The VA often pays the lowest prices for drugs in the nation, being able to negotiate what it pays for medications, often at a steep discount compared to other government agencies and Medicare.
The big funding support pharma has given the "No" campaign reflects both the huge amount that California state agencies spend on medications annually — around $4 billion — and concerns drug companies have that other states might follow suit with drug-price control initiatives of their own in the event that Prop 61 passes.
"They're running scared," said Michael Weinstein, president of the AIDS Healthcare Foundation, the main backer of Prop 61, also known as "the California Drug Price Relief Act."
"Their own internal polls got them nervous," said Weinstein, whose "Yes" campaign's message refers to "greedy drug companies" that are "overcharging California's taxpayers and consumers by billions of dollars each year for life-saving medicines, putting profits over people."
But the "No on 61" campaign, which in addition to pharma companies includes patient advocates, doctors, veterans' groups, labor unions and other AIDS activists, warns that the measure could have negative unintended consequences that would include higher drug costs for many people, and decreased access to some medications.
Several drug companies, Merck, Pfizer and Amgen, released identically worded statements to CNBC on Monday they have "serious concerns about this poorly-written measure because of the negative impact it will have on Californians," adding that, "We are part of a broad and growing coalition of organizations."
Pharma's contributions — which include more than $9 million apiece from Merck, Pfizer and Johnson & Johnson — combined with the $16 million or so spent by "Yes" advocates led by the AIDS Healthcare Foundation have made Prop 61 the most expensive ballot measure ever in California, and possibly the most expensive in U.S. history, according to the politics site Ballotpedia.
Despite the huge spending edge by the "No" side, which fueled an onslaught of television ads, a recent Field Poll found voters split evenly — 47 percent to 47 percent — on the measure.
The expensive and contentious campaigning over Prop 61, which has drawn enthusiastic support from Vermont Sen. Bernie Sanders, got personal on Sunday.
The "Yes" campaign released a series of 15-second YouTube ads showing CEOs of pharma companies on "Wanted" posters, saying they were being sought "for gouging the American public & taxpayers with killer drug prices."
One such ad, featuring J&J CEO Alex Gorsky, noted that his salary last year was $23.8 million, and said the company in 2013 paid $2.2 billion "to settle criminal charges of illegally promoting the improper use of its anti-psychotic drug Risperdal for use by elderly patients despite studies that showed the drug increases risk of stroke and diabetes." The ad ends with the message "Vote Yes on Prop 61."
J&J spokesman Ernie Knewitz told CNBC, "As we have learned through the 2016 election campaign, personal attacks do not serve the interests of the American public or foster a balanced discussion on the substantive issues facing the nation."