Toronto, Canada (Toronto Star) May 17, 2006

The fragile coalition that Health Minister George Smitherman had knit together in support of his controversial prescription drug legislation appears to be unravelling.

When he rolled out the legislation a month ago at a splashy event at the MaRS Centre in downtown Toronto, Smitherman had three people on stage with him - two representatives of patients and one spokesperson for pharmacists.

They all said positive things about the legislation, Bill 102. The patient advocates liked the fact that it did not contain "reference-based pricing," a practice in other provinces whereby the government pays only for the cheapest drug in any given category.

And the pharmacists were overjoyed that Bill 102 recognized their value as front-line health-care providers with a special $50 million fund to compensate them for time spent coaching seniors on medication management and the like.

As for the generic drug manufacturers, while they were not on stage, they were quietly supportive of the legislation, which would require more "inter-changeability" of drugs - substituting their products for those of their brand-name competitors.

The brand-name drug companies (a.k.a. Big Pharma) were opposed to Bill 102, of course. But Smitherman was confident he could fight and win a one-front war against them.

Now, four weeks later, patient advocates are beginning to question the language in the bill around interchangeability and to wonder whether the government is introducing reference-based pricing in disguise.

"I'm certainly concerned about the language with respect to interchangeability," says Louise Binder of the Best Medicines Coalition, who was one of those sharing the platform with Smitherman last month.

"It needs further amplification and clarification."

Conservative Leader John Tory picked up on these concerns last week in the Legislature, where he brandished a leaked cabinet document that specifically mentions "reference-based pricing" as part of Bill 102.

In response, Smitherman dismissed Tory's concerns as groundless and said the Conservative leader "seems to have taken a smoking gun and shot himself in the foot with it."

But in a private meeting last week with patient advocates, Smitherman reportedly suggested he was open to changing the language with regard to inter-changeability of generic and brand-name drugs.

Meanwhile, the support of the Ontario Pharmacists Association (OPA) for Bill 102 is also weakening. Indeed, at last week's annual meeting of the association, OPA President Marc Kealey - another one of those who were on stage with Smitherman - got an earful from rank-and-file members over his perceived soft-pedalling of criticisms of the bill.

Among other concerns, pharmacists are worried Bill 102 will terminate hundreds of millions of dollars in rebates paid to them by generic drug firms as incentives to stock their products.

There were also whispers in the corridors of the OPA meeting about Kealey's Liberal connections. He worked as an aide in the Peterson government of the late 1980s and last summer he hosted a fundraiser for Smitherman.

Asked about this yesterday, Kealey noted that he also hosted a fundraiser for Tony Clement when he was minister of health in the previous Conservative government.

Kealey added that he is no longer "active" in the provincial Liberal party, but he acknowledged that he is chairing a fundraiser for another Liberal MPP, Peter Fonseca. "He's a friend of mine," explained Kealey.

As for his approach to Bill 102, Kealey said he has been working quietly behind the scenes to get changes in the legislation. "We're dealing with this in the most professional and accurate way we can," he said.

But other pharmacists, clearly frustrated by this quiet diplomacy, picketed Smitherman's speech to the Economic Club of Toronto on Monday and held a press conference at Queen's Park yesterday to voice their concerns about Bill 102 in public.

The problem for Smitherman is that, if he restores rebates or weakens the interchangeability clauses, he would likely lose the support of the generic firms for Bill 102.

And he still has the brand-name firms to contend with. They are lobbying furiously against Bill 102 behind the scenes and are taking their case directly to Premier Dalton McGuinty, who has agreed to meet with them at some unspecified later date.

This could evolve into a multi-front war. History tells us that they are much harder to win.

Ian Urquhart's provincial affairs column appears Monday, Wednesday and Saturday

Source: The Toronto Star