<html><head><meta http-equiv="Content-Type" content="text/html charset=utf-8"></head><body style="word-wrap: break-word; -webkit-nbsp-mode: space; -webkit-line-break: after-white-space;" class=""><div class=""><i class="">Updated leak makes clear the TPP can be used by Big Pharma to attack the cost-saving measures of government-run health programs, including Medicare and Medicaid…</i></div><div class=""><i class=""><br class=""></i></div><div class=""><br class=""></div><a href="http://www.nytimes.com/2015/06/11/business/international/us-shifts-stance-on-drug-pricing-in-pacific-trade-pact-talks-document-reveals.html?_r=1" class="">http://www.nytimes.com/2015/06/11/business/international/us-shifts-stance-on-drug-pricing-in-pacific-trade-pact-talks-document-reveals.html?_r=1</a><div class=""><br class=""></div><div class=""><h1 itemprop="headline" id="story-heading" class="story-heading" style="font-size: 2.125rem; line-height: 2.375rem; font-family: nyt-cheltenham, georgia, 'times new roman', times, serif; margin: 0px 0px 10px; font-style: italic;">U.S. Shifts Stance on Drug Pricing in Pacific Trade Pact Talks, Document Reveals</h1><div class=""><br class=""></div></div><div class=""><span class="byline" itemprop="author creator" itemscope="" itemtype="http://schema.org/Person" itemid="http://topics.nytimes.com/top/reference/timestopics/people/w/jonathan_weisman/index.html" style="font-size: 0.6875rem; line-height: 0.75rem; font-weight: 700; font-family: nyt-cheltenham-sh, georgia, 'times new roman', times, serif; color: rgb(51, 51, 51);">By <a href="http://topics.nytimes.com/top/reference/timestopics/people/w/jonathan_weisman/index.html" rel="author" title="More Articles by JONATHAN WEISMAN" style="text-decoration: none; color: rgb(0, 0, 0);" class=""><span class="byline-author" data-byline-name="JONATHAN WEISMAN" itemprop="name">JONATHAN WEISMAN</span></a></span><time class="dateline" datetime="2015-06-10" style="font-size: 0.6875rem; line-height: 0.75rem; font-family: nyt-cheltenham-sh, georgia, 'times new roman', times, serif; margin-left: 12px;">JUNE 10, 2015</time></div><div class=""><br class=""></div><div class=""><p class="story-body-text story-content" data-para-count="282" data-total-count="282" itemprop="articleBody" id="story-continues-1" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">WASHINGTON — Facing resistance from its Pacific trading partners, the Obama administration is no longer demanding protection for pharmaceutical prices under the 12-nation Trans-Pacific Partnership, according to a newly leaked “transparency” annex of the proposed trade accord.</p><p class="story-body-text story-content" data-para-count="429" data-total-count="711" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">But American negotiators are still pressing participating governments to open up the process that sets reimbursement rates for drugs and medical devices. Public health professionals, generic drugmakers and activists opposed to the trade deal, which is still being negotiated, contend that it will empower big pharmaceutical firms to command higher reimbursement rates in the United States and abroad, at the expense of consumers.</p><p class="story-body-text story-content" data-para-count="120" data-total-count="831" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">They also say that it could expose international markets to the direct consumer appeals that Americans have experienced.</p><p class="story-body-text story-content" data-para-count="577" data-total-count="1408" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">“It was very clear to everyone except the U.S. that the initial proposal wasn’t about transparency; it was about getting market access for the pharmaceutical industry by giving them greater access to and influence over decision-making processes around pricing and reimbursement,” said Deborah Gleeson, a lecturer at the School of Psychology and Public Health at La Trobe University in Australia, who has seen the leaked document. And even though it has been toned down, she said, “I think it’s a shame that the annex is still being considered at all for the T.P.P.”</p><p class="story-body-text story-content" data-para-count="586" data-total-count="1994" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">The pharmaceutical and medical device annex is the latest document obtained by The New York Times in collaboration with the watchdog group WikiLeaks, and it was released <a title="New York Times article" href="http://www.nytimes.com/2015/06/01/business/obamas-push-for-trade-deal-faces-bipartisan-peril-in-house.html" style="color: rgb(50, 104, 145);" class="">ahead of the House vote</a> on whether to give <a href="http://topics.nytimes.com/top/reference/timestopics/people/o/barack_obama/index.html?inline=nyt-per" title="More articles about Barack Obama" class="meta-per" style="color: rgb(50, 104, 145);">President Obama</a> expanded powers to complete the Trans-Pacific Partnership. The Senate <a title="New York Times article" href="http://www.nytimes.com/2015/05/23/business/senate-vote-is-a-victory-for-obama-on-trade-but-a-tougher-test-awaits.html" style="color: rgb(50, 104, 145);" class="">has already approved</a> legislation giving the president “trade promotion authority,” or fast-track power to complete trade deals that cannot be amended or filibustered by Congress. A House vote on final passage of the bill, which could come as early as Friday, appears extremely close.</p><p class="story-body-text story-content" data-para-count="256" data-total-count="2250" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">The Pacific accord, the largest since the North American Free Trade Agreement two decades ago, would link countries stretching from Canada and Chile to Japan and Australia into a new regimen of trade rules that would cover 40 percent of the global economy.</p><figure id="trans-pacific-partnership-map" class=" interactive interactive-embedded limit-small layout-xlarge has-adjacency" style="margin: 15px 0px; position: relative; width: 1050px; overflow: hidden; padding-top: 15px; padding-bottom: 15px; border-top-width: 1px; border-top-style: solid; border-top-color: rgb(226, 226, 226); border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(226, 226, 226); min-width: 300px; color: rgb(51, 51, 51); font-family: nyt-cheltenham, georgia, 'times new roman', times, serif; font-size: 16px;"><a class="visually-hidden skip-to-text-link" href="http://www.nytimes.com/2015/06/11/business/international/us-shifts-stance-on-drug-pricing-in-pacific-trade-pact-talks-document-reveals.html?_r=1#story-continues-2" style="position: absolute; width: 1px; height: 1px; margin: -1px; padding: 0px; border: 0px; clip: rect(0px, 0px, 0px, 0px); overflow: hidden; text-decoration: none; color: rgb(50, 104, 145);">Continue reading the main story</a><figcaption class="interactive-caption" style="font-size: 0.75rem; line-height: 1rem; font-family: nyt-cheltenham-sh, georgia, 'times new roman', times, serif; color: rgb(102, 102, 102);"><h2 class="interactive-headline" style="font-size: 1.25rem; line-height: 1.5rem; font-family: nyt-cheltenham, georgia, 'times new roman', times, serif; margin: 0px 0px 3px; color: rgb(51, 51, 51);">Trans-Pacific Partnership Countries </h2></figcaption><div class="interactive-graphic" style="margin-bottom: 10px;"><div id="g-Trans-Pacific-Partnership-MAP-box" class="ai2html"><div id="g-Trans-Pacific-Partnership-MAP-1050" class="g-artboard g-show-xlarge" style="margin: 0px auto; position: relative; overflow: hidden; width: 1050px;"><div id="g-Trans-Pacific-Partnership-MAP-1050-graphic" class=""><img id="g-ai2-0" class="g-aiImg" data-src="http://graphics8.nytimes.com/newsgraphics/2015/05/21/tpp-map/151bad325125819edbe2482c4df0e82200d34aa0/Trans-Pacific-Partnership-MAP-1050.png" data-height-multiplier="0.4486" style="max-width: 100%; display: block;" apple-inline="yes" height="559" width="1245" apple-width="yes" apple-height="yes" src="cid:5632AC42-B99D-4FA8-92FD-87D8F29F92CF@hsd1.pa.comcast.net."><div id="g-ai2-1" class="g-aiAbs g-trade_copy" style="position: absolute; top: 8.492600440979004%; left: 74.8718032836914%; width: 90.203125px; margin-left: -45.09375px;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: center; color: rgb(0, 0, 0);" class="">Canada</div></div><div id="g-ai2-2" class="g-aiAbs g-trade_copy" style="position: absolute; top: 11.889599800109863%; left: 74.8718032836914%; width: 63.828125px; margin-left: -31.90625px;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: center; color: rgb(0, 0, 0);" class="">$658</div></div><div id="g-ai2-3" class="g-aiAbs g-trade_copy" style="position: absolute; top: 26.75160026550293%; left: 78.35859680175781%; width: 168.546875px; margin-left: -84.265625px;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-weight: 700; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: center; color: rgb(0, 0, 0);" class="">United States</div></div><div id="g-ai2-4" class="g-aiAbs g-trade_copy" style="position: absolute; top: 27.17620086669922%; left: 45.48440170288086%; width: 69.265625px; margin-left: -34.625px;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: center; color: rgb(0, 0, 0);" class="">Japan</div></div><div id="g-ai2-5" class="g-aiAbs g-trade_copy" style="position: absolute; top: 30.785600662231445%; left: 45.48440170288086%; width: 63.828125px; margin-left: -31.90625px;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: center; color: rgb(0, 0, 0);" class="">$201</div></div><div id="g-ai2-6" class="g-aiAbs g-trade_copy" style="position: absolute; top: 40.339698791503906%; left: 78.57080078125%; width: 84.828125px; margin-left: -42.40625px;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: center; color: rgb(0, 0, 0);" class="">Mexico</div></div><div id="g-ai2-7" class="g-aiAbs g-trade_copy" style="position: absolute; top: 40.551998138427734%; left: 34.930999755859375%;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; color: rgb(0, 0, 0);" class="">Vietnam $36</div></div><div id="g-ai2-8" class="g-aiAbs g-trade_copy" style="position: absolute; top: 43.52439880371094%; left: 78.57080078125%; width: 63.828125px; margin-left: -31.90625px;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: center; color: rgb(0, 0, 0);" class="">$534</div></div><div id="g-ai2-9" class="g-aiAbs g-trade_copy" style="position: absolute; top: 48.40760040283203%; left: 37.754798889160156%;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; color: rgb(0, 0, 0);" class="">Brunei $0.6</div></div><div id="g-ai2-10" class="g-aiAbs g-trade_copy" style="position: absolute; top: 52.22930145263672%; right: 68.3958969116211%;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: right; color: rgb(0, 0, 0);" class="">Malaysia $44</div></div><div id="g-ai2-11" class="g-aiAbs g-trade_copy" style="position: absolute; top: 60.721900939941406%; right: 67.05280303955078%;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: right; color: rgb(0, 0, 0);" class="">Singapore</div><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: right; color: rgb(0, 0, 0);" class="">$47</div></div><div id="g-ai2-12" class="g-aiAbs g-trade_copy" style="position: absolute; top: 66.45439910888672%; right: 13.766799926757813%;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: right; color: rgb(0, 0, 0);" class="">Peru</div><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: right; color: rgb(0, 0, 0);" class="">$16</div></div><div id="g-ai2-13" class="g-aiAbs g-trade_copy" style="position: absolute; top: 72.82379913330078%; right: 57.688899993896484%;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: right; color: rgb(0, 0, 0);" class="">Australia</div><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: right; color: rgb(0, 0, 0);" class="">$37</div></div><div id="g-ai2-14" class="g-aiAbs g-trade_copy" style="position: absolute; top: 87.47350311279297%; right: 9.522199630737305%;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: right; color: rgb(0, 0, 0);" class="">Chile</div><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: right; color: rgb(0, 0, 0);" class="">$26</div></div><div id="g-ai2-15" class="g-aiAbs g-trade_copy" style="position: absolute; top: 87.89810180664063%; left: 26.500999450683594%; width: 706.6875px; margin-left: -353.34375px;"><div style="margin: 0px; line-height: 22px; font-weight: 700; font-family: nyt-franklin, arial, helvetica, sans-serif; text-align: center; color: rgb(0, 0, 0);" class="">Total goods traded with the United States in 2014</div></div><div id="g-ai2-16" class="g-aiAbs g-trade_copy" style="position: absolute; top: 89.59660339355469%; left: 55.52920150756836%;"><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; color: rgb(0, 0, 0);" class="">New Zealand</div><div style="margin: 0px; font-size: 14px; line-height: 15px; font-family: nyt-franklin, arial, helvetica, sans-serif; color: rgb(0, 0, 0);" class="">$8</div></div><div id="g-ai2-17" class="g-aiAbs g-trade_copy" style="position: absolute; top: 92.14440155029297%; left: 26.500999450683594%; width: 746.9375px; margin-left: -373.46875px;"><div style="margin: 0px; font-size: 14px; line-height: 22px; font-family: nyt-franklin, arial, helvetica, sans-serif; font-style: italic; text-align: center; color: rgb(128, 128, 128);" class="">Imports plus exports, not including services, in billions of dollars</div></div></div></div></div></div><div class="footer"><div class="interactive-source" style="font-size: 0.75rem; line-height: 0.875rem; font-family: nyt-franklin, arial, helvetica, sans-serif; color: rgb(153, 153, 153); margin-top: 0px;">Census Bureau </div><div class="interactive-credit" style="font-size: 0.75rem; line-height: 0.875rem; font-family: nyt-franklin, arial, helvetica, sans-serif; color: rgb(153, 153, 153); margin-top: 8px;"><div style="margin: 0px 45px 2px 0px; font-size: 1rem; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif;" class=""><br class="webkit-block-placeholder"></div>By The New York Times </div></div></figure><aside class="nocontent marginalia related-coverage-marginalia robots-nocontent" data-marginalia-type="sprinkled" role="complementary" module="RelatedCoverage-Marginalia" style="border-top-width: 1px; border-top-style: dotted; border-top-color: rgb(153, 153, 153); width: 300px; float: right; clear: right; margin: 0px 0px 45px 7px; padding-top: 10px; color: rgb(51, 51, 51); font-family: nyt-cheltenham, georgia, 'times new roman', times, serif; font-size: 16px;"><div class="nocontent robots-nocontent"><a class="visually-hidden skip-to-text-link" href="http://www.nytimes.com/2015/06/11/business/international/us-shifts-stance-on-drug-pricing-in-pacific-trade-pact-talks-document-reveals.html?_r=1#story-continues-2" style="position: absolute; width: 1px; height: 1px; margin: -1px; padding: 0px; border: 0px; clip: rect(0px, 0px, 0px, 0px); overflow: hidden; text-decoration: none; color: rgb(50, 104, 145);">Continue reading the main story</a><header class=""><h2 class="module-heading" style="font-size: 0.6875rem; line-height: 0.6875rem; font-family: nyt-franklin, arial, helvetica, sans-serif; margin: 0px 0px 1em; color: rgb(0, 0, 0); text-transform: uppercase;">RELATED COVERAGE</h2></header><ul style="margin: 0px; list-style: none; padding-left: 0px;" class=""><li style="font-size: 1rem; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; margin-bottom: 0.75em;" class=""><article class="story theme-summary"><a class="story-link" href="http://www.nytimes.com/2015/05/12/business/unpacking-the-trans-pacific-partnership-trade-deal.html" in_tag="ul" kaspersky_status="skipped" style="display: block; color: rgb(50, 104, 145); text-decoration: none;"><div class="thumb" style="float: left; clear: none; margin: 0px 10px 0px 0px; width: 65px; height: auto; position: relative; max-width: 65px; cursor: pointer;"><img alt="A container wharf in Tokyo." style="max-width: 100%; border: none; display: block;" apple-inline="yes" id="B5694C5D-4BC1-4B37-B4F2-1639EF1604DD" height="75" width="75" apple-width="yes" apple-height="yes" src="cid:01FC4B7A-915E-45CE-B03F-F2ADDF534EF0@hsd1.pa.comcast.net." class=""><div class="media-action-overlay" style="position: absolute; bottom: 8%; left: 8%;"></div></div><h2 class="story-heading" style="font-size: 0.8125rem; line-height: 1.0625rem; font-weight: 400; font-family: nyt-cheltenham-sh, georgia, 'times new roman', times, serif; margin: 0px; color: rgb(51, 51, 51); cursor: pointer; float: left; width: 223.5px; clear: right;"><span class="story-heading-text" style="color: rgb(50, 104, 145); padding-right: 0.75em;">The Trans-Pacific Partnership Trade Deal: What It Would Mean</span><time class="dateline" datetime="2015-05-11" style="font-size: 0.625rem; line-height: 1.0625rem; font-family: nyt-franklin, arial, helvetica, sans-serif; color: rgb(153, 153, 153); white-space: nowrap; display: inline-block;">MAY 11, 2015</time></h2></a></article></li><li style="font-size: 1rem; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; margin-bottom: 0px;" class=""><article class="story theme-summary"><a class="story-link" href="http://www.nytimes.com/2015/06/01/business/obamas-push-for-trade-deal-faces-bipartisan-peril-in-house.html" in_tag="ul" kaspersky_status="skipped" style="display: block; color: rgb(50, 104, 145); text-decoration: none;"><div class="thumb" style="float: left; clear: none; margin: 0px 10px 0px 0px; width: 65px; height: auto; position: relative; max-width: 65px; cursor: pointer;"><img alt="“We’re not quite there, but we’re getting close,” said Representative Paul D. Ryan of Wisconsin. At a hearing, he used a wedge of cheese to point out barriers to United States dairy exports." style="max-width: 100%; border: none; display: block;" apple-inline="yes" id="9277646C-EA85-45ED-B7F6-553FB56EE23D" height="75" width="75" apple-width="yes" apple-height="yes" src="cid:96ED514D-F611-47A5-B237-E683BF24C6E6@hsd1.pa.comcast.net." class=""><div class="media-action-overlay" style="position: absolute; bottom: 8%; left: 8%;"></div></div><h2 class="story-heading" style="font-size: 0.8125rem; line-height: 1.0625rem; font-weight: 400; font-family: nyt-cheltenham-sh, georgia, 'times new roman', times, serif; margin: 0px; color: rgb(51, 51, 51); cursor: pointer; float: left; width: 223.5px; clear: right;"><span class="story-heading-text" style="color: rgb(50, 104, 145); padding-right: 0.75em;">Obama’s Trade Deal Faces Bipartisan Peril in the House</span><time class="dateline" datetime="2015-05-31" style="font-size: 0.625rem; line-height: 1.0625rem; font-family: nyt-franklin, arial, helvetica, sans-serif; color: rgb(153, 153, 153); white-space: nowrap; display: inline-block;">MAY 31, 2015</time></h2></a></article></li></ul></div></aside><p class="story-body-text story-content" data-para-count="434" data-total-count="2684" itemprop="articleBody" id="story-continues-2" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">Opponents of both the Pacific deal and the legislation to grant trade promotion authority have long targeted the pharmaceutical issue. Foreign governments and health care activists have accused pharmaceutical giants, mostly based in the United States, of protecting profits over public health, especially in poor countries where neither the government nor consumers can afford to pay rates anywhere close to those charged in the West.</p><p class="story-body-text story-content" data-para-count="186" data-total-count="2870" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">That fight re-emerged in the Pacific trade negotiations, which involve countries with strong cost-containment policies, like New Zealand, as well as poor countries like Peru and Vietnam.</p><p class="story-body-text story-content" data-para-count="293" data-total-count="3163" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">The agreement “will increase the cost of medicines worldwide, starting with the 12 countries that are negotiating the Trans-Pacific Partnership,” said Judit Rius Sanjuan, a lawyer at Doctors Without Borders, a humanitarian organization that provides medical care in more than 60 countries.</p><div class="nocontent ad ad-placeholder robots-nocontent" style="float: right; clear: right; margin: 0px 0px 40px 7px; color: rgb(51, 51, 51); font-family: nyt-cheltenham, georgia, 'times new roman', times, serif; font-size: 16px;"><div class="accessibility-ad-header visually-hidden" style="position: absolute; width: 1px; height: 1px; margin: -1px; padding: 0px; border: 0px; clip: rect(0px, 0px, 0px, 0px); overflow: hidden;"><p style="margin: 0px 0px 1em; font-size: 1rem; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif;" class="">Advertisement</p></div><a class="visually-hidden skip-to-text-link" href="http://www.nytimes.com/2015/06/11/business/international/us-shifts-stance-on-drug-pricing-in-pacific-trade-pact-talks-document-reveals.html?_r=1#story-continues-3" style="position: absolute; width: 1px; height: 1px; margin: -1px; padding: 0px; border: 0px; clip: rect(0px, 0px, 0px, 0px); overflow: hidden; text-decoration: none; color: rgb(50, 104, 145);">Continue reading the main story</a><iframe frameborder="0" class="frame-for-article ad-frame" style="border-style: none; width: 300px; height: 250px;"></iframe></div><p class="story-body-text story-content" data-para-count="167" data-total-count="3330" itemprop="articleBody" id="story-continues-3" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">Drug companies, however, say they need to be able to charge fair prices to compensate for the billions of dollars and decades of research that go into their medicines.</p><p class="story-body-text story-content" data-para-count="328" data-total-count="3658" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">Jay Taylor, vice president for international affairs for the Pharmaceutical Research and Manufacturers of America, said penetrating the opaque process for getting a drug considered for a national health system, listed as available and properly priced is central to free trade for drug makers. “It is market access,” he said.</p><p class="story-body-text story-content" data-para-count="330" data-total-count="3988" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">That is particularly true for the Pacific accord, he said, because one of the countries, New Zealand, has a powerful system for holding down drug costs — and keeping drug makers in the dark. New Zealand’s health system has been held up as a model for the Pacific region, a prospect the pharmaceutical industry does not relish.</p><p class="story-body-text story-content" data-para-count="170" data-total-count="4158" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">“There are no clear timelines for review, no sense of what a complete dossier is to get a fair review,” Mr. Taylor said. “It’s a question of basic due process.”</p><p class="story-body-text story-content" data-para-count="525" data-total-count="4683" itemprop="articleBody" id="story-continues-4" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">Pharmaceutical firms and their trade associations have filed by far more lobbying disclosure forms on the Pacific trade negotiations than any other industry, according to the watchdog <a href="http://sunlightfoundation.com/blog/2014/03/13/tpp-lobby/" style="color: rgb(50, 104, 145);" class="">Sunlight Foundation</a>. More broadly, the pharmaceutical and health product industries have been active political players in the United States for decades. They have been the <a href="https://www.opensecrets.org/lobby/top.php?indexType=i" style="color: rgb(50, 104, 145);" class="">biggest spenders on lobbying</a>, and drug company deal-making with the Obama administration and in Congress was instrumental in securing passage of the Affordable Care Act.</p><p class="story-body-text story-content" data-para-count="347" data-total-count="5030" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">Public health professionals say pharmaceutical industry lobbying is meant to diminish the power of government health programs that trim reimbursement rates to the global pharmaceutical giants. The newly leaked annex, dated Dec. 17, 2014, explicitly lists <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicare/index.html?inline=nyt-classifier" title="Recent and archival health news about Medicare." class="meta-classifier" style="color: rgb(50, 104, 145);">Medicare</a> and the Centers for Medicare and Medicaid Services as falling under its strictures.</p><p class="story-body-text story-content" data-para-count="26" data-total-count="5056" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">That may embolden critics.</p><p class="story-body-text story-content" data-para-count="386" data-total-count="5442" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">“The leak is just the latest glaring example of why fast-tracking the T.P.P. would undermine the health of Americans and the other countries and cost our government more, all to the benefit of pharma’s profits,” said Lori Wallach, director of Public Citizen’s Global Trade Watch and one of the most prominent voices in the coalition working to scuttle trade promotion authority.</p><p class="story-body-text story-content" data-para-count="399" data-total-count="5841" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">Officials at the United States Trade Representative’s office, while declining to comment on a leak they would not acknowledge, say rules in the Pacific accord would have no impact on the United States because Medicare and <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicaid/index.html?inline=nyt-classifier" title="Recent and archival health news about Medicaid." class="meta-classifier" style="color: rgb(50, 104, 145);">Medicaid</a> already adhere to them. The U.S.T.R. worked with the Centers for Medicare and Medicaid Services and the Health and Human Services Department to develop the proposals.</p><figure id="document-annex-of-proposed-pacific-trade-accord" class=" interactive layout-large promo" style="margin: 15px auto 15px 135px; position: relative; width: 540px; overflow: hidden; padding-top: 15px; padding-bottom: 15px; border-top-width: 1px; border-top-style: solid; border-top-color: rgb(226, 226, 226); border-bottom-width: 1px; border-bottom-style: solid; border-bottom-color: rgb(226, 226, 226); max-width: 945px; cursor: pointer; color: rgb(51, 51, 51); font-family: nyt-cheltenham, georgia, 'times new roman', times, serif; font-size: 16px;"><a class="visually-hidden skip-to-text-link" href="http://www.nytimes.com/2015/06/11/business/international/us-shifts-stance-on-drug-pricing-in-pacific-trade-pact-talks-document-reveals.html?_r=1#story-continues-5" style="position: absolute; width: 1px; height: 1px; margin: -1px; padding: 0px; border: 0px; clip: rect(0px, 0px, 0px, 0px); overflow: hidden; text-decoration: none; color: rgb(51, 51, 51);">Continue reading the main story</a><a href="http://www.nytimes.com/interactive/2015/06/10/business/international/document-annex-of-proposed-pacific-trade-accord.html" style="text-decoration: none; color: rgb(51, 51, 51);" class=""><figcaption class="interactive-caption" style="font-size: 0.75rem; line-height: 1rem; font-family: nyt-cheltenham-sh, georgia, 'times new roman', times, serif; color: rgb(102, 102, 102); width: 210px; margin-right: 15px; float: left;"><h3 class="interactive-kicker" style="font-size: 0.6875rem; line-height: 0.8125rem; font-weight: 400; font-family: nyt-franklin, arial, helvetica, sans-serif; margin: 0px 0px 5px; text-transform: uppercase;">DOCUMENT </h3><h2 class="interactive-headline" style="font-size: 1.25rem; line-height: 1.3125rem; font-family: nyt-cheltenham, georgia, 'times new roman', times, serif; margin: 0px 0px 3px; color: rgb(51, 51, 51);">Annex of Proposed Pacific Trade Accord </h2><p class="interactive-summary" style="margin: 0px 0px 10px; font-size: 0.875rem; line-height: 1.125rem;">The Obama Administration is shifting its stance on drug pricing in the Trans-Pacific Partnership talks, according to a newly leaked “transparency” annex of the proposed trade accord. </p></figcaption><div class="interactive-image-container" style="width: 315px; position: relative; float: right;"><div class="interactive-image" style="transition: opacity 0.3s; -webkit-transition: opacity 0.3s;"><img style="max-width: 100%; border: none;" apple-inline="yes" id="5FAEA3A0-BAE8-4B91-BF37-02C2AA1B3500" height="330" width="495" apple-width="yes" apple-height="yes" src="cid:3B8274F9-4A34-4F85-BEA1-4A3BF080D272@hsd1.pa.comcast.net." class=""></div><div class="interactive-overlay" style="border-top-left-radius: 4px; border-top-right-radius: 4px; border-bottom-right-radius: 4px; border-bottom-left-radius: 4px; position: absolute; left: 15px; bottom: 15px; background-color: rgb(50, 104, 145); border: 1px solid rgb(0, 66, 118); padding: 15px;"><span class="interactive-overlay-icon icon sprite-icon" style="display: inline-block; line-height: 0; vertical-align: -5px; background-image: url(http://a1.nyt.com/assets/article/20150609-162827/images/sprite/sprite-no-repeat.svg); width: 18px; height: 22px; background-position: -461px -54px; background-repeat: no-repeat no-repeat;"></span> <span class="interactive-overlay-text" style="font-size: 0.75rem; line-height: 1.1875rem; font-weight: 600; font-family: nyt-franklin, arial, helvetica, sans-serif; text-transform: uppercase; margin-left: 4px; color: rgb(255, 255, 255);">OPEN DOCUMENT </span></div></div></a></figure><p class="story-body-text story-content" data-para-count="192" data-total-count="6033" itemprop="articleBody" id="story-continues-5" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">“Already, transparency and procedural fairness are integral parts of the U.S. legal system and as such are principles reflected in U.S. trade agreements,” the U.S.T.R. said in a statement.</p><p class="story-body-text story-content" data-para-count="306" data-total-count="6339" itemprop="articleBody" id="story-continues-6" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">While the leaked annex may fall short of what pharmaceutical companies wanted, it also offers them new opportunities to challenge the decisions of trading partners on which drugs they will offer their citizens through government health care programs and the rates at which they will reimburse drug sellers.</p><div class="nocontent ad ad-placeholder robots-nocontent" style="float: right; clear: right; margin: 0px 0px 40px 7px; color: rgb(51, 51, 51); font-family: nyt-cheltenham, georgia, 'times new roman', times, serif; font-size: 16px;"><div class="accessibility-ad-header visually-hidden" style="position: absolute; width: 1px; height: 1px; margin: -1px; padding: 0px; border: 0px; clip: rect(0px, 0px, 0px, 0px); overflow: hidden;"><p style="margin: 0px 0px 1em; font-size: 1rem; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif;" class="">Advertisement</p></div><a class="visually-hidden skip-to-text-link" href="http://www.nytimes.com/2015/06/11/business/international/us-shifts-stance-on-drug-pricing-in-pacific-trade-pact-talks-document-reveals.html?_r=1#story-continues-7" style="position: absolute; 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overflow: hidden;" class=""></iframe></div><div id="MiddleRightN" class="nocontent middle-right-ad ad text-ad robots-nocontent" style="float: right; clear: right; margin: 0px 0px 40px 7px; position: relative; color: rgb(51, 51, 51); font-family: nyt-cheltenham, georgia, 'times new roman', times, serif; font-size: 16px;"><div class="accessibility-ad-header visually-hidden" style="position: absolute; width: 1px; height: 1px; margin: -1px; padding: 0px; border: 0px; clip: rect(0px, 0px, 0px, 0px); overflow: hidden;"><p style="margin: 0px 0px 1em; font-size: 1rem; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif;" class="">Advertisement</p></div><a class="visually-hidden skip-to-text-link" href="http://www.nytimes.com/2015/06/11/business/international/us-shifts-stance-on-drug-pricing-in-pacific-trade-pact-talks-document-reveals.html?_r=1#story-continues-7" style="position: absolute; width: 1px; height: 1px; margin: -1px; padding: 0px; border: 0px; clip: rect(0px, 0px, 0px, 0px); overflow: hidden; text-decoration: none; color: rgb(50, 104, 145);">Continue reading the main story</a><iframe frameborder="0" class="frame-for-article ad-frame" style="border-style: none; width: 300px; height: 250px;"></iframe></div><p class="story-body-text story-content" data-para-count="325" data-total-count="6664" itemprop="articleBody" id="story-continues-7" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">A version of the Trans-Pacific Partnership annex that leaked in 2011 made explicit reference to “competitive market-derived prices,” promising drug companies the chance to appeal rates deemed insufficient. Those are gone, “a victory for the non-U.S. partners to some extent,” Ms. Gleeson, the Australian expert, said.</p><aside class=" selected-comment-marginalia marginalia comments-marginalia" data-marginalia-type="sprinkled" data-skip-to-para-id="story-continues-8" style="border-top-width: 1px; border-top-style: dotted; border-top-color: rgb(153, 153, 153); width: 300px; float: right; clear: right; margin: 0px 0px 45px 7px; padding-top: 10px; color: rgb(51, 51, 51); font-family: nyt-cheltenham, georgia, 'times new roman', times, serif; font-size: 16px;"><a class="visually-hidden" href="http://www.nytimes.com/2015/06/11/business/international/us-shifts-stance-on-drug-pricing-in-pacific-trade-pact-talks-document-reveals.html?_r=1#story-continues-8" style="position: absolute; width: 1px; height: 1px; margin: -1px; padding: 0px; border: 0px; clip: rect(0px, 0px, 0px, 0px); overflow: hidden; text-decoration: none; color: rgb(50, 104, 145);">Continue reading the main story</a><header class=""><h2 class="module-heading" style="font-size: 0.75rem; line-height: 0.9375rem; font-family: nyt-franklin, arial, helvetica, sans-serif; margin: 0px 0px 1em; color: rgb(50, 104, 145); text-transform: uppercase;"><span class="icon" style="display: inline-block; line-height: 0; vertical-align: middle; position: relative; -webkit-transition: background-color 0.3s; transition: background-color 0.3s; width: 20px; height: 13px; background-color: rgb(135, 156, 180); border-top-left-radius: 1px; border-top-right-radius: 1px; border-bottom-right-radius: 1px; border-bottom-left-radius: 1px; margin: -3px 8px 0px 0px;"></span>RECENT COMMENTS</h2></header><div class="comments-view" style="margin-bottom: 15px;"><article class="comment" data-permid="15178005" style="margin-top: 0px;"><header class=""><h2 class="commenter" style="font-size: 0.8125rem; line-height: 0.9375rem; font-family: nyt-franklin, arial, helvetica, sans-serif; margin: 0px; display: inline-block; color: rgb(0, 0, 0);">CDW</h2> <time class="comment-time" datetime="" style="font-size: 0.75rem; line-height: 0.9375rem; font-family: nyt-franklin, arial, helvetica, sans-serif; margin-left: 5px; color: rgb(153, 153, 153);">1 hour ago</time></header><div style="margin: 0px; font-size: 0.8125rem; line-height: 1rem; font-family: nyt-franklin, arial, helvetica, sans-serif; color: rgb(102, 102, 102);" class="">No wonder the Obama administration and supporters of TPA/TPP want negotiations carried out in secret. Although the pharmaceutical companies...</div></article><article class="comment" data-permid="15177950" style="margin-top: 15px;"><header class=""><h2 class="commenter" style="font-size: 0.8125rem; line-height: 0.9375rem; font-family: nyt-franklin, arial, helvetica, sans-serif; margin: 0px; display: inline-block; color: rgb(0, 0, 0);">Jim Michie</h2> <time class="comment-time" datetime="" style="font-size: 0.75rem; line-height: 0.9375rem; font-family: nyt-franklin, arial, helvetica, sans-serif; margin-left: 5px; color: rgb(153, 153, 153);">1 hour ago</time></header><div style="margin: 0px; font-size: 0.8125rem; line-height: 1rem; font-family: nyt-franklin, arial, helvetica, sans-serif; color: rgb(102, 102, 102);" class="">Barack Obama tops all previous attempts by the White House to wreck the economy for the poor, labor, health care and virtually all that...</div></article><article class="comment" data-permid="15177945" style="margin-top: 15px;"><header class=""><h2 class="commenter" style="font-size: 0.8125rem; line-height: 0.9375rem; font-family: nyt-franklin, arial, helvetica, sans-serif; margin: 0px; display: inline-block; color: rgb(0, 0, 0);">swm</h2> <time class="comment-time" datetime="" style="font-size: 0.75rem; line-height: 0.9375rem; font-family: nyt-franklin, arial, helvetica, sans-serif; margin-left: 5px; color: rgb(153, 153, 153);">1 hour ago</time></header><div style="margin: 0px; font-size: 0.8125rem; line-height: 1rem; font-family: nyt-franklin, arial, helvetica, sans-serif; color: rgb(102, 102, 102);" class="">The Obama administration is throwing everyone under the bus by letting the pharmaceutical companies have free reign on pricing. </div></article></div><footer style="border-top-width: 1px; border-top-style: solid; border-top-color: rgb(226, 226, 226); padding-top: 2px;" class=""><ul class="comment-actions" style="margin: 0px; list-style: none; padding-left: 0px;"><li class="comment-count" style="font-size: 0.625rem; line-height: 1.375rem; font-family: nyt-franklin, arial, helvetica, sans-serif; margin-bottom: 0.75em; display: inline-block; margin-right: 12px; text-transform: uppercase; cursor: pointer; color: rgb(50, 104, 145);">SEE ALL COMMENTS</li> <li class="comment-reply" style="font-size: 0.625rem; line-height: 1.375rem; font-family: nyt-franklin, arial, helvetica, sans-serif; margin-bottom: 0px; display: inline-block; margin-right: 12px; text-transform: uppercase; cursor: pointer; color: rgb(50, 104, 145);">WRITE A COMMENT</li></ul></footer></aside><p class="story-body-text story-content" data-para-count="392" data-total-count="7056" itemprop="articleBody" id="story-continues-8" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">But Pacific accord negotiators do appear ready to grant pharmaceutical and medical device makers more power to influence participating governments. The 12 countries involved, and any others that might join later, would have to disclose rules and guidelines for deciding which medical products would be made available through government programs and at what rate providers would be reimbursed.</p><p class="story-body-text story-content" data-para-count="343" data-total-count="7399" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">Drug companies and medical device makers would have to be given “timely opportunities to provide comments at relevant points in the decision-making process.” And governments would have to offer a review process “that may be invoked at the request of an applicant directly affected” by the decisions of national health care authorities.</p><p class="story-body-text story-content" data-para-count="409" data-total-count="7808" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">In the United States, pharmaceutical companies and Medicare have fought for years over which drugs are listed for reimbursement, especially when Medicare lists generic drugs over name brands. While advocates of the trade deal, including President Obama, say opening markets to competition should lower prices for consumers, generic drug makers say the Trans-Pacific Trade Partership could raise costs instead.</p><p class="story-body-text story-content" data-para-count="246" data-total-count="8054" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">Heather Bresch, the chief executive of <a href="http://topics.nytimes.com/top/news/business/companies/mylan_laboratories/index.html?inline=nyt-org" title="More information about Mylan Inc" class="meta-org" style="color: rgb(50, 104, 145);">Mylan</a>, one of the largest generic-drug makers, said that the brand-name pharmaceutical industry was “establishing, through U.S. trade policy, an international system designed to maximize its monopolies.”</p><p class="story-body-text story-content" data-para-count="451" data-total-count="8505" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">The annex also tackles restrictions in many countries on direct marketing to consumers, mandating that drug companies be allowed to “disseminate to health professionals and consumers through the manufacturer’s Internet site” in each country “truthful and not misleading information” on products approved for sale in that country. It does, however, say such dissemination must reflect each country’s “laws, regulations, and procedures.”</p><p class="story-body-text story-content" data-para-count="458" data-total-count="8963" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">By explicitly listing the Centers for Medicare and Medicaid Services, the annex makes it clear the United States is not immune to Trans-Pacific Partnership rules. Japan, Australia and New Zealand may not have pharmaceutical companies as powerful as the United States’ but under the accord, United States subsidiaries located in Pacific trade partners could use the accord’s dispute resolution process to tackle perceived violations by Medicare officials.</p><p class="story-body-text story-content" data-para-count="197" data-total-count="9160" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">The annex makes clear that disputes over pharmaceutical listing procedures would not be subject to government-to-government dispute resolution, the World Trade Organization and retaliatory tariffs.</p><button class=" theme-speech-bubble comments-button button" data-skip-to-para-id="story-continues-9" style="margin: 0px; font-size: 0.6875rem; vertical-align: middle; line-height: 0.8125rem; cursor: pointer; font-family: nyt-franklin, arial, helvetica, sans-serif; border-top-left-radius: 3px; border-top-right-radius: 3px; border-bottom-right-radius: 3px; border-bottom-left-radius: 3px; -webkit-transition: background-color 0.3s; transition: background-color 0.3s; padding: 3px 15px 22px 0px; border: none; background-color: rgb(255, 255, 255); color: rgb(255, 255, 255); text-transform: uppercase; float: left; position: relative;"><a class="visually-hidden" href="http://www.nytimes.com/2015/06/11/business/international/us-shifts-stance-on-drug-pricing-in-pacific-trade-pact-talks-document-reveals.html?_r=1#story-continues-9" style="position: absolute; width: 1px; height: 1px; margin: -1px; padding: 0px; border: 0px; clip: rect(0px, 0px, 0px, 0px); overflow: hidden; text-decoration: none; color: rgb(50, 104, 145);">CONTINUE READING THE MAIN STORY</a><span class="icon" style="display: inline-block; line-height: 0; vertical-align: middle; position: relative; -webkit-transition: background-color 0.3s; transition: background-color 0.3s; width: 90px; height: 55px; background-color: rgb(135, 156, 180); border-top-left-radius: 4px; border-top-right-radius: 4px; border-bottom-right-radius: 4px; border-bottom-left-radius: 4px; padding: 0px;"></span><span class="button-text" style="display: inline-block; vertical-align: middle; margin-left: 0px; width: 86px; position: absolute; left: 0px; top: 0px; padding: 15px 2px 7px; letter-spacing: 0.05em;"><span class="count" style="font-size: 1.375rem; line-height: 1rem; font-weight: 700; display: block;">4</span><span class="units" style="font-size: 0.6875rem; line-height: 0.6875rem; display: block; margin-top: 6px;">COMMENTS</span></span></button><p class="story-body-text story-content" data-para-count="205" data-total-count="9365" itemprop="articleBody" id="story-continues-9" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">Instead, disputes would be resolved through the <a href="http://www.nytimes.com/2015/03/26/business/trans-pacific-partnership-seen-as-door-for-foreign-suits-against-us.html" style="color: rgb(50, 104, 145);" class="">Investor-State Dispute Settlement </a>process, which involves three-lawyer extrajudicial tribunals organized under rules set by the United Nations or World Bank.</p><p class="story-body-text story-content" data-para-count="378" data-total-count="9743" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">That could be significant, both for current Medicare practices and future efforts to lower cost, said Peter Maybarduk of Public Citizen’s Global Access to Medicines project. Drug makers have limited access to Centers for Medicare and Medicaid Services policy makers as they decide which drugs to list and how much to reimburse. The Trans-Pacific Partnership could change that.</p><p class="story-body-text story-content" data-para-count="422" data-total-count="10165" itemprop="articleBody" style="margin: 0px 0px 1em 135px; font-size: 16px; line-height: 1.4375rem; font-family: georgia, 'times new roman', times, serif; width: 532px; max-width: 540px; color: rgb(51, 51, 51);">It could also hinder efforts by many Democrats to change federal law precluding the government from negotiating drug prices directly with pharmaceutical makers. To make that work, the Centers for Medicare and Medicaid Services would need a “national formulary” — a government list of accepted medications. But each decision is subject to review and appeal, which would make it far more difficult, Mr. Maybarduk said.</p><footer class="story-footer story-content" style="margin-left: 135px; width: 532px; margin-top: 24px; margin-bottom: 45px; color: rgb(51, 51, 51); font-family: nyt-cheltenham, georgia, 'times new roman', times, serif; font-size: 16px;"><div class="story-meta"><div class="story-notes"><p style="margin: 0px 0px 1em; font-size: 0.875rem; line-height: 1.125rem; font-family: nyt-franklin, arial, helvetica, sans-serif;" class="">Robert Pear contributed reporting.</p></div></div></footer></div></body></html>