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 TPP Talks in Peru Focus Pharmaceutical Issues Disclosed in Leaked Text on Pricing and Patent Policies
NLARx Executive Director Sharon Treat attended the TPP events in Lima, Peru recently and presented on medicines issues at the official stakeholder forum October 25. The talks include nine Pacific Rim nations, including the US, but could expand to include as many at 22 nations before the ink is dry on a final deal, with Canada, Japan and the Philipines poised to get involved soon, according to US negotiators. Here is a nice roundup on the Peru talks posted by Knowledge Ecology International. 
While the trade talks haven't received much media attention here in the US, they are a big deal in Peru where health advocates worry that the trade deal will make drugs unaffordable, and in New Zealand, where the national Pharmac program, under which New Zealanders can purchase most drugs for a few dollars a script, is exceedingly popular (see this "Pharmac attack" web posting.) Leaked negotiating text was posted on the Internet during the Lima talks, including texts on healthcare transparency and pricing and intellectual property. The leaked provisions are somewhat similar to the Korea and Australia agreements and raised many concerns among access to medicines groups, state legislators, and even law professors. More
For complete leaked text, relevant documents and analysis, we recommend the InfoJustice website as well as Public Citizen's Access to Medicines Campaign. Read Sharon Treat's statement on the leaked text here. NLARx, state legislators and other state officials have raised concerns about both procedural and substantive provisions in the Australia and the Korea FTAs, which include pharmaceutical provisions that could conflict with the effective implementation of Medicaid and reduce access to affordable medicines under 340B and other programs.
A new provision would require drug reimbursement lists such as preferred drug lists to consider new uses for drugs already on the list, even if those new uses have been approved by no countries and are based on a single industry study. While reimbursing for the new use could be denied, it would have to be justified with a detailed written report and an opportunity to appeal drafted the drug company. For an example of how this gaming of an evidence-based system could play out, read this article from Australia, "The tricks companies use to get over-priced drugs on the PBS." Although the Australia FTA's pharmaceutical provisions [Annex 2-C] and now the Korea agreement are a done deal, the Trans-Pacific Partnership Agreement is still being negotiated, and thus is still open to change.
While state legislators were able to convince the USTR to include a footnote in in the Korea FTA "carving out" Medicaid from its provisions, we continue to have concerns because this carve-out does not include other important programs such as 340B, and because the FTAs would essentially lock the US into the current way of pricing drugs in Medicare Part D and call into question reforms in the Affordable Care Act. From the leaked text, it is impossible to know whether the USTR intends to carve out Medicaid, expand the carve-out to other programs, or delete the carve-out altogether, and the USTR's chief negotiator did not answer a question about the carve-out at the stakeholder briefing in Lima.
Read more on these issues:
State resolutions and letters on trade and medicines
NLARx Resolution opposing provisions in the TPPA
Vermont Governor Peter Shumlin's letter to President Obama
Background on trade agreements and pharmaceutical policy
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