US pharmacy benefit lobby group ramps up spending as lawmakers close in, ET HealthWorld


Washington: As U.S. pharmacy benefit companies face scrutiny from lawmakers and regulators, the main group representing them in Washington has nearly doubled its lobbying spend to over $15 million in 2023, a Reuters review of congressional disclosures shows.

That puts them behind only the $27 million spent by the Pharmaceutical Research and Manufacturers of America (PhRMA), the usual No. 1 and main lobby group for drugmakers that has tried to deflect criticism for high drug prices by blaming the industry’s middlemen, the pharmacy benefit managers (PBMs).

The $15 million spent by the PBM lobby group, Pharmaceutical Care Management Association (PCMA), dwarfs the $8.6 million it spent in 2022 and $7.8 million in 2021.

The 2023 figures, which were revealed after fourth-quarter lobbying disclosure forms were released this week, have not been previously reported.

Lawmakers and the Federal Trade Commission (FTC) have been investigating the role of PBMs in rising healthcare costs. Several proposed bills would require them to make their business dealings public, including the fees they earn on transactions.

“In recent years, policymakers have come to realise that PBMs deserve some of the blame for high drug prices,” said Larry Levitt, vice president for health policy at KFF. “It’s not surprising that PBMs would be ramping up their lobbying to try to fend off efforts to regulate them more strictly.”

PBMs negotiate payments for prescription medicines with drugmakers on behalf of clients – primarily employers and health insurers – and decide which to include on their lists of covered drugs.

Critics say PBMs have driven up prices and enriched themselves rather than negotiate for lower ones. PBMs deny those accusations and say they play an important role in holding down drug costs for their clients, and that most after-market discounts go to their customers.

PCMA, which represents top PBMs like CVS Health’s Caremark, Cigna Group’s ExpressScripts, UnitedHealth Group‘s OptumRX, Prime Therapeutics, and Humana , spent over $5 million in the last quarter alone.

A PCMA spokesperson said it is imperative to educate lawmakers and the public on the role of PBMs in lowering prescription drug costs.

PhRMA in the past year has launched several television and internet ads blaming “pharmacy middlemen” for high drug prices.

“In Washington and nationwide, Big Pharma continues its extraordinarily high advertising spending to blame-game others for high drug costs,” the PCMA spokesperson said.


“The more people look under the hood at the broken PBM model, the clearer it is that the system needs to be fixed,” said PhRMA spokesperson Nick McGee.

“There’s a growing bipartisan chorus of regulators, policymakers, patients, providers, pharmacists, smaller PBMs and others across the country calling for action,” he said.

KFF’s Levitt agreed that while PhRMA plays a large role in driving scrutiny over PBMs, it is not alone. Democrats and Republicans are digging into its practices and employers are asking for more transparency on their dealings, he said.

“The passage of the inflation reduction (act) paved the way for more of a bipartisan effort to scrutinise PBMs more closely.”

PhRMA retained the top spot for lobbying spending in its industry it has held since 2001, and was among the overall top five spenders nationwide. Its $27 million in 2023 was used to try to curry favor on various issues including the implementation of the first drug price negotiation program in the government’s Medicare health plan for older people under the Inflation Reduction Act.

Negotiations started this year for prices will not take effect until 2026.

The Biotechnology Innovation Organization (BIO) fell from second place to seventh, its disclosures showed, as it saw a swathe of exits in 2023, most recently by Pfizer, which is also represented by PhRMA.

BIO declined to comment on its lobbying expenditures. A spokesperson said their numbers vary every year and are not based on a single issue. BIO spent $12 million to $13 million a year from 2019-2022.

  • Published On Jan 25, 2024 at 07:27 PM IST

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