WASHINGTON — An initiative that would have attempted to cap drug prices in South Dakota was removed from the statewide ballot by a judge on Monday, the second time that a court has prevented such a measure from going before voters in the 2018 election.

The ruling came after a court determined the measure’s supporters had improperly gathered some of the signatures necessary to qualify it for the ballot, according to the initiative’s biotech-backed opposition.

A District of Columbia elections board also ruled in January against a nearly identical measure being placed on the ballot in 2018.

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The decisions mean that, unlike in the past two years, the midterm elections are unlikely to feature clashes over proposals to bar local health programs, including most Medicaid programs, from paying higher drug prices than the Department of Veterans Affairs.

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Initiated Measure 26 in South Dakota and the District of Columbia Drug Price Relief Act of 2018 would have followed initiatives that went to voters in California in 2016 and Ohio in 2017. Both ballot measures were rejected, though in California only narrowly.

The legal complaint that stopped the South Dakota initiative was filed by the campaign committee South Dakotans Against the Deceptive Rx Ballot Issue. Joni Johnson, the group’s chairwoman, is the executive director of South Dakota Biotech, the state affiliate of the Biotechnology Innovation Organization, a Washington trade group.

“IM26 was about deception from the beginning,” the group said in a statement. “Proponents of this deceptive proposal took a bad idea rejected by voters in California and Ohio, funded it with contributions from an out-of-state health care organization and violated the law in attempting to qualify it for the ballot.”

The other major pharmaceutical trade group, PhRMA, had challenged the equivalent ballot measure in a D.C. elections board, where a judge ruled it was not appropriate for consideration by voters since it interfered with the local government’s discretion in spending local funds.

In all four cases, the AIDS Healthcare Foundation, a global nonprofit based in Los Angeles, has supplied the vast majority of the financial backing and advocacy in favor of the measures.

The nonprofit’s CEO, Michael Weinstein, is a polarizing figure inside and outside the HIV/AIDS advocacy community, having opposed the use of drugs meant to minimize risk of HIV transmission through sex and waged similarly controversial fights at the ballot box against Los Angeles real estate developers and the porn industry.

Citing the ballot-box defeats in California and Ohio, the “No on IM26” campaign called the judge’s ruling “strike three” for Weinstein in its press release.

While support for the initiative does not necessarily fall along traditional partisan lines, South Dakota is among the country’s most conservative states, with President Trump beating Hillary Clinton there by a 62-32 margin in 2016. The South Dakota Republican Party included opposition to IM26 in its 2018 platform.

Experts are split on whether measures to cap drug prices at the price paid by Veterans Affairs programs are effective. Not only are such measures seen as difficult to implement, but many elements of VA contracts would remain confidential, and drug makers would not be bound to sell at the discounted price offered to the VA.

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