisco is "in last place in the nation in terms of housing people with HIV and AIDS," and pointed to city statistics on homelessness.
In late June, the biennial San Francisco Homeless Point-In-Time Count and Survey was released and, for the first time, included statistics on LGBT people. The report found that out of a total of 7,350 homeless people, more than one in four (29 percent) identified as lesbian, gay, bisexual or "other" for a total of 2,132.
"With 29 percent of the un-housed population in San Francisco being LGBT, anything we can do to save money so we can spend it on housing we have a moral obligation to do," said Basinger.
Martha Knutzen and Ron Flynn, co-chairs of the Alice B. Toklas LGBT Democratic Club, are among those who submitted statements in favor of Prop D, although the ballot pamphlet says they signed on as individuals and not on behalf of an organization. The Alice club is supporting Prop D. The Harvey Milk LGBT Democratic Club took no position on the measure in its list of endorsements.