The most expensive ballot measure in California is coming down to the wire

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The price of prescription drugs has been a topic of heated debate in the US over the last year.

So it's no surprise that the most expensive measure on California's ballot Tuesday is about drug pricing, with drug companies pouring millions into lobbying efforts aimed at voting it down.

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Both those in favor and opposed have been pulling out the stops in recent weeks as support for the ballot measure has waned and drug company opposition has grown. A poll released Friday showed the race as neck and neck, with 47% voting yes, 47% voting no, and another 6% undecided or abstaining.

What Prop 61 would do

Proposition 61 would keep the prices of prescription drugs capped at the price the Department of Veterans Affairs (VA) pays for them. Unlike other government agencies, the VA can negotiate drug prices, and gets the lowest prices on prescription drugs of any government agency. The proposition would apply only to drugs that are paid for by California's state government.

Backers of Prop 61 say it would save the state millions, even billions, on prescription drug spending. Currently, the VA gets a discount of about 24% off traditional drug prices, and the agency can negotiate further discounts on top of that. And the state spends a lot on pharmaceuticals.

More on the issues

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So far, more than $125 million has been raised for lobbying efforts for Prop 61, with the majority of that coming from drug companies that oppose it. The proposition has also attracted the attention of Vermont Senator Bernie Sanders, who has repeatedly said he believes drug prices are too high. Sanders was in California on Monday speaking at the state capitol to convince residents to vote "yes" on the proposition. If the proposition passes in California, his hope is that it could lead to a national movement.

"This could be the shot heard 'round the world," Sanders said Monday to a rally in Los Angeles.

Prop 61AP

Who would benefit

Prop 61 is designed to set drug prices at the lowest possible price. One problem with it, however, is that the proposition doesn't lay down the concrete tools for how to make it happen.

Currently, about 26% of California's 38.8 million residents have their health insurance covered by state programs — and for some of them, Prop 61 would be great news. But others would get left out. Anyone on Medi-Cal's managed care plan (roughly 75% of the people on Medi-Cal), would see no direct benefit. That's because those plans go through commercial health insurers, which are in charge of negotiating their own drug discounts.

Who's on each side

Hundreds of groups have donated to either support or oppose the proposition, but here are some of the most prominent backers and opponents.

"Yes on Prop 61"

  • The AIDS Healthcare Foundation — $14.7 million
  • The California Nurses Association — $55,430

"No on Prop 61"

  • Pharmaceutical companies have donated more than $109 million in total, with the top 10 donors having contributed about $69.8 million
  • Merck & Co. — $9,420,395
  • Pfizer —$9,420,395
  • Johnson & Johnson — $9,301,646

Other groups have come out vocally either in support or opposition to the proposition. In an October editorial opposing the measure, the LA Times' editorial board argued that the proposition was short-sighted.

Drugmakers that could be losing money on the discounts they now have to give the state could just turn around and give everyone else fewer discounts. "The underlying problem of fast-rising drug prices needs to be addressed comprehensively and nationally, so that relief for some doesn't come at the expense of others," the editorial board wrote.

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SEE ALSO: Everyone wants a piece of the drug industry and it's one reason prices are rising so fast

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