Advisers to Presidential candidates discuss positions on reimportation, generics, biotechnology medications

Democratic presidential nominee Sen. Barack Obama (Ill.) and Republican presidential nominee Sen. John McCain (Ariz.) have begun "reviewing their support" for prescription drug reimportation in response to recent cases of contaminated medications and other products from other nations, advisers to the candidates said on Thursday during the annual conference of the Generic Pharmaceutical Association in Washington, D.C., Reuters/Boston Globe reports.

According to Reuters/Globe, the advisers indicated that the candidates had not "abandoned reimportation but had realized it would be more difficult."

Dora Hughes, a health care policy adviser to Obama, said, "Both candidates were in favor of reimportation and sort of subsequent to the heparin incident (there's) a lot less enthusiasm," adding, "We have a better understanding of the challenges that go along to support the importation." Douglas Holtz-Eakin, a senior policy adviser to McCain, said, "We now realize the challenges for doing that are greater than before" (Heavey, Reuters/Boston Globe, 9/18).

Other Issues

The advisers also said that both candidates would make expanded use of generic medications one of the top priorities on their health care agendas.

Hughes said, "We know that expanding the use of generics and eliminating barriers to that goal must be a centerpoint of any health reform effort." She added that Obama supports the elimination of reverse payment agreements, under which brand-name pharmaceutical companies pay generic pharmaceutical companies to delay market entry of generic medications.

Holtz-Eakin said, "Controlling health care costs has to be the imperative of any effective health care reform," adding, "Senator McCain's instincts are to make the period as short as possible so that you can get products to market more quickly." According to Holtz-Eakin, McCain also would seek to revise the tax code to discourage the shift in prescription drug manufacturing to other nations. He said, "The simplest way to make sure supply chains are safe is to make sure they begin and end in the U.S." (Perrone, AP/BusinessWeek, 9/18).

The advisers also said that both candidates support legislation to allow FDA to approve generic versions of biotechnology medications. Both candidates also support the shortest possible period of market exclusivity for brand-name biotechnology companies under such legislation, the advisers said.

Hughes said that "14 years (of data exclusivity), as requested by the biotech industry, is excessively long," adding that "we're tilted toward the shorter period." Holtz-Eakin said, "The basic instinct should be: push the period down to the shortest period that maintains the appropriate innovation incentives" (McCarthy, CQ HealthBeat, 9/18).

Mental Health Care

The National Alliance on Mental Illness on Thursday released information from Obama and McCain on their positions on mental health care issues, the Los Angeles Times "Booster Shots" reports. Earlier this year, NAMI sent a 24-question survey to all of the presidential candidates that asked about their positions on a number of mental health care issues.

Obama responded that he "strongly supported" all efforts to improve and promote mental health care. He wrote, "I believe we should prohibit group health plans from imposing treatment or financial limitations on mental health and substance-related disorder benefits that are different from those applied to medical or surgical services."

McCain cited the need for improved treatment for substance use disorders, adding that "we also have an obligation to do a better job of teaching our children the benefits of good lifestyles and the perils of addictive activities." He added, "A sensible goal is to design reimbursement for taking care of the whole patient, whatever ails them, and recognize the essential role mental health treatment plays in the overall health of the patient and the reduction in physical health needs" (Roan, "Booster Shots," Los Angeles Times, 9/18). The full release is available online.

Experts Debate Health Care Reform

Physicians, economists, professors, politicians and business leaders on Wednesday and Thursday during the "America's Healthcare at Risk: Finding a Cure" conference in Orlando, Fla., discussed areas in which Democrats and Republicans agree on health care reform, the Miami Herald reports. During the conference, co-sponsored by the White House Writers Group and the West Wing Writers, pollster Michael Berland said that "health care reform is being advocated by everyone -- and that's where it stops" because of the lack of agreement on the issue.

However, according to former HHS Secretary Tommy Thompson and former Senate Majority Leader Tom Daschle (D-S.D.), both Obama and McCain agree on the need to reduce health care costs through increased use of health care information technology, preventive care, disease management and wellness programs. John Engler, CEO of the National Association of Manufacturers, said, "Health IT will save us north of $100 million a year."

Irwin Redlener, a Columbia University physician who represented Obama at the conference, said that the recent economic downturn "makes an even more compelling case" for health care reform that helps more residents obtain health insurance. Andy Stern, president of the Service Employees International Union, added, "This is the time we really need reform." Democratic consultant James Carville in an interview said, "My sense is there are too many knives flying through the air right now," and health care likely will have to wait for a "better economy." Republican consultant Karl Rove in an interview said that many health care reform proposals from Republicans do not require funds from the federal government and that the McCain health care plan is "very sellable."

Florida Gov. Charlie Crist (R) also spoke about the Cover Florida plan, which aims to offer low-cost health coverage to uninsured state residents. Crist said that perhaps states should take the lead in overhauling the health care system, adding, "There's such a difficulty getting anything done in Washington" (Dorschner, Miami Herald, 9/19).

A webcast of the conference will be available online Monday at kaisernetwork.org.

Elizabeth Edwards Testimony

Elizabeth Edwards, the wife of former Democratic presidential candidate and former Sen. John Edwards (N.C.), on Thursday during a House Energy and Commerce Health Subcommittee hearing "forcefully denounced" the McCain health care proposal, CongressDaily reports.

The McCain proposal would replace an income tax break for employees who receive health insurance from employers with a refundable tax credit of as much as $2,500 for individuals and $5,000 for families to purchase coverage through their employers or the individual market. In addition, the proposal would provide federal subsidies for high-risk health insurance pools to help residents who cannot obtain private health insurance because of pre-existing medical conditions. The proposal also would allow residents to purchase health insurance across state lines.

Elizabeth Edwards, whom the subcommittee invited to testify about the differences between employer-sponsored and individual health insurance, diverted from her prepared remarks, which did not include any political statements or criticism of the McCain proposal, according to subcommittee Chair Frank Pallone (D-N.J.).

During the hearing, Elizabeth Edwards said, "Sen. McCain and I have something in common, and that is neither one of us would be insured under his health care plan" (Hunt, CongressDaily, 9/18). She added, "If you're 55 with cancer ... good luck to you" (Barratt, McClatchy, 9/18). In addition, Elizabeth Edwards said, "The individual market makes it more difficult to get insurance," adding, "For an individual policy, the administrative costs are close to three times what it costs for a group plan. This is exactly the opposite direction that we want to go." Elizabeth Edwards also said that consumer choice in health care is not the same as choice for other products. She said, "Deciding which cancer treatment to use, chemotherapy, radiation or surgery, will simply never be the same as deciding between a Dodge, a Buick or a Ford" (CongressDaily, 9/18).

Broadcast Coverage

NBC's "Nightly News" on Thursday examined the Obama and McCain health care proposals. The segment includes comments from Obama, McCain, Andrew Bindman of the University of California-San Francisco and Alisha Poreda, a mother (Bazell, "Nightly News," NBC, 9/18).