BIG MONEY CLUB THE - REVEALING THE PLAYERS AND THEIR CAMPAIGN TO STOP PHARMACARE SHARON BATT, PHD - CANADIAN FEDERATION OF NURSES UNIONS
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THE
BIG
MONEY
CLUB
Revealing the Players and Their Campaign to Stop Pharmacare
Sharon Batt, PhD
M ARC H 2019
CANADIAN FEDERATION OF
NURSES UNIONS (CFNU)
WE ARE CANADA’S NURSES.
We represent close to 200,000 frontline care providers and nursing students working in hos-
pitals, long-term care facilities, community health care and our homes. We speak to all levels
of government, other health care stakeholders and the public about evidence-based policy
options to improve patient care, working conditions and our public health care system.
Published by: Project team: ISBN:
Canadian Federation of Sebastian 978-1-7753845-2-6
Nurses Unions Ronderos-Morgan
2841 Riverside Drive Carol Reichert Printed & Bound:
Ottawa, ON K1V 8X7 Oxana Genina Imprimerie Plantagenet
613-526-4661 Printing
Layout and Graphics:
www.nursesunions.ca Alyster Mahoney
© 2019 Canadian Federation of Nurses Unions
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any
means without the permission of the publisher.
CONTENTS MESSAGE FROM LINDA SILAS I INTRODUCTION 1 WHY CANADA NEEDS UNIVERSAL SINGLE-PAYER PHARMACARE 3 OPPOSING VOICES: BIG PHARMA, BIG INSURANCE, BIG MONEY 4 SUPPORTING VOICES: ORGANIZED LABOUR 5 HIDDEN PUPPET-MASTERS: THE BILLIONAIRES 9 BIG MONEY’S THREE-PRONGED STRATEGY TO STOP PHARMACARE 10 CONCLUSION 22 REFERENCES 24 APPENDIX A: MESSAGE FROM LINDA SILAS (FRANÇAIS) 30 APPENDIX B: INTRODUCTION (FRANÇAIS) 33 APPENDIX C: CONCLUSION (FRANÇAIS) 35 AUTHOR’S BIO 36
MESSAGE FROM
LINDA SILAS
Lin d a Sila s s p e a k i n g a t c o n f e r e n c e , 2018 .
WE CAN DO BETTER!
The Big Money Club tells the implementation of a national minute of every day without
story of the outsized influ- universal public pharmacare pharmacare, and up to 640
ence of ultra-rich actors in program in Canada: a pro- Canadians die prematurely
the pharmacare debate in gram that covers everyone, each year from one illness
Canada. These actors see regardless of circumstance, alone because of financial
dollar signs in the preserva- and that saves money and barriers to prescriptions. We
tion of the current system eliminates inefficiencies can and must do better. But
and are funding a campaign through joint purchasing powerful actors are working
to protect their profits. and streamlined administra- to stop change for the bet-
tion. According to previous ter. These actors are the Big
For over 20 years, the expert reports commis- Pharma and Big Insurance
Canadian Federation of sioned by the CFNU, Cana- lobbies, as well as Billion-
Nurses Unions (CFNU) da wastes up to $14,000 aires, from Canada and the
has advocated for the health care dollars per U.S.
I BIG MONEY CLUB
As prescription drug expen- Pharmacare (ACINP) in Feb- will you defend? Will the
diture rises with every year, ruary 2018, the Big Money Canadian government cave
and new high-priced medi- Club actors have ramped to the interests of the ultra-
cines come on the market, up their campaign to stop rich or do the right thing
pharmaceutical giants are pharmacare. Flush with and establish pharmacare
living in a golden age of resources, they are buying for everyone?
profits (over 20% per year). influence through lobbying Despite the resources mobi-
Health insurance compa- and advertising, enlisting a lized by Big Money, Cana-
nies in Canada, deregulated suite of industry-linked think dians are unwavering in
in the 1990s, are enjoying tanks and commentators their support for universal
billions in profits from the to create an echo-chamber pharmacare. Even though
lucrative health benefits of validators, and calling about two-thirds of Canadi-
market. Billionaire philan- on the U.S. administration ans have workplace health
thropists, with ties to these for help. They are doubling insurance plans, a new
profitable sectors, also down on their campaign to national poll from Environics
bankroll campaigns to stop keep Canadians from bene- Research, commissioned by
pharmacare. fiting from a system that the CFNU, shows that 88%
would save lives and save of Canadians prefer a sim-
Since the launch of the money. ple cost-effective prescrip-
Advisory Council for the Canadians need to ask our tion drug coverage program
Implementation of National government: whose interests that covers everyone in the
INCREASE IN PRICES, PROFITS & LOBBYING 104
MEETINGS
AVE. POST TAX PROFIT MARGIN (dashed line)
in 2018
49
AVE. over
SHARE OF SALES (solid line)
11 YRS.
15
Number of
Pharma Group
MEETINGS lobby meetings
in 2008
High-cost patent-
ed medicine
Profit margin
for 25 top drug
companies
YEAR
U.S. General Accounting Office analysis of Bloomberg data, Nov. 2018, PMPRB Annual Report,
2017 - July 24, 2018, Records of the Office of the Commissioner of Lobbying of Canada
CANADIAN FEDERATION OF NURSES UNIONS II
$
14,000 per minute
in health care dollars
wasted without
pharmacare
country rather than another For 20 years, the CFNU has universal public pharmacare
patchwork plan. A similar documented the results of program is the common
proportion (84%) believe Canada’s failure to imple- sense solution. Experts and
that governments should ment a national pharmacare evidence, as well as the
invest in our public health program as part of Medicare: experience of other coun-
care system, covering pre- unnecessary deaths and tries, show that a program
scription drugs the same way premature health declines, that covers everyone saves
that hospitals and doctors along with significant costs money by eliminating ineffi-
are covered. After all, why to Canada’s health system. ciencies through joint pur-
should coverage of pre- As patient advocates who chasing and streamlined
scribed drugs end when you see the health impacts of the administration.
leave the hospital? lack of access to prescription
drugs firsthand, the CFNU
recognizes that a national SINCERELY,
Linda Silas
President
Canadian Federation of Nurses Unions
III BIG MONEY CLUB
INTRODUCTION
Canadian households, to a recent national sur- research, that prove the
employers and govern- vey said they or someone benefits of a system of sin-
ments spent $34 billion on in their household failed to gle-payer coverage for all
prescription drugs in 2018. ¹ take prescriptions as needed Canadians?
That’s more per capita than because of cost. 3 In 2016
virtually any other country over 700,000 Canadians This report reveals the ele-
with universal health cov- had to forego spending on phants in the room: the
erage in the Organization food because of the price of pharmaceutical and insur-
for Economic Cooperation drugs. 4 ance industries. Both profit
and Development (OECD). substantially from the cur-
The reason for Canada’s For numerous reasons that rent system and are deploy-
outlier status is no mys- will be detailed below, ing considerable resources
tery: prescription drugs are implementing a single-payer to block meaningful change.
not part of the universal public pharmacare plan for This report also reveals
system of health insurance all in Canada is undeniably other actors hiding behind
that promotes quality and a common sense option that the curtains: Canadian and
equality of care while con- will improve Canada and foreign billionaires who
trolling costs. Instead, we help Canadians. invest heavily to maintain
have a patchwork of public the current system where
plans with eligibility require- The question so often over- over one hundred thousand
ments and restrictions that looked is, who opposes the public and private plans
vary from one province or plan? Who benefits from the provide Canadians with
territory to the next, and current fractured system, unequal, inefficient and
employer-based private and who wants to stop its unfair coverage. Our frag-
plans that vary by employer, overdue transformation into mented system also props
level of pay, age and other a fairer and more efficient up the artificially high drug
factors unrelated to medical system? Moreover, who has prices in Canada that cause
need. At least 20% of Cana- the power to effectively waste and suffering.
dians have insufficient or no undermine the mountains
drug coverage at all, ² which of evidence, from more
is why 23% of respondents than five decades of policy
CANADIAN FEDERATION OF NURSES UNIONS 1
IN THIS REPORT WE ASK:
What is the face of Big Money in the
pharmacare debate?
How do Big Pharma and Big Insurance benefit
from the status quo?
What is the Big Money strategy to stop a national
drug plan for Canadians?
2 BIG MONEY CLUB
WHY CANADA NEEDS UNIVERSAL
SINGLE-PAYER PHARMACARE
Decades of expert policy and based on value for and territorial organizations
reports, from the 1964 money. The single-payer representing academics,
Royal Commission on Health (government) plan would health care workers, patients
Services to a report by be billed for the cost of and others recently signed
the House of Commons prescribed drugs in the a document of Consensus
Standing Committee same way that physician Principles, outlining a model
on Health from 2018, 5 visits and hospital stays are of a universal, single-payer
have reached the same now covered. Patient access and public pharmacare
conclusion: pharmaceutical to covered medications program for Canada. 10 The
drugs should be part of would be ensured without reasons for this strong
the universal and publicly financial barriers or other support are simple: the
funded national health impediments. potential benefits of
care system. Countries Those currently backing such a program include
such as the Netherlands, such a plan include improved public health, a
Sweden, the UK, Australia health policy experts and more efficient and effective
and New Zealand all enjoy economists, who study health system, 11 a stronger
an effective and efficient prescription drug coverage, 6 economy, 12 13 14 a more equal
prescription drug plan nurses and many physicians, and fair society, 15 16 and a
for everyone. Such a plan who see the consequences more robust, transparent
would provide coverage for of our patchwork system in democracy. 17 18 As The
a single, national formulary their daily work, 7 8 and 91% Globe and Mail writes: “The
(or list) of drugs that are of Canadians, according to bottom line is that Canada
judged safe and effective an Angus Reid poll. 9 As well, outspends most of the world
by scientific evidence over 80 national, provincial on prescription medicines,
2019 POLLING DATA
Prescription drugs should be covered as part of our public health care system,
the same way that hospitals and doctors are covered.
E
EE E E A GRE
AGR AGR DIS E
GLY HAT HAT A GRE
TRO
N MEW SO MEW DIS
S SO LY
43% 41% 13% O NG
STR
3%
43% 41% 13% 84% AGREE
CFNU-commissioned Environics poll, January 2019.
CANADIAN FEDERATION OF NURSES UNIONS 3
700,000
Canadians reduced spending on
food to pay for prescriptions.
This is equivalent to the
population of Winnipeg.
even while leaving many biosimilars (the generic- One simple line sums up the
Canadians without like substitutes for the new economics underlying the
coverage.” 19 high-priced biologic drugs case for a universal sin-
that are rapidly gaining gle-payer pharmacare pro-
Built right, a universal, market share). Altogether, gram: “The bigger the buyer,
single-payer pharmacare these measures would the bigger the bargaining
plan in Canada would lower spending on drugs by power!” Under the current
reduce prices through about 30%, saving billions system, that potential bar-
bulk purchasing, reduce and aligning prices in gaining power is fragmented
wasteful and inappropriate Canada more closely with into many thousands of drug
prescribing, and favour less those in other high-income plan payers.
expensive generics and countries. 20
OPPOSING VOICES: BIG PHARMA,
BIG INSURANCE, BIG MONEY
Considering the evidence coalition of deep-pocketed private insurance industry
and the momentum, it’s hard interests with the enor- stand to lose billions if uni-
to imagine why a universal mous capacity to marshal versal public pharmacare
single-payer pharmacare resources is mounting a becomes a reality. 22 23 Not
plan wouldn’t be a shoo-in campaign to stop phar- surprisingly, they both
for Canada. However, efforts macare in its tracks. Why oppose the plan.
to make drug coverage fair the opposition? The mul-
and economical have failed tinational pharmaceutical Innovative Medicines
before and could fail again. 21 industry – enjoying substan- Canada (IMC), the Cana-
On the opponent’s side, a tial profit margins – and the dian lobby group for the
4 BIG MONEY CLUBpharmaceutical industry, gaps” plan. 24 “Fill the gaps” little to change the current
and the Canadian Life and means yet another targeted dysfunctional patchwork
Health Insurance Association public plan that would only system of coverage. To para-
(CLHIA), which represents cover segments of the popu- phrase a prominent Cana-
private health insurance lation who currently have no dian health policy expert, “a
companies, both advocate coverage or whose coverage patchwork system doesn’t
for a piecemeal “fill the falls short. 25 This would do need more patches.”
SUPPORTING VOICES:
ORGANIZED LABOUR
On the proponents side a public pharmacare plan 2017. While these entities
there are also some well-re- for all Canadians. 26 Simi- have resources to spend on
sourced actors, in partic- larly, the Canadian Labour advocacy, there are some
ular organized labour. The Congress, representing over crucial differences between
Canadian Federation of 3 million unionized work- them and Big Corporate
Nurses Unions (CFNU) has, ers in Canada, made phar- Money – namely motivation
for decades, advocated for macare a core campaign in and spending power. On
PROFIT MARGIN FOR TOP 25 DRUG COMPANIES 2010-2015
Average After-Tax Profit Margin
AVE. AFTER-TAX PROFIT MARGIN
20% PROFIT
BIG PHARMA
PROFIT
MARGINS
RISING
YEAR
U.S. General Accounting Office analysis of Bloomberg data, Nov. 2017
CANADIAN FEDERATION OF NURSES UNIONS 59 % of Quebecers don’t
fill prescriptions because
of cost
pharmacare, neither profits larger than those of labour. has failed to control costs
nor the interests of share- Statistics on lobbying and is a system that is nei-
holders (or members) are spending in Canada aren’t ther equitable nor sustain-
motivating factors for the publicly available, however, able. 31
labour movement. That’s the US provides us with
because unionized workers some illustrative compari- The Quebec model has been
generally enjoy much better sons. South of the border, lucrative for the pharmaceu-
extended health benefits the US Chamber of Com- tical and insurance indus-
than non-unionized work- merce alone spent six times tries. The private insurance
ers 27 by virtue of collective more on lobbying in 2018 plans that continue to be
bargaining. On the other than all the U.S. public sec- abundant in Quebec make
hand, corporations view a tor unions put together. 28 29 money with every prescrip-
potential pharmacare plan tion, resulting in higher
through the prism of profits costs with little focus on
and shareholder dividends. QUEBEC’S PLAN: health outcomes.
The labour movement’s A MODEL TO AVOID
concern is for the sustain- A “fill the gaps” system Health consequences
ability of public medicare, could take many forms, Private plans often provide
a program that it has sup- including the one used in an open formulary, I which
ported since its inception. Quebec over the past two amounts to coverage for
This includes the expansion decades. Under this pro- whatever a physician or
of important services such gram, all large employers other health provider pre-
as home care and mental must include drug coverage scribes. This can undermine
health. The CFNU, Canada’s in their employee insurance patient health since pre-
largest organization repre- packages, and all employees scribing choices are often
senting nurses, represents must participate, including based on marketing by the
the perspectives of frontline purchasing coverage for pharmaceutical industry
nurse members who witness their dependants. The pub- of newer – more expen-
the daily tragedies of a lack lic plans pick up the rest. In sive – drugs rather than
of adequate drug coverage theory, everyone is insured clinical evidence. 32 Indeed,
in Canada. On spending either publicly or privately. 30 a recent report found that
power, the lobbying coffers The evidence proves, how- 91% of new patented drugs
of the corporate sector are ever, that the Quebec model that entered the Canadian
I Open formularies also distort the economic incentives for drug manufacturers. If we accept to
pay for drugs with no additional proven therapeutic value, drug manufacturers have less eco-
nomic incentive to focus their resources on producing drugs that add therapeutic value.
6 BIG MONEY CLUBRAPID RISE IN MARKET SHARE OF HIGH-PRICED DRUGS
50%
SHARE OF SALES
40% Under 10% in
2006 and over
30%
40% in 2017
20%
10%
OVER 40%
0%
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
& INCREASING
YEAR
Patented medicine in Canada with an annual average cost of at least $10,000.
PMPRB Annual Report, 2017 - July 24, 2018
market did not provide a drug listed on the Beers cost of private plans aver-
a significant therapeutic list, a list of drugs deemed ages at 18%, compared
80
improvement over existing potentially inappropriate to under 2% in the public
products. 33 for seniors because the risk plan. 41 The result: Quebec
70 of serious adverse events spends yearly around $200
The current deadly opioid (e.g., falls, cognitive decline, more per person than the
epidemic sweeping North dizziness and stroke) out- rest of Canada 42 on pre-
60
America is evidence of the weighs the benefits. Thir- scriptions, making Quebec’s
damage that inappropriate ty-one percent of seniors system one of the most
prescribing can have on were chronic users of these expensive in the world. The
50
patients. Years of allegedly drugs. 38 evidence shows the big
inaccurate marketing by winners in Quebec drug
40
Purdue Pharma, 34 combined Finally, drug co-payments coverage model are industry
with liberal prescribing and deductibles in the Que- stakeholders. 43
practices and open formu- bec public system pose
30
laries, contributed to a crisis additional access barriers Opposition to the Quebec
of opioid addiction involving for patients. 39 Almost 9% of model has emerged from
20
millions of North Americans Quebeckers don’t fill pre- within Quebec in recent
and resulted in over 50,000 scriptions because of cost. 40 years. Workers’ organiza-
deaths in 2017 alone. 35 36 In tions like the Fédération
10
Europe, where pharmaceuti- des travailleurs et travail-
High prices
cal regulation is tighter and leuses du Quebec and oth-
open formularies much less The Quebec model also ers, including consumer
0
common, 2014
the rate of addic-2015 maintains an inefficient
2016 2017advocacy groups,
2018 are pub-
tion is less significant. 37 multi-payer system that fails licly opposed because of
to leverage its potential the waste it creates and its
Overprescribing goes bargaining power to lower failure to resolve barriers to
beyond opioids. In 2016 just prices. It also duplicates accessing medications. 44
under half of all seniors in administrative costs. In
Canada were prescribed Quebec, the administrative
CANADIAN FEDERATION OF NURSES UNIONS 7HEALTH INSURANCE PROFITS GROWING
DOLLARS, BILLIONS
PROFITS
INCREASING
Source: Law, M., Kratzer, J.,
Dhalla, I. (2014). The increasing
inefficiency of private health
insurance in Canada. CMAJ. 186,
12: E470-E474
YEAR | MEDICAL LOSS RATIO (% of premiums paid as benefits for group plans)
HOW ‘FILL THE gargantuan price differences government to opt for a
GAPS’ BENEFITS between medicines with “fill the gaps” mix of pub-
near equivalent therapeutic lic and private insurance.
BIG PHARMA
benefits. Recently it was They promote the notion
Turning the flawed Quebec revealed in Canada that a that improved drug “access”
model, or something resem- drug company was charging through an open formulary
bling it, into a national pro- over 6000% more for its is good for patients.
gram would be a gift to the newly patented drug than
pharmaceutical industry. No the retail price of the pre- Private insurance companies
improved bargaining power existing equivalent. The only cover more than $10 billion
would be achieved to bring difference offered by the in prescription drug costs
down the price of phar- new therapy was a longer in Canada today, 48 much of
maceuticals to Canadians. timed-release of the active which is profit for them. This
Overprescribing and inap- ingredients. 47 Without the wasn’t always the case. In
propriate prescribing, which effective regulation and 1997 Canada changed a law
industry marketing facili- discipline of a single-payer that required insurance com-
tates, would continue. And, system, price inflation panies to be owned by, and
the industry would have the such as this will continue accountable to, insurance
additional bonus of more to exist to the benefit of policy-holders. II By 2011,
than 50 million prescriptions pharmaceutical company the gap between premiums
per year 45 – drugs that many revenues. and payouts had grown
currently can’t afford – with three fold over 1991 figures.
the public plan picking up This translated into billions
the cost. 46 HOW ‘FILL THE in increased profits and
GAPS’ BENEFITS administrative costs for the
The economics of our BIG INSURANCE insurance industry. 49 Public
multi-payer system, with pharmacare would threaten
The Canadian insurance
its abundance of open a significant share of that
industry also wants the
formularies, can permit
II The new law allowed large insurers to become for-profit companies owned by shareholders.
Providing a return on investment to shareholders became the priority, rather than benefiting the
interests of plan members. In fact, the proportion of premium income that insured group plans
spent on benefits dropped from a previous 92% in 1991 to 74% in 2011.
8 BIG MONEY CLUBrevenue. patient may pay 10% to 40% Overall, administrative costs
Even for Canadians with pri- of the cost, meaning finan- rise considerably in a sys-
vate plans, access to drugs cial barriers persist. As drug tem with many thousands 51
can be troublesome since prices continue to rise, plans of private plans, and these
most private plans don’t will continue to reduce their costs are passed on to work-
provide full coverage: a share of coverage. 50 ers and employers. 52
HIDDEN PUPPET-MASTERS:
THE BILLIONAIRES
The multinational phar- the Koch brothers have that serve the interests of
maceutical and private assiduously nurtured the wealthy. Billionaires
insurance companies are a right-wing intellec- bankroll many think tanks in
not the only powerful and tual ecosystem of think Canada, such as the Fraser
wealthy interests invest- tanks and journals that Institute and the Macdon-
ing in the campaign to stop has had a powerful ald-Laurier Institute, 58 which
pharmacare. There is also impact on electoral pol- consistently produce lop-
a global network of billion- itics and the legislative sided papers without peer
aires who are connected agenda of the United review that oppose phar-
to efforts to prevent drugs States and beyond.” 54 macare.
from becoming part of
Canada’s public health care - Chrystia Freeland A lack of transparency
system. 53 keeps the public mostly in
Since the early 1970s, net- the dark about the amount
According to current Liberal works of the ultra-rich of funding the ultra-rich
Minister of Foreign Affairs, have bankrolled campaigns contribute to anti-phar-
Chrystia Freeland, in her designed to protect the macare campaigns. However,
2012 book, plutocrats drug patent system 55 56 and as powerful shareholders in
(another word for the ultra- to keep prescription drugs the most profitable sectors
rich) use their money to priced as if they were pre- of the economy, billionaires
finance a political agenda cious commodities rather have a major financial stake
that brings increased profits than the prescribed medical in preserving the lucrative
to themselves and their necessities that they are. multi-payer “fill the gaps”
enterprises: system of coverage. More-
Strategies from a playbook over, since the vast majority
“Some farsighted plu- for changing society, 57 devel- of private financing for pre-
tocrats try to use their oped by one of the Ameri- scription drugs comes from
money not merely to can billionaire Koch family’s premiums, which represent
buy public office for “charitable” foundations, are a greater share of household
themselves but to currently being deployed in income for modest and low-
redirect the reigning Canada’s drug policy sphere. er-income households, the
ideology of a nation, The goal is to influence the current system is markedly
a region, or even the public, media and decision rich-friendly.
world... billionaires like makers to support policies
CANADIAN FEDERATION OF NURSES UNIONS 9A B C
CREATE CALL ON
BUY INFLUENCE
ECHO-CHAMBERS FOREIGN BACK-UP
BIG MONEY’S THREE-PRONGED
STRATEGY TO STOP PHARMACARE
To oppose a common
sense pharmacare plan in A) BUY INFLUENCE
Canada and protect their
profit margins, billionaires with politicians and policymakers
and big-moneyed inter- through lobbying and advertising;
ests are using a multi-fac-
eted strategy of influ-
encing decision makers.
These include the follow-
B) CREATE ECHO-CHAMBERS
ing three prongs: that distort information and promote a
baseless fear of change;
C) CALL ON FOREIGN BACK-UP
by appealing to the Trump Administra-
tion to apply pressure on Canada.
10 BIG MONEY CLUBThe following examples recommendations at a
show this strategy in action. Lobby Day event on Parlia-
ment Hill. A press release
A) BUY INFLUENCE stated that the Standing
Committee’s recommen-
Since the announcement of
dations would “reduce the
the federal Advisory Coun-
quality of health benefit
cil on the Implementation
plans for millions of people.”
of National Pharmacare
Further, the release claimed,
(ACINP) in federal Budget
the proposed plan would
2018, the pharmaceutical
cost taxpayers an extra
and insurance industries
$20 billion. 59 (This figure
have embarked on a lobby-
doesn’t factor in the nearly
ing frenzy in Ottawa. Lob-
$15 billion 60 in existing and
bying and advertising are
The Hill Times, June 4, 2018 poorly controlled public
two ways that industries use
spending. Any net cost of a
their money to buy influ-
pharmacare program would
ence. In this case, the goal Big Insurance and billion-
be more than offset by
is to advocate for a “fill the aires are funnelling into the
revenues capturing some of
gaps” system, which is more anti-pharmacare campaigns.
the estimated $11 billion in
lucrative to them and worse No mechanism exists in Can-
savings to Canadians that
for Canadians. ada to ensure that level of
would result. 61 Furthermore,
transparency. However, it is
these figures don’t take into
No one knows exactly how possible to gather fragments
account the public cost of
much money Big Pharma, of evidence that suggest a
tax subsidies for private
complex tapestry of lobby-
health benefit plans and the
ing and advertising activity
private coverage bought for
being deployed by these
public employees.)
actors to protect their inter-
ests.
This was followed by a
series of three half-page ads
CLHIA and the Health
in the The Hill Times III in May,
Insurance Industry
June and November 2018.
Shortly after the House of With the headline “Better
Commons Standing Com- Health Benefits for Every-
mittee on Health issued its one,” the CLHIA ads reiter-
report endorsing publicly ated the industry’s key posi-
funded pharmacare in April tion: that a program, which
2018, members of CLHIA preserves the private insur-
CLHIA Twitter Campaign, challenged the Committee’s ance industry’s market share
June 18-20, 2018
(essentially “fill the gaps”),
III At a time when digital advertising predominates, it is nearly impossible to gather records of
online advertising. Though not a household name, we use The Hill Times as a proxy for the
broader media advertising campaign deployed by the opponents of pharmacare. We chose The
Hill Times for two reasons. First, it is a bi-weekly print newspaper that is a go-to publication for
politicians and senior bureaucrats in Ottawa on political and public policy news. If your goal is
to put your message in front of the eyes of key decision makers, The Hill Times is a good place to
start. Second, as a print publication, subscribers can easily access its publication archives.
CANADIAN FEDERATION OF NURSES UNIONS 11RESEARCH & DEVELOPMENT SPENDING VS. DRUG SALES 67
Growing gap between R&D Spending and Sales by Patented Drug Industry
REVENUE
Revenue UP
R&D Spending DOWN
R&D
YEAR
Patented Medicine Prices Review Board - CBC News
is the best policy option for for 2 million Canadians. Gov- Innovative Medicines
Canada. Any government ernments should help those Canada and the Pharma
changes to coverage ought people while protecting the Industry
simply to add another layer workplace health benefits Considering the growing
of targeted public coverage that others enjoy.” The clear potential profits on
to the existing public-pri- objective of the ads was to the horizon from high-
vate mix, the ads suggested. target Canada’s premiers cost medications, the
and senior staff with a mes- pharmaceutical industry has
CLHIA also turned to Twit- sage opposing universal a lot to lose from a strong
ter to spread its core mes- single-payer pharmacare. single-payer bargainer
sage from July 18-20, 2018, for Canada. According to
when provincial premiers CLHIA’s lobbying efforts the latest report from the
met for their annual sum- with Canadian decision Patented Medicine Prices
mit in St. Andrew’s by-the- makers also rose consid- Review Board (PMPRB), IV
Sea, New Brunswick. During erably with the launch of within a decade the number
the days of the premiers’ the ACINP in Budget 2018. of patented medicines in
summit, CLHIA-promoted From 2017 to 2018, CLHIA’s Canada with an annual
ads appeared regularly on non-trade-related lobby- cost of at least $10,000
Twitter feeds geo-located ing activity rose by roughly more than tripled. They
to that hamlet with a popu- 61%. 62 The evidence suggests now account for over 40%
lation of 1,500 people. Using a ramping-up of efforts by of patented medicine sales,
the guise of a micro-site the Big Insurance to stop rising from 7.6% in 2006.
called betterhealthbenefits. pharmacare from being Despite this escalation
ca, CLHIA’s ads read: “Cost delivered to Canadians. in the share of costs, the
of medicines are a problem number of people using
IV The PMPRB is an arms-length, quasi-judicial body established in 1987 to ensure that the price of
patented drugs is not excessive. It has raised concerns about rising prices of these medications.
12 BIG MONEY CLUB500 % increase
in lobbying
activity
R&D SPENDING
% GROWTH OF
in one year
these medicines is less than investment in Canada.” year – the same year
1% of the population. 63 This In fact, history proves false the Trudeau government
high-priced pharmaceutical claims linking revenue to announced the ACINP. This
market is, to a large degree, R&D investments in life sci- figure is even more excep-
preserved by Canada’s ences. Indeed since 2000, tional comparing it to the
current multi-payer system industry revenues have numbers from 2015 and 2016
of drug coverage. soared while R&D invest- – an election and post-elec-
ments have stagnated. 64 The tion year. In both years, IMC
In 2018, corresponding industry’s research invest- took 54 non-trade-related
with the launch of the ments in Canada fell in 2017 lobbying meetings, just over
ACINP, Innovative Medicines to a paltry 4.1 % (from 4.4% half the number in 2018.
Canada (IMC) increased its in 2016) of Canadian sales The pharmaceutical indus-
lobbying and advertising (4.6% for members of Inno- try sees the implementation
efforts substantially. They vative Medicines Canada, of pharmacare as worthy of
bought fifteen full-colour down from 4.9% in 2016). 65 the deployment of unprece-
ads in The Hill Times in 2018 Merck, AstraZeneca, Sano- dented lobbying resources.
alone. The ads included fi-Aventis and Johnson &
claims that pharmacare Johnson have either closed Pharma Influence over
could result in patients or scaled down their Cana- Patient Groups
being forced to go without dian research facilities, lay- In the past two decades,
medications: “Far-reaching ing off staff. 66 drug companies in Canada
changes to Canada’s and abroad have poured mil-
patented drug regime will The IMC and Canada’s lions of dollars into funding
lead to job losses, a cutback pharmaceutical giants also patient advocacy groups,
in R&D investment and increased lobbying efforts which now have a formal
reduced access to the latest in 2018. In fact, IMC’s non- role in many drug policy
therapies,” stated one ad. trade-related lobbying structures. 68 Many of these
Another cautioned, “Far- meetings rose from 18 in patient groups are tiny
reaching Health Canada 2017 to 104 in 2018. This organizations that valiantly
reforms could undermine was a 500% increase in lob- fight for the well-being of
life sciences research and bying activity in one
CANADIAN FEDERATION OF NURSES UNIONS 13FEDERAL LOBBYING BY PHARMA LOBBY GROUP: NUMBER OF MEETINGS
(Trade-related meetings excluded) V
Number of meetings
increases as Ottawa 104 WHY SO
considers Pharmacare
MANY
MEETINGS
49 LAST YEAR?
15
2008 Average 2018
over 11 yrs.
Records of the Office of the Commissioner of Lobbying of Canada
their often vulnerable patients were “strongly With few other funding
patients, yet they are ham- opposed” to switching from options available to them,
strung by a lack of funding their brand name drug to a cases like this suggest that
sources. cheaper biosimilar. The two many patient groups are
companies that paid for the given little choice but to
As one Canadian patient report, Janssen and AbbVie, take the conditions placed
group recently discov- are two with a lot to lose on them by Big Pharma
ered, to its dismay, funding from biosimilar competition. funders, or face closure.
arrangements with patient Feeling manipulated, the
groups often come with group’s president e-mailed It is not easy to know the
strings attached. 69 members of his board and scale of pharmaceutical
recommended the group funding of patient groups,
In October 2018, The Globe take its name off the report. since few companies pub-
and Mail broke a story illus- Board members agreed, licly disclose such contri-
trating this phenomenon. despite the fact that Jans- butions. To their credit,
In 2016 the president of sen and AbbVie had pro- GlaxoSmithKline is a rare
the Canadian Spondylitis vided 90% of the group’s example of a company that
Association, which rep- budget the previous year. effectively discloses its
resents patients with a type Janssen then rejected the patient group funding to the
of arthritis that affects the group’s requests for funding public. Here is their data for
spine, attended a focus in 2017 and 2018 (AbbVie 2017 – likely only a drop in
group project which ended continued its funding). 70 the bucket of all funding for
with groups being asked to patient groups:
sign a report (destined for
Health Canada) that said
V Meetings explicitly relating to international trade were excluded from our count because of the
importance of the NAFTA renegotiations in 2018.
14 BIG MONEY CLUBGLAXOSMITHKLINE VI 2017 FUNDING OF PATIENT GROUPS & GSK’S % 71
Total $ to group % of group’s
Group
in 2017 2017 revenues
Asthma Society of Canada 101,560 10.2%
BC Lung Association 20,000 < 1%
Best Medicines Coalition 35,000 13.5%
Canadian Lung Association 50,000 < 1%
Canadian Organization for Rare Disorders 5,000 1.3%
Chronic Obstructive Pulmonary Disease Canada 25,000 8.1%
Gastrointestinal Society 25,000 2.6%
Immunize Canada 30,000 16.9%
L’Association Pulmonaire du Quebec 65,000 2.3%
Lung Association of AB & NWT 12,500public disclosure practices,
it is challenging to uncover
who the donors are and how
much they contribute. Nev-
ertheless, some examples
can be traced that show
part of the overall picture.
From Canada
One deep-pocketed Cana-
dian funder is the Aurea
Foundation, a registered
charitable organization
founded by the late Cana-
dian billionaire Peter Munk.
From 2011 to 2017, Aurea
gave $1,675,568 to the Fra-
ser Institute, $1,255,000
The Hill Times, February 12, 2018
to the Macdonald-Laurier
Institute, and $968,000
to the Montreal Economic
therapies under private drug interests. Information is
Institute, 75 three think tanks
plans than those who rely generated and disseminated
that oppose pharmacare.
solely on a public plan. 73 to the public via think tanks
Additional funding included
Innovative Medicines Canada and other policy outfits
$5 million in donations by
bought a Hill Times ad two funded by wealthy donors
the Munk family in 2016 to
months earlier with a similar and corporations with a
establish the Peter Munk
message to the patient vested interest in stopping
Centre for Free Enterprise
group. 74 pharmacare from emerg-
ing in Canada. A revolving Education at the Fraser
Institute. 76
These examples suggest door connects the cast of
that pharmaceutical giants characters at the Canadian
One of Canada’s wealthiest
are sometimes able to buy think tanks to the pharma-
families, the Westons, who
additional lobbying influ- ceutical industry and larger
own Shoppers Drug Mart –
ence through their condi- U.S.-based conservative
Canada’s largest pharmacy
tional funding of under-re- and business-friendly insti-
chain – also frequently
sourced patient groups. tutions. What emerges is a
supports the Fraser Insti-
media campaign involving
tute. Their charitable fam-
many industry-linked orga-
B) CREATE ECHO nizations singing from the ily foundation has a history
CHAMBERS same song book. of collaboration 77 with the
Institute, including reports
The second prong in the of $22 million in funding. 78
strategy to stop phar- Following the money
macare is the creation of trail
From the U.S.
echo-chambers of informa- Think tanks that oppose
tion designed to convince Foreign billionaires and Big
pharmacare draw funds from
the public and media to Pharma lobbies are also
the ultra-rich and large cor-
favour policies that ulti- generous donors to Cana-
porations both from Canada
mately serve commercial dian think tanks that oppose
and abroad. Due to murky
16 BIG MONEY CLUB$ Millions in funding from
U.S. Pharma lobby to change
Canadian health care
pharmacare. dysfunction in their system. $400,000 from the Searle
The industry worried that, Freedom Trust, a private
In 2004, the U.S. pharma- as state, federal and foreign foundation founded with
ceutical industry’s lobbying governments tried to wealth from G.D. Searle
arm, the Pharmaceutical expand access to affordable pharmaceuticals (now part
Research and Manufac- drugs, the resulting of Pfizer, another pharma
turers of America, known price controls and other giant). 83
as PhRMA, ramped up its regulations would tie the
lobbying budget to U.S. drug makers’ hands. Price Canadian think tanks also
$150 million to support control efforts in Canada receive funding from the
a series of projects that were seen as particularly U.S.-based Atlas Network,
would target American problematic because which is itself funded by
legislators, but also foreign they created “politically billionaires such as the
governments, including unsustainable cross-border Koch brothers. 84 Founded
Canada. The plan was ded- pricing differences…” 80 and initially bankrolled by
icated to funding a stand- British billionaire Antony
ing network of economists, The Fraser Institute has Fisher, Atlas Network was
“thought leaders” and think received $4.3 million in an extension of Fisher ’s
tanks to act as an intellec- foreign funding over 10 mission to “litter the
tual echo-chamber sympa- years from billionaire U.S. world with free-market
thetic to the industry, and donors, beginning in the think tanks.” 85 Among the
to develop strategic alli- early 2000s. More than half 13 organizations listed as
ances with doctors, patients, (approximately $2.7 million) Canadian global partners
universities and influen- of the total foreign funding of the Atlas Network are
tial members of minority came from the Eli Lilly and the Canadian Taxpayers
groups. The PhRMA bud- Co. Foundation, a charita- Federation (CTF), the Fraser
get included $1 million “to ble arm of pharmaceutical Institute, the Montreal
change the Canadian health giant Eli Lilly. 81 82 According Economic Institute (MIC),
care system.” 79 to the U.S.-based Center for and the MacDonald-Laurier
Media and Democracy – an Institute for Public Policy. 86
One objective of PhRMA organization that tracks By becoming a global
was to keep global drug corporations’ PR campaigns partner, these Canadian
prices high – including and identifies corporate think tanks become eligible
those north of the border, front groups – between 1995 for grants, training and
where our lower drug prices and 2014 the Fraser Insti- awards throughout the year.
and public health care tute received over $1 million To become a partner, think
system constantly remind from the Charles G. Koch tanks must share the Atlas
Americans of the level of Charitable Foundation, and Network vision of “a free,
CANADIAN FEDERATION OF NURSES UNIONS 17INTERNATIONAL U.S. ATLAS
BILLIONAIRES NETWORK
prosperous and peaceful the pharmaceutical sector a Washington D.C-based
world where limited and larger U.S.-based think conservative and indus-
governments defend the rule tanks. Although numerous try-linked think tank, the
of law, private property and examples exist, here are R-Street Institute.
free markets.” 87 three.
Creating the
What little information is avail- The Canadian Health echo-chamber
able suggests the Atlas Net- Policy Institute is another
The Fraser Institute in Van-
work is promoting a model think tank that opposes
couver is one of the most
of elaborate mass persuasion pharmacare and whose ties
established conservative
strategies using YouTube, to deep-pocketed donors
think tanks in Canada.
Facebook, WhatsApp and other run deep. Its’ founder is a
Founded in 1974, it has
social media to rebrand public former CEO and director of
maintained a long-stand-
debate and to mobilize low- Health Policy Studies at the
ing campaign to oppose
cost organizing to advance the Fraser Institute, and was
public single-payer health
interests of corporate elites Executive Director of Health
care. As interest in phar-
and profits. The Atlas Network and Economic Policy at
macare picked up in recent
also is actively supporting the Innovative Medicines Canada
years, the Fraser Institute
creation of new think tanks that for four years. 91 Despite a
began contributing to the
support its mission in Canada staff contingent of three,
echo-chamber of opposition.
and abroad.88 the CHPI bills itself as an
In 2018 alone, the Fra-
“evidence-based activist
ser Institute published six
According to the Atlas think tank.”
articles opposing universal
Network’s Annual Report
single-payer pharmacare
for 2016, Canadian partner A former federal director of
and/or supporting Big Phar-
organizations received over the CTF for six years subse-
ma-friendly “fill the gaps”.
$200,000 in grant funding, quently moved on to Rx&D
Articles included titles such
though it is unclear which (the precursor to Innovative
as “Pharmacare is the wrong
organizations in particular Medicines Canada) and now
solution at the wrong time” 93
benefited. 89 90 works as a Senior Director
and “Before implementing
for Government Relations
national pharmacare, look
The revolving door with Purdue Pharma. 92
at what provinces already
The cast of characters offer.” 94
One of the current senior
who work for these indus-
fellows with the Macdon-
try-funded think tanks Moving further afield,
ald-Laurier Institute is
often have deep ties to the Institute also pitches
also an associate fellow at
18 BIG MONEY CLUBCAMPAIGN
CANADIAN
TO STOP
THINK TANKS
PHARMACARE
opinion pieces in local titles such as “Canadians are “The risks that come with
newspapers in order to being fooled into thinking a national pharmacare pro-
access new audiences across we’ll like pharmacare: we gram, in the The Globe and
Canada. For example, in really, really won’t,” “Turns Mail and “National phar-
an effort to sway public out nearly all Canadians macare plan not the answer ”
opinion in just one small already have drug cover- in the Ottawa Citizen.
province, the Fraser Institute age, despite the pharmacare
has published opinion myths” and “We can make As a key Atlas Network
pieces with titles such medicine affordable without member in Canada, the
as “Prescription Drugs in the damage pharmacare will CTF 98 has also put phar-
Canada – target those who cause Canadians.” macare in its cross-hairs.
need help,” in the Moncton The CTF recently published
Times, and “Pharmacare – As recently as January 23, a piece against pharmacare
be careful what you wish 2019, the Canadian Health on CBC’s Opinion web-
for ” in the New Brunswick Policy Institute secured site in October 2018, titled
Telegraph-Journal. 95 the publication of another “There will be no such thing
opinion piece in the Finan- as painless national phar-
Adding to the echo-cham- cial Post, entitled “Trudeau macare.” In other publica-
ber, the billionaire-funded spreads the Big Pharmacare tions, CTF parrots the lines
Macdonald-Laurier Institute myth that scores of Canadi- of big-moneyed interests,
also published five articles ans can’t afford medicine.” 97 declaring that “there should
in 2018, opposing universal never be a national phar-
single-payer pharmacare. The Montreal Economic macare program,” and that
Titles include “Fill in the Institute (MEI), an Atlas rather “more participation
gaps to strengthen phar- partner and recipi- by the private sector ” is the
macare” and “Single-payer ent of funding from the best path forward. 99 Armed
pharmacare is a cure worse Aurea Foundation, adds with its base of 140,000
than the system,” the latter yet another voice to the supporters across Canada,
of which was published in anti-public pharmacare echo the CTF has a powerful
The Hill Times in November chamber. In additional to capacity to bolster the Big
2018. 96 numerous media interviews, Money echo-chamber in
one of the MEI-based econ- Canada.
As well, the Macdonald-Lau- omists has written articles
rier Institute secured pub- with the titles “Do we need Domestic and foreign bil-
lication of three opinion a public drug insurance lionaires and pharmaceutical
pieces in the Financial Post monopoly in Canada?” in giants have long targeted
in 2018 on pharmacare, with the MEI health care series, Canada’s public health
CANADIAN FEDERATION OF NURSES UNIONS 19U.S. DOWNGRADED CANADA’S
STATUS AS A TRADING PARTNER
AFTER PROPOSED DRUG PRICE
CONTROLS ANNOUNCED
system and now want to and investment and a pub- implementation of promised
prevent Canada from imple- lic relations campaign that stricter price rules for pre-
menting a universal sin- blames Canada for health scriptions in Canada passed
gle-payer pharmacare plan care ills in the U.S. without action. Reports
that Canadians so badly suggest there are no plans
need. In an effort to head In 2018 the U.S. to meet any future dead-
off public antipathy towards downgraded Canada’s line. 101 The single purpose
them, these deep-pocketed status as a trading partner of the price ceilings is to
interests have deployed after Canada announced prevent corporate gouging
a campaign of mass pub- our intent to apply stricter of patients while their med-
lic persuasion, using price rules for prescriptions icines are on patent. While
echo-chambers to achieve medications in the revised the government’s reasons
their goal. PMPRB regulations. Canada for this delay are unclear,
was already on the U.S. the powerful weight of U.S.
C) CALL ON “Watch List” mainly due commercial pressure and Big
FOREIGN BACK-UP to our pharmaceutical Pharma lobbying has been
policy designed to defend applied on this issue. Every
The deep-pocketed cam- the public interest. A 2018 day, Canadians are paying
paign to influence prescrip- report switched us to the price.
tion drug policy and stop the “Priority Watch List”
pharmacare in Canada has because of serious concerns Adding to the pressure,
also called upon the Trump about Canada’s policies on President Trump began
Administration for support. patent protection. 100 blaming Canada in 2018 for
Given the power of the phar- high drug prices in the U.S.
maceutical lobby in U.S. pol- In Canada credible concern He argued that Canada gets
itics, it’s little surprise that is mounting that this kind of a free ride on U.S. innova-
their attention has turned Big Pharma lobbying tac- tion. 102 This is hard to imag-
to Canada. And, it would tic, possibly assisted by the ine when we pay the third
appear that the Trump Trump Administration, is highest per capita prices in
Administration has obliged starting to work. The dead- the Organisation for Eco-
with threats to curtail trade line (January 1, 2019) for the nomic Co-operation and
20 BIG MONEY CLUBNorth America’s Biggest
Lobbying Spenders:
1. Big Pharma
2. Big Insurance
Development (OECD). 103 amount they spent on lob- negotiations (NAFTA 2.0).
bying in 2018, Big Pharma The Trump Administration’s
In reality the U.S. govern- topped the list. The phar- bluster and threats pres-
ment, under pressure from maceutical industry spent sured Canada into agreeing
its powerful pharmaceutical $280 million, and the insur- to the extension of data
sector, is the only coun- ance industry, at $156 mil- protection for biologic med-
try among rich nations not lion, ranked second. 106 icines (the highest-priced
to enact price controls on Lobbying data in Canada medications on the market)
drugs. These high prices reflects a similar degree of from eight years to ten. 107
help make the pharmaceuti- lobbying influence this side The prolongation of this
cal industry one of the most of the border (consider, period of data protection
profitable industries in the among other sources, the amounts to longer market
U.S., with a 2016 net profit 500% increase in lobbying monopolies for hugely prof-
margin of over 20%. 104 activity by Innovative Medi- itable pharmaceutical giants
cines Canada between 2017 and higher costs to Cana-
Meanwhile, pharmaceutical and 2018). dian patients. It also means
giants put more money into a further fiscal burden on
marketing, paying out cor- In addition to exerting Canadian governments, who
porate dividends and buying investment pressures, the cover 42.7% of drug spend-
back corporate stock than U.S. administration also ing in Canada. 108 Finally, it
they spend in the discov- demanded concessions could increase the cost of
ery of new drugs. 105 When from Canada on drug prices implementing a national
the U.S. watchdog group during the recent United pharmacare program.
OpenSecrets ranked 121 States-Mexico-Canada
industries according to the trade agreement (USMCA)
CANADIAN FEDERATION OF NURSES UNIONS 21CONCLUSION
Though seemingly diverse, creating echo-chambers whose over 3 million mem-
virtually all the opposition to distort the information bers experience the cost of
to pharmacare can be traced available to the public and the current dysfunctional
back to a network of well- the media, and to promote a system; a consensus of over
funded interests exerting fear of change. Finally, they 80 national, provincial and
their influence largely in are calling for back-up from territorial organizations of
secret. This Big Money Club the Trump Administration to all kinds in all sectors, who
– made up of pharmaceu- exert international commer- support a system that is uni-
tical companies, the health cial pressure on Canada to versal, single-payer, public,
insurance industry, and maintain the status quo and accessible, comprehensive
both Canadian and foreign reconsider reforms. and portable; and the grass-
free-market billionaires – are roots of the Liberal, NDP
the only players who stand As Canadians look to the and Green parties. Cana-
to lose from pharmacare. federal election in the fall dians must demand of our
For the rest of Canadians, of 2019, we cannot let the elected officials that they
pharmacare would be a sub- big-moneyed interests dis- choose policies that defend
stantial gain. tort health policy in Canada the interests of all Canadi-
to the exclusive benefit of ans over Big Money. It’s time
With deep pockets and con- their profit margins. Instead Canadians enjoyed a com-
siderable resources, the Big the Canadian government mon sense pharmacare plan
Money Club is employing an should be listening to who built to provide coverage
expansive strategy involving supports pharmacare and for everyone, control costs
three key prongs to stop the why. The supporters include and keep prices down. It’s
delivery of pharmacare to nurses and health care work- time to do what’s right for
Canadians. Tapping into a ers, who see everyday the the public’s health and the
deep well of resources and tragedies of the current country’s economy.
overlapping networks, they system; over 200 health
are influencing politicians policy experts, who signed
and policymakers through on to Pharmacare2020,
lobbying and inflamma- based on the evidence 109 ; the
tory advertising. They are Canadian Labour Congress,
22 BIG MONEY CLUBIT’S TIME
PRESCRIPTION
DRUGS BE
CONSIDERED
PART OF OUR
PUBLIC HEALTH
CARE SYSTEM
CANADIAN FEDERATION OF NURSES UNIONS 23REFERENCES
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