While pharmacy benefit managers are set to answer questions before the Senate Finance Committee on Tuesday, they’ve already been broadcasting their point of view to lawmakers for months.
With drug costs front and center in Washington, D.C., these days, PBMs, drugmakers and other healthcare groups have been shelling out millions on advertising and lobbying, each hoping to sway politicians—and consumers, for that matter—and fend off criticism.
The leading PBM trade association, Pharmaceutical Care Management Association (PCMA), for instance, is running two campaigns that started this year—one touting the value of PBMs for patients and the second advocating for continued Medicare and Medicaid negotiating power.
It's easy to see why, particularly with the latter campaign: The Trump administration has proposed abolishing PBM rebates in those two government health programs, denying the middlemen a share of the rebate pie and turning them into fee-for-service companies instead. Rebates would be allowed only if given to patients at the point of sale.
The Campaign for Sustainable Rx Pricing (CSRxP)—a group that includes PBMs as well as insurers, hospitals and physician groups—has also taken to advertising to fight off that rebate proposal. It recently launched a seven-figure national campaign that includes TV ads, “highlighting the negative effects of the administration’s proposed rebate rule,” said a CSRxP spokesman.
Meanwhile, PhRMA, the drug industry association, has been touting its own perspective through an ongoing “Let’s Talk About Cost” campaign that began in 2017 with ads “focused on ensuring insurers and PBMs share negotiated discounts and rebates directly with patients at the pharmacy counter,” said PhRMA spokesperson Holly Campbell in an email. It recently launched a Medicare-focused campaign to highlight its view on the right way and wrong way to tackle affordability issues in the program.
Even AARP, which is also a member of CSRxP, has launched advertising on drug pricing policies. The organization for seniors is running ads targeted in D.C. and key battleground states. The radio, print and online video spots implore legislators to “protect seniors, not drug company profits.”
While the healthcare system has been a hot topic for years, the Trump administration’s fiery rhetoric and drug pricing proposals have prompted a ramp-up in lobbying and other efforts to influence policy and public opinion, said Dan Auble, senior researcher at the Center for Responsive Politics, the nonprofit behind the Open Secrets lobby spending database.
Pharma and health product lobby spending jumped 12.7% for the 2017–2018 period compared with the previous two-year cycle, CRP figures show. Overall lobbying spend grew just 6.5% during the same time.
“Pharmaceuticals are perennially one of the biggest spenders on lobbying, and they also give a substantial amount of campaign contributions. In lobbying, we often see when issues come up—whether in Congress or in the public consciousness—when there may be a threat or possibility of new legislation or regulation, those industries and important companies within the affected industry will ramp up lobbying spending,” Auble said.
The CSRxP spokesman said the PBM hearing this week will be a “big test” in whether Big Pharma’s effort to paint PBMs as unnecessary middlemen is working as drug companies try to steer the conversation away from their own role. Other issues on the table include the current drug rebate system, changes in protected categories of drugs and list prices in drug advertising.