Everyone wants to pay less for prescription drugs.

That's the selling point for supporters of the Ohio Drug Price Relief Act heading into what promises to be a contentious and expensive campaign this fall about an initiated statute ballot issue that's supposed to reduce the price of prescription drugs.

Ohioans Against the Deceptive Rx Ballot Issue, the group opposing the initiative, faces an uphill battle, saying that it won't save consumers money on prescription drugs as promised and could in fact backfire, making some drugs more expensive or simply unavailable.

Bottom line: Ohioans should get ready for a rock 'em, sock 'em campaign dominated by loads of television commercials leading up to the Nov. 7 election. The drug campaign could be the most costly in Ohio history, topping the $64 million spent on a failed casino issue in 2008.

Ohioans will represent the issue before voters, but out-of-state interests are the financial power behind the scenes.

The California-based AIDS Healthcare Foundation is backing the Ohio ballot issue, as it did a similar proposal that was defeated 53 percent to 47 percent last November in California. The Ohio proposal, in general, would require the state and related entities to pay no more for prescription drugs than does the U.S. Department of Veterans Affairs, a discount reportedly up to 40 percent. Sponsors say a trickle-down effect would help customers by cutting prices on other prescription drugs.

The AIDS Healthcare Foundation contributed the vast majority of the $19.9 million spent in favor of the California issue.

The opposition is anchored by the deep pockets of the Pharmaceutical Research and Manufacturers of America, a trade association that includes most major drug manufacturers.

Spending against the California measure was stunning, with pharmaceutical companies providing nearly all $111 million in contributions. Merck & Co. and Pfizer Inc. each contributed $9.4 million, Johnson & Johnson gave $9.3 million, and seven other companies chipped in from $4.5 million to $7.7 million apiece, according to the California secretary of state.

The issue potentially would affect about 4.15 million Ohioans, including more than 3 million on Medicaid, the program for people with low incomes or disabilities. It would also affect state retirement programs, people in state prisons, mental health and developmental disability facilities, 114,000 state employees, people covered by the Bureau of Workers' Compensation and many others.

Americans spent about $450 billion on prescription drugs last year, or $323 billion when rebates and discounts were considered. While the rise of generic drugs has cut costs for many consumers, the prices of certain other drugs have soared, including medications for cancer treatment, hepatitis and diabetes.

Harvoni, a hepatitis C drug made by Gilead Sciences, tops the list of the most expensive drugs at $87,800 for a 30-day supply, exclusive of discounts, according to a report on MSNBC. Other drugs also cost thousands of dollars per month.

Dennis Willard, spokesman for the Ohio Drug Price Relief Act, said the issue, if passed, would "lower drug prices for the sick and suffering" while sending a message to "greedy drug companies."

"Ohio taxpayers right now are paying too much for drugs. ... This will lower those drug prices by taking them to the same prices the Veterans Administration pays for these drugs, saving $400 million," Willard said. "We're seeing people die every day. This will give Ohioans a chance to say, 'Enough is enough.'"

He added, "We're going to tell the story of how these outrageous drug profits and drug prices hurt everyday Ohioans."

Willard's team includes Rex Elsass, nationally known political consultant who is former executive director of the Ohio Republican Party; Greg Schultz, who ran President Barack Obama's Ohio campaign; Matt Borges, former GOP state party chairman; and Ron Malone, former union leader and now a Democratic political consultant.

Jenny Camper, a Columbus consultant who represents PhRMA, said a coalition being formed to oppose the issue will include "organizations representing military veterans, nurses, doctors, patients, safety professionals, labor, business leaders, faith communities and others, who will do everything they can to ensure voters are thoroughly educated about the facts of this proposed statute. Health policy experts who have studied the proposal say it would be very damaging to Ohio and Ohioans."

A report done by Vorys Health Care Advisors and Health Management Associates and paid for by the pharmaceutical industry was highly critical of the Ohio proposal. The study said it is "highly unlikely the proposed statute could be implemented" because of its complexities, and even if it were, "state programs would be forced to adopt additional program changes that could, in fact, restrict access to drugs for Ohio consumers."

The report said the proposal would negatively affect third-party payers, such as private insurers, and might trigger increases rather than decreases in drug prices.

The drug issue has been batted around in Ohio for 18 months since being submitted in December 2015. As an initiated statute, it had to be considered by the General Assembly before being submitted to the voters. Lawmakers did not act, but the pharmaceutical group challenged the legality of the signature-collection process. Thousands of signatures were thrown out, and the foundation submitted new ones.

The Ohio Supreme Court ruled in favor of the foundation, and last fall Secretary of State Jon Husted certified the initiated statute to appear on the November 2017 ballot.

ajohnson@dispatch.com

@ohioaj