BILL ANALYSIS                                                                                                                                                                                                    Ó






                                                                     AB 463


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          Date of Hearing:  January 12, 2016 


                            ASSEMBLY COMMITTEE ON HEALTH


                                    Bonta, Chair


          AB 463 (Chiu) - As Amended January 4,  
          2016


          SUBJECT:  Pharmaceutical Cost Transparency Act of 2016.


          SUMMARY:  Requires pharmaceutical companies to file an annual  
          report with the Office of Statewide Health Planning and  
          Development (OSHPD) containing specified information regarding  
          the development and pricing of prescription drugs.   
          Specifically, this bill:


          1)Establishes the Pharmaceutical Cost Transparency Act of 2016,  
            which requires that a pharmaceutical manufacturer that sells a  
            prescription drug in California file a report with OSHPD if  
            the wholesale acquisition cost (WAC) of the drug is more than  
            $10,000 annually or per course of treatment.  



          2)Requires the report to include the following:

             a)   The total cost of production of the drug, including:

               i)     Research and development costs, both to the  
                 manufacturer and any predecessor companies;

               ii)    Clinical trial and regulatory costs, both to the  











                                                                     AB 463


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                 manufacturer and any predecessor companies;



               iii)   Materials, manufacturing, and administration costs  
                 of the drug;



               iv)    Costs paid by any other entity, including federal,  
                 state, or other governmental programs or any form of  
                 subsidy, grant or other support; 



               v)     Acquisitions costs of the drug, including patents,  
                 licensing, or acquisition of another corporate entity;  
                 and, 



               vi)    Marketing and advertising costs for the promotion of  
                 the drug, as specified. 



             b)   A cumulative annual history of the average wholesale  
               price (AWP) and WAC increases, and which month the  
               increases took effect; 

             c)   Total company profits attributable to the drug;



             d)   Total amount of financial assistance the manufacturer  
               has provided through patient prescriptions assistance  
               programs, if available; and,













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             e)   The total costs of drugs or research projects that  
               failed to succeed through the process to market approval.
          3)Requires the report in 2) above to be audited by a fully  
            independent third-party auditor prior to filing. 

          4)Limits the reporting of information required by 2)a) above  
            from five years prior to the filing date of an Investigational  
            New Drug application with the United States Food and Drug  
            Administration (FDA) to the approval date of the New Drug  
            Application by the FDA.  Permits a manufacturer to separately  
            provide information outside of this time frame.



          5)Requires that the report be filed with OSHPD annually, on a  
            form prescribed by OSHPD, no later than May 1 of each year. 



          6)Requires OSHPD to issue an annual report to the Legislature  
            outlining the information submitted pursuant to this measure,  
            and to post the report publicly on its Website. 



          7)Requires OSHPD to convene an advisory workgroup to develop the  
            submission form. Specifies that the workgroup must include, at  
            least, representatives from the pharmaceutical industry,  
            health care service plans and insurers, pharmacy benefit  
            managers, governmental agencies, consumer advocates and  
            physicians. 



          8)Requires OSHPD to maintain the confidentiality of any  
            information that the director deems to be confidential,  











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            proprietary information of the prescription drug manufacturer  
            and the disclosure of which would cause the manufacturer  
            competitive harm, as specified.



          9)Finds and declares that the report required by this measure  
            imposes a limitation on the public right to access that  
            information  


          EXISTING LAW:  


          1)Establishes OSHPD and requires each organization that  
            operates, conducts, or maintains a health facility to make and  
            file with OSHPD certain specified reports, including a  
            hospital discharge abstract data record that currently  
            includes 19 elements of data per admission that are required  
            to be included.



          2)Requires OSHPD to compile and publish summaries of individual  
            facility and aggregate data that do not contain  
            patient-specific information for the purposes of public  
            disclosure.
          FISCAL EFFECT:  This bill has not been analyzed by a fiscal  
          committee. 


          COMMENTS: 


          1)PURPOSE OF THIS BILL.  The author asserts that as prices for  
            both new and existing prescription drugs continue to rise, it  
            is critically important to analyze drug price and underlying  
            costs that drive drug pricing to inform the development of  
            policies that will ensure access to affordable medications.   











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            Legislation is needed to enhance transparency in prescription  
            drug pricing so policymakers and purchasers can deliver on the  
            promise of health care coverage and affordability.  According  
            to the author, manufacturers should report data to the State  
            of California in order to provide taxpayers, policymakers and  
            consumers with insight into cost centers associated with drug  
            development and availability.
          2)BACKGROUND.  The high price of some prescription drugs has  
            raised questions about their affordability, whether their cost  
            is worth the clinical benefits they provide, and the financial  
            model of the current healthcare system.  The rising costs of  
            prescription drugs are placing an increasing burden on payers,  
            employers, and patients.  Notably, new Hepatitis C virus (HCV)  
            treatment options that cure the underlying disease with  
            remarkable efficiency offer a drastic improvement over  
            previous therapies.  Payment systems have been significantly  
            impacted by the cost of these drugs since their arrival on the  
            market, but many argue that patients and payers will benefit  
            in the long run by the avoided downstream costs such as cancer  
            treatment and liver transplants.  Other high priced drugs  
            offer striking therapeutic advances for a range of very  
            serious conditions, including cancer,  rheumatoid arthritis,  
            multiple sclerosis, and many others.  Policymakers are faced  
            with balancing the need to reward pharmaceutical breakthroughs  
            in order to ensure the innovation of future cures with the  
            fact that payers and patients have limited resources to afford  
            very high prices.

          3)THE RISING COSTS OF DRUGS.  A report by the IMS Institute for  
            Healthcare Informatics states that total U.S. spending on  
            medicines was $373.9 billion in 2014, an increase of 13.1%  
            from the amount spent in 2013<1>.  This is the highest single  
            year increase since 2001 (when growth reached 17.0%).   
            According to the Centers for Medicare and Medicaid Services  
            (CMS) prescription drug spending growth was predicted to be  
            around 6.4% in 2015, driven by increases in the use of  
            prescription drugs among people who are newly insured and  


          ---------------------------
          <1> IMS Institute for Healthcare Informatics. Global Outlook for  
          Medicines Through 2018. November 2014. 










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            those who move to more generous insurance plans as a result of  
            the premium and cost-sharing subsidies offered by the Patient  
            Protection and Affordable Care Act (ACA).  Additionally, fewer  
            branded drugs are losing patent exclusivity to generics.  

            CMS also found that prescription drugs generally account for  
            10% of all healthcare dollars spent.  The CMS National Health  
            Expenditures report found that healthcare spending in all  
            segments grew 3.6% in 2013.  In late 2014, IMS projected that  
            despite a temporary increase in U.S. spending growth in 2014,  
            pharmacy spending would moderate to 5% to 8% over the next few  
            years, coming back in-line with overall healthcare spending  
            growth. 

             a)   Specialty and High-Cost Drugs.  Historically, a majority  
               of drugs approved by the FDA were small-molecule products,  
               manufactured using simple processes, were  
               self-administered, and most often dispensed through retail  
               pharmacies.  Today, many of the drugs being approved each  
               year are being lumped into a poorly defined group known as  
               "specialty drugs."  These drugs are often large molecule or  
               biologic products; which means they are produced using  
               advanced biotechnology and may require special  
               administration, monitoring, and handling.  According to a  
               2012 report by United Healthcare<2>, treatment for complex  
               or life-threatening health conditions now includes the use  
               of certain drugs broadly referred to as specialty drugs.   
               While no standard definition exists, specialty drugs  
               generally are defined as having one or more of the  
               following characteristics: 



               i)     Complex to manufacture, requiring special handling  
                 and administration; 


               -------------------------
          <2>  
          http://www.unitedhealthgroup.com/~/media/UHG/PDF/2014/UNH-The-Gro 
          wth-Of-Specialty-Pharmacy.ashx










                                                                     AB 463


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               ii)    Injectable or oral, self-administered or  
                 administered by a health care provider;



               iii)   Costly, both in total and on a per-patient basis  
                 (taken by a relatively small share of the population who  
                 have complex medical conditions); or,



               iv)    Difficult for patients to take without ongoing  
                 clinical support, making them challenging for providers  
                 to manage.





          Historically, specialty drugs were usually injectable drugs and  
          were used to treat conditions like cancer, rheumatoid arthritis,  
          multiple sclerosis, and growth disorders; today, their use has  
          expanded beyond those conditions to include treatment for other  
          chronic and inflammatory conditions and through other modes of  
          administration.  The FDA has approved about 300 drugs which many  
          consider "specialty," compared to a mere handful available two  
          decades ago.  In recent years, 70% of new drugs approved by FDA  
          have been considered specialty drugs.


          


          Most of the conditions targeted by these specialty drugs tend to  
          be chronic and progressive in nature and can impact quality of  
          life, along with morbidity and mortality.  Examples include  
          growth hormone disorders, rheumatoid arthritis, asthma, multiple  
          sclerosis, hepatitis C, hemophilia, cancer, and lupus.  Cancer  
          drugs represent a very large segment of specialty drugs, and can  











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          cost up to $10,000 per month.  Cancer drugs traditionally are  
          delivered either through IV fluid or through injection in a  
          physician's office or hospital, and were often covered through  
          the plan's medical benefit, rather than pharmacy benefit.   
          Recently, oral anticancer medications have also been used in  
          cancer treatment either as an adjunct to IV therapy, as a  
          substitution for IV therapy, or alone. Oral anticancer  
          medications are being prescribed more frequently for cancer  
          treatment, and an estimated 25% of anticancer agents currently  
          in development are oral cancer treatments.  With the advent of  
          oral chemotherapeutics, and recent changes in benefit designs,  
          some of most the expensive drugs have shifted to pharmacy  
          benefit instead of medical benefit.  


          


          Another group of high-cost specialty drugs are "orphan drugs,"  
          those that are developed to treat very rare diseases.  The FDA  
          provides orphan status to drugs and biologics which are intended  
          for the treatment, diagnosis or prevention of rare  
          diseases/disorders that affect fewer than 200,000 people in the  
          U.S., or are not expected to recover the costs of developing and  
          marketing a treatment drug.  Because orphan drugs treat very  
          rare conditions, their high market price is often justified to  
          balance the need to fund manufacturers' research and development  
          toward medical breakthroughs that might not otherwise happen.   
          In recent years, concerns have been raised by payers that  
          manufacturers are charging prices typically reserved for orphan  
          drugs for new drugs that treat a significantly larger  
          population.  Due to expected approval of more specialty drugs,  
          the movement of expensive drugs into pharmacy benefits, and  
          charging specialty drug prices for non-specialty drugs, the high  
          cost of prescription drugs is at the forefront for the public,  
          payers, and policymakers.  














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             b)   The $1,000 Pill Sparks Controversy.  In December 2013,  
               the FDA approved a drug produced by Gilead Sciences called  
               Sovaldi for the treatment of HCV.  Sovaldi represents a  
               significant advancement in treatment for HCV as it provides  
               a higher cure rate, allows for a shorter duration of  
               treatment, has fewer adverse side effects, and opens up  
               treatment options for individuals with comorbid conditions  
               for which traditional treatments are contraindicated.   
               While the drug has been found to be remarkably effective  
               (curing 90% or more patients over the course of 12 weeks,  
               according to the FDA), Gilead Sciences has come under heavy  
               fire for initially pricing Sovaldi at $1,000 per pill.   
               Critics have raised additional concerns due to variation in  
               costs globally.  According to an April 13, 2014 article in  
               the San Francisco Chronicle, Gilead prices the treatment at  
               $57,000 in the United Kingdom, $66,000 in Germany, while in  
               Egypt and other developing countries the treatment costs  
               $900, which is 99% less than the U.S. cost. 
                 


          After nearly a year of market exclusivity for Sovaldi, in late  
          2014 Abbvie gained FDA approval to market rival HCV treatment  
          Viekira Pak.  Pharmacy benefit managers, like ExpressScripts and  
          CVS Caremark quickly signed deals agreeing to exclusive coverage  
          for specific brand drugs on their formulary, in return for a  
          hefty price discount on the drug.  At least two more competitor  
          drugs are currently in final stages of clinical trials and could  
          be on the market in the near future; the increased competition  
          in the market is expected to bring costs down significantly.  In  
          early 2015, Gilead announced it would be offering rebates of up  
          to 46% on Sovaldi now that multiple rival drugs have entered the  
          market. 















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          Many insurers and government programs have tried to limit their  
          financial exposure by reserving Sovaldi and other new drugs for  
          patients with more advanced liver disease.  This has raised  
          concerns among patient advocates that cost-containment measures  
          might force patients to wait until their condition has  
          dangerously worsened before they are deemed eligible for the  
          cure.





          4)DETERMINING THE COST TO CONSUMERS IS DIFFICULT.  



             a)   Price Benchmarks.  Knowing how much a drug costs is  
               difficult; there are many different prices for each drug  
               and different ways of expressing those prices.  In the US,  
               the two most common ways of stating drug prices are the WAC  
               and AWP.  Neither one, though, is the actual price paid by  
               a payer, nor are they what their names imply.  Rather,  
               they're standardized ways of expressing a price, thus  
               allowing comparisons to be made from one drug to another.   
               AWP is a benchmark that has been used for over 40 years for  
               pricing and reimbursement of prescription drugs for both  
               government and private payers.  Initially, the AWP was  
               intended to represent the average price that wholesalers  
               used to sell medications to providers, such as physicians,  
               pharmacies, and other customers.  However, the AWP is not a  
               true representation of actual market prices for either  
               generic or brand drug products.  AWP has often been  
               compared to the "list price" or "sticker price," meaning it  
               is an elevated drug price that is rarely what is actually  
               paid.  AWP is not a government-regulated figure, does not  
               include buyer volume discounts or rebates often involved in  
               prescription drug sales.  As such, the AWP, while used  
               throughout the industry, is a controversial pricing  











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               benchmark.

             b)   Sticker Price vs Actual Price Paid Varies Widely.   The  
               WAC price of a drug on the market, as originally announced  
               by the company is also rarely the price paid by a payer.   
               The actual price paid by any one payer is proprietary  
               information, complicating discussions of value and cost to  
               consumers.  Drug companies negotiate with payers -  
               Medicare, Medicaid, insurers, and pharmacy benefit plans -  
               to set an initial gross sales price.  Drug manufacturers  
               pay rebates back to government entities, creating a  
               difference between gross sales for a drug and net sales.   
               The rebates are not publicly available, and vary highly  
               among payers and for different drugs.  Estimates put them  
               between 2% for innovative new drugs all the way to 60% for  
               drugs that have several competitors or generics on the  
               market.  


          


          Federal law requires manufacturers to provide rebates to CMS and  
          state Medicaid agencies.  The program requires a drug  
          manufacturer to enter into, and have in effect, a national  
          rebate agreement with the Secretary of the Department of Health  
          and Human Services (HHS) in exchange for state Medicaid coverage  
          of most of the manufacturer's drugs.  These rebates are paid by  
          drug manufacturers on a quarterly basis to states and are shared  
          between the states and the Federal government to offset the  
          overall cost of prescription drugs under the Medicaid program.   
          According to the Department of Healthcare Services (DHCS), drug  
          manufacturers are required to pay a Medi-Cal rebate for all  
          outpatient drugs that are dispensed and paid for by the Medi-Cal  
          program.  In addition, some manufacturers have agreed to pay  
          supplemental Medi-Cal rebates above the standard rebate.   
          Federal law requires rebates for prescriptions offered through  
          the AIDS Drug Assistance Program (ADAP), in part because of the  
          high cost of HIV/AIDS medications.  According to the Kaiser  











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          Family Foundation, drug manufacturer rebates account for 40% of  
          the annual ADAP budget<3>. 


           


             c)   Impact on State Finances.  With the state Medi-Cal  
               program covering nearly one-third of Californians, combined  
               with CalPERS, ADAP, state hospitals, and corrections, the  
               state and taxpayer liability for increasing drug costs is  
               significant.  According to a December 2015 report published  
               by the U.S. Senate Committee on Finance, Medi-Cal's  
               fee-for-service system alone spent nearly $25 million  
               treating roughly 340 patients with Sovaldi and Harvoni in  
               2014<4>.  Med-Cal fee-for-service represents only a  
               fraction of the entire Medi-Cal population, so the full  
               amount spent by the state is likely much higher. The  
               2015-16 California state budget allocated $228 million for  
               high cost drugs to DHCS and the Department of Corrections  
               and Rehabilitation.  In December 2015, it was reported that  
               CalPERS spent $438 million on specialty drugs, and increase  
               of 32% from the previous year.  This represents one quarter  
               of the total drug costs paid by CalPERS, while only 1% of  
               the prescriptions filled. 

          5)The cost of developing drugs.  The research and development  
            process is complex, costly, and time-consuming.  According to  
            the California Biotechnology Foundation, it takes 10 to 15  
            years and costs $1.2 billion, on average, to advance on  
            potential new medicine from a research concept to an  
            FDA-approved treatment.  Failure is built into the research  
            system.  Roughly 95% of candidates entering clinical trial  
          ---------------------------
          <3>  
          http://kff.org/hivaids/fact-sheet/aids-drug-assistance-programs/
          <4>  
          http://www.finance.senate.gov/ranking-members-news/wyden-grassley 
          -sovaldi-investigation-finds-revenue-driven-pricing-strategy-behi 
          nd-84-000-hepatitis-drug










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            will eventually fail.  On average, only one out of every 10  
            thousand potential new compounds becomes a new drug.   
            According to the Pharmaceutical Manufacturers of America  
            (PhRMA), out of every 5,000 to 10,000 screened compounds, only  
            250 enter preclinical testing, five enter human clinical  
            trials, and one is approved by the FDA. 
          
            Due to the complexity and length of time invested in research,  
            it is difficult for analysts and researchers to assess exactly  
            how much it costs to bring one drug to market.  The timeframe  
            of development can last for decades, and may be a combination  
            of efforts from multiple companies or previous research on  
            other drugs.  An analysis of publicly available data performed  
            by Forbes magazine in 2013 estimated the cost of bringing a  
            drug to market can vary from $350 Million to $4.5 Billion<5>.   






             a)   Exclusivity, Patents, and Generic Drugs.  Patent  
               exclusivity for a new molecule starts when the initial new  
                   drug application is filed with the FDA.  While patents  
               generally cover a molecule for 20 years, the time it takes  
               each drug to come to market varies and therefore the  
               remaining patented time varies among drugs - typically 10  
               to 12 years.  As drugs come off patent the presence of  
               generic competition dramatically reduces price.  For  
               example, blockbuster drugs such as Lipitor, Cymbalta, and  
               OxyContin have recently come off patent as part of a wave  
               of billions of dollars' worth of brand blockbuster  
             --------------------------
             --------------------------
          <5>  
          http://www.forbes.com/sites/matthewherper/2013/08/11/how-the-stag 
          gering-cost-of-inventing-new-drugs-is-shaping-the-future-of-medic 
          ine/












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               medications losing patent protection<6>.  This led to  
               unprecedented availability of generic drugs, while the  
               resulting competition among manufacturers and suppliers of  
               new generic medications drove down drug costs substantially  
               in the most popular drugs.  The high rate of generic  
               utilization in recent years has led to more than 80% of  
               prescriptions being now filled with generic medicines.   
               However, the pace of price reductions has begun to slow and  
               some generic drugs; for example, doxycycline and oxycodone,  
               available generically for many years, experienced  
               considerable price increases in 2014.
          


             b)   Publicly Available Reports and Information.  Publicly  
               traded companies report significant amounts of financial  
               data to shareholders and the government in annual U.S.  
               Securities and Exchange Commission (SEC) filings.  The  
               items include such things as research and development  
               costs, marketing, sales, advertising, information  
               technology, legal defense, the cost of raw materials, and  
               more.  These reports are filed on an annual basis, and not  
               compiled over the lifetime of drug development.   
               Additionally, these reports contain aggregate information  
               for all products on the market and currently being  
               developed by a manufacturer.  Some small companies might  
               bring a single drug to market in a given year, but larger  
               companies might have many drugs approved for market every  
               year.  For example, a recent filing by Pfizer stated that  
               in one year they had 276 projects in all phases of  
               development; 13 were in phase 3 clinical trials, 65 in  
               earlier phases of clinical trials, and the remaining 200  
               were in very early discovery phases.  The Committee notes  



             --------------------------
          <6> The 2014 Drug Trend report, Express Scripts Labs, March 2015










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               that some of the information required by this bill is  
               available in these SEC filings, but this information is  
               reported in aggregate for the company as a whole, not  
               broken down by specific drug as this bill would require.  
            6)SUPPORT.  Supporters believe that this bill is necessary due to the  
            lack of transparency surrounding the pricing of prescription  
            drugs.  Proponents state that the public and policymakers  
            should know more about the pricing of drugs in order to  
            determine if the value is worth exorbitant costs.  The ACA has  
            increased transparency across our health care system but  
            unfortunately not regarding prescription drug costs and  
            pricing.  Anthem Blue Cross writes that this bill will bring  
            the increasing cost of pharmaceuticals into to the broader  
            conversation around how to control health care costs in the  
            coming years.  While the focus of controlling costs is  
            generally directed at health plans and insurers, it is time  
            for drug manufacturers and other entities to participate in  
            this conversation and offer solutions to reduce costs.  
            The California School Employees Association and other  
            supporters believe that the information provided by this bill  
            will provide accountability into the pricing process and help  
            the public know what the costs are based on.  AIDS Healthcare  
            Foundation believes that the lack of drug pricing transparency  
            has been a detriment to the state and its citizens for too  
            long.  Many of the supporters argue that high prescription  
            drug prices affect the overall cost of delivering health care  
            threatens the long-term success of the ACA and put enormous  
            cost pressure on state and local governments.  Health Net  
            states that health plans, insurers, hospitals, and physicians  
            are all required to submit extensive cost and quality data to  
            regulators to guide them in their policymaking.  If the high  
            cost of these new specialty drugs is justified by the  
            investment the pharmaceutical companies have made to develop,  
            manufacture, and market these drugs then the reporting  
            requirements of this bill will demonstrate this. 


          7)SUPPORT IF AMENDED.  The California Association of Physician  
            Groups (CAPG) would support a bill that demonstrably produced  











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            a transparency program that reflects the true value of a drug,  
            even if it carries a high price tag.  CAPG states that  
            unfortunately, even with the recent amendments, this bill  
            falls short of a viable solution to this problem for several  
            reasons, including:  most of the information sought in the  
            filing process will likely be deemed to be proprietary and  
            thus will not end up being publicly reported; the failure to  
            recognize and include the actual drug pricing after rebate  
            produces data that does not reflect the true market cost of  
            the targeted drugs; and the failure to address the rapid  
            inflation of generic drug costs, which impact a much broader  
            segment of the patient population. 
            8)OPPOSITION.  Opponents argue this bill will result in increased costs  
            without tangible results.  The Biotechnology Industry  
            Organization states that this bill does not provide adequate  
            context for the complex issue of pricing, which is based not  
            just on manufacturers' costs, but also on market forces and an  
            assessment of value that cannot simply be reduced to a few  
            lines on a balance sheet.  The Pharmaceutical Research and  
            Manufacturers of American (PhRMA) opposes this bill and claims  
            it would create new burdensome reporting requirements on an  
            industry that should otherwise be dedicating its resources to  
            bringing new therapies and cures to prescribing physicians and  
            their patients.  PhRMA asserts that the information required  
            by this bill would be difficult to ascertain, and complying  
            with the reporting requirements imposed in the bill will be  
            costly for the life sciences industry.  The Orange County  
            Business Council states that these types of disclosures are  
            limited due to confidentiality and proprietary reasons because  
            substantial competitive information can be gleaned from costs  
            associated with specific research and development information  
            and sales and marketing information by marketplace  
            competitors.  
          REGISTERED SUPPORT / OPPOSITION:


          Support













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          AIDS Healthcare Foundation
          American Federation of State, County and Municipal Employees,  
          AFL-CIO
          American Medical Students Association
          America's Health Insurance Plans
          Anaheim Chamber of Commerce
          Anthem Blue Cross
          Association of California Life and Health Insurance Companies
          Blue Shield of California
          California Association of Health Plans
          California Hepatitis Alliance
          California Labor Federation
          California Nurses Association 
          California PACE Association
          California Pan-Ethnic Health Network
          California Professional Firefighters
          California School Employees Association
          California Teachers Association
          CALPIRG 
          Consumers Union
          Fresno Chamber of Commerce
          Greater West Covina Business Association
          Health Access
          Health Net
          Industry Manufacturers Council
          Kaiser Permanente
          Laborers International Union of North America Local 777 and 792
          Los Angeles Area Chamber of Commerce
          L.A. Care Health Plan
          Molina Healthcare
          Montebello Chamber of Commerce
          National Council of Asian Pacific Islander Physicians
          National Multiple Sclerosis Society
          National Physicians Alliance
          Ontario Chamber of Commerce
          Public Citizen's Global Access to Medicines Program
          Redlands Chamber of Commerce
          Richmond Chamber of Commerce
          San Gabriel Valley Economic Partnership











                                                                     AB 463


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          San Gabriel Valley Regional Chamber of Commerce
          San Mateo Area Chamber of Commerce
          San Ramon Chamber of Commerce
          SEIU California
          Small Business Majority
          State Building and Construction Trades Council, AFL-CIO
          Torrance Area Chamber of Commerce
          UFCW Western States Council
          United Nurses Associations of California/Union of Health Care  
          Professionals
          Universities Allied for Essential Medicines
          Valley Industry and Commerce Association, Healthcare Committee 
          Young Professionals Chronic Disease Network



          


          Opposition
          AbbVie
          Allergan
          Amgen
          Astellas Pharma
          BayBio
          Bayer
          Biocom
          Biogen
          BioMarin Pharmaceutical
          Biotechnology Innovation Organization
          Boehringer-Ingelheim
          Bristol-Myers Squibb
          California Life Sciences Association
          California Manufacturers & Technology Association
          Eisai
          Eli Lilly
          Genzyme
          Genentech
          GlaxoSmithKline











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          International Foundation for Autoimmune Arthritis
          Irvine Chamber of Commerce
          Mental Health Systems
          Orange County Business Council
          Otsuka Pharmaceutical Development & Commercialization, Inc.
          Pfizer
          Pharmaceuticals Research and Manufacturers of America
          Sanofi
          Sunovion
          Takeda Pharmaceutical Company
          TechNet
          UCB


          Analysis Prepared  
          by:              Dharia McGrew / HEALTH / (916) 319-2097