Big Pharma's shelling out big-time to patient organizations. Is there any quid pro quo?

It's been eight months since Big Pharma executives faced a grilling by the Senate Finance Committee over their pricing decisions. But the scrutiny is far from over—and now, the committee is digging into pharma funding for patient advocacy groups, which have been known to speak in tunes that are music to the industry’s ears.

AbbVie, Bristol-Myers Squibb, Pfizer, Merck & Co., AstraZeneca and Johnson & Johnson together contributed more than $680 million to hundreds of patient groups and other nonprofits last year, according to a Bloomberg examination of data the companies sent to the Finance Committee.

The total tally more than doubled the $321 million the six companies handed out in 2015 and significantly exceeded what the industry itself spent on lobbying. In 2018, the entire pharmaceutical and health products industry—including pharmaceutical benefit managers—spent $283 million in lobbying U.S. lawmakers, according to the independent research group OpenSecrets.

AbbVie’s spending on patient groups contributed the lion’s share of the jump, according to Bloomberg, from well below $100 million in 2015 to about $350 million in 2018. AbbVie, Bristol-Myers and Pfizer ranked as the three biggest spenders.

AbbVie, in a response to Bloomberg, said it's looking for information about certain conditions targeted by its products when deciding what groups to fund.

RELATED: Expect more transparency around pharma's advocacy group partnerships in 2019

The companies handed over their donation data to the Finance Committee after executives testified in February about rising drug prices. Sanofi's then-CEO Olivier Brandicourt also appeared at the hearing, but the Bloomberg report doesn't include donation data from the French pharma. During the testimony, Sen. Ron Wyden, the committee’s ranking member, pointed to the connection between Humira sales and AbbVie CEO Richard Gonzalez’s pay as “problematic.”

It’s unclear whether the torrent of cash has affected the patient groups' stance on pharma-related issues, but they certainly have supported causes that align with the companies’ own.

Patient advocacy groups are meant to educate and provide support services to patients and caregivers. Drugmakers also count on their insights from patients, which can be important in guiding their decision-making, R&D and marketing.

Some groups also promote messages that are beneficial to drug companies, and the large amount of money they've collected from the industry raises questions about potential conflicts of interest and the credibility of their own testimony to Congress.

For example, patient groups routinely appear at FDA Advisory Committee meetings to support a new product's approval. They also speak at public hearings organized by the Institute for Clinical and Economic Review, often saying a negative review by the drug-cost watchdog could keep patients from getting access to a needed treatment.

The Patient Access Network Foundation, which collected the most in donations from the six companies over the past three years, joined dozens of other nonprofits in warning the Finance Committee about proposed changes to Medicare's Part D benefit. The proposals might be detrimental to “beneficiaries’ costs and access to prescription drugs,” the groups said, as noted by Bloomberg. A spokeswoman for the organization told the news outlet that its advocacy work isn’t influenced by drugmakers.

RELATED: Pfizer inks $23.8M deal to settle Justice Department's charity kickback probe

Earlier this year, several patient advocacy groups rallied in objection to a Trump administration plan that would introduce step therapy in Medicare, essentially requiring patients to try cheaper drugs before moving to more costly ones. The plan would also allow drugs to be kicked off Part D formularies if price hikes are too steep. A Kaiser Health News analysis found that about half of the groups that objected had received funding from the pharmaceutical industry.

Meanwhile, the Justice Department has been investigating pharma donations to certain assistance organizations that help patients afford their medicines. Celgene, Biogen, Gilead Sciences, Pfizer, Johnson & Johnson and Valeant (now Bausch Health), among others, have been roped into that probe.

The federal prosecutors alleged the companies earmarked their donations, requiring the patient charities to use the money to offer copay assistance for their own drugs. Last May, Pfizer agreed to pay $23.8 million to settle the probe around its cancer drugs Sutent and Inlyta and arrhythmia drug Tikosyn.