Hillary Clinton – Where the Candidates Stand – Part 2

SenatorclintonclxBy contrast to most of the other candidates, the healthcare plan laid out by Senator Hillary Clinton (D-NY) is quite comprehensive, which should be no surprise given her history with the issue.   That said, the organization of the written plan is a bit of a challenge, and one is encouraged to read the entire plan rather than the three-page executive summary at the beginning, which does not exactly track with the plan. 

At her campaign site, you can see a summary of Senator Clinton’s healthcare plan, or you can download the entire 16-page plan.  The overwhelming element to this plan is insurance reform and she aims to increase the number of insured through various mechanisms that include new insurance schemes and practices that will expand coverage, lower premiums and to increase the ability of the insured to stay that way. 

It is in the last section of the plan (not the executive summary) where the five categories being addressed in this review are found under the heading "Fiscal Responsibility that Honors our Priorities" each is addressed with brevity.  However, she is also laying claim with this section to $4 billion in savings as a result of their implementation: 

  1. Importation of Drugs – While not mentioned in the body of the plan, allowing reimportation is figured into the balance sheet at the end of the plan that computes the $4 billion savings. 
  2. Medicare Part D Reform – She states that she favors applying purchasing leverage to reduce prescription drug costs by allowing Medicare to negotiate lower drug prices. also part of the $4 billion savings.
  3. Pharmaceutical Marketing Restrictions - There is no specific mention of what she means by this, but the plan states that she should provide "more oversight over pharmaceutical companies’ financial relationships with providers."  There is no mention of direct-to-consumer advertising or data marketing practices, but seems to focus solely on the relationship with prescribers.  This is also part of the $4 billion savings. 
  4. Follow-on-Biologic Regulation – She states that part of the savings that will be realized in her plan will come from creating a pathway for "biogeneric" drug competition but fails to detail what that pathway would look like.  Her choice of the term "biogenerics" regarded by many in industry as a misnomer since biologics cannot be exactly copied and therefore cannot be generics in the same sense of a chemical compound is open to interpretation, but may signal an unwillingness to embrace that position.
  5. Generic Promotion – Again with no specificity, the plan states that an object of the plan is "removing barriers to generic competition" and that is the sum of dedicated effort to that subject.  Whether this means an erosion of intellectual property or other means of removing barriers is simply not clear. 

Analysis:  If each of the elements of this plan listed above were enacted, the future growth of pharmaceutical sales would likely be impacted.  As the IMS report released last week noted, one of the reasons IMS was projecting lower growth for pharmaceutical sales was the increase in generics and the attacks on intellectual property.  The use of the term "biogeneric" along with the anticipation of savings to the government may mean that she is interested in a pathway that offers the least protection for intellectual property of biologics, which some may see as having a chilling effect on innovation in that industry.  The plan assumes a $4 billion savings from enacting reforms 1-5 above, but without specifics addressing each of these there is no way to assess the accuracy of that claim.  Despite the fact that the plan is comprehensive in scope, it is very short on details when the future of the pharmaceutical and biologic markets are concerned. 

Next on deck – Senator Christopher Dodd (D-CONN). but beware, it is slim pickins. 

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