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Big pharma isn't the only powerful player in the prescription drug pricing fight

The Washington Post: The Early 202

Few industries have lobbied harder to shape Democrats’ massive health care, child care and climate bill than the pharmaceutical industry, which has spent months working to kill the party’s plan to lower prescription drug prices.

But there's also a well-funded counteroffensive being waged by powerful collection of patient groups, health insurers, hospitals, other health-care interests and AARP. And they've arguably won the first round. The influential seniors' lobby alone has spent more than $16 million so far this year on TV, radio and digital advertising urging lawmakers to include drug pricing reforms in the bill, according to AARP. AARP has shelled out $8.5 million on lobbying on drug pricing and other issues in the first nine months of this year, according to disclosure filings — a little more than a third of the $22.4 million that Pharmaceutical Research and Manufacturers of America, the industry’s flagship trade group, has spent.

But, crucially, AARP has been able to rely on its tens of millions of members for lobbying help. When the White House earlier issued a framework for the bill excluding drug pricing, AARP members made more than 9,000 calls to congressional offices in one week. As lawmakers return to Washington today to take up Democrats' roughly $2 trillion package — while also working to stave off a government shutdown by Friday and finding a way to raise the debt limit in the coming weeks — the group has leaned into the imagery of taking on one of the most powerful players in Washington. “PhRMA has the money. We have the voters,” David Certner, an AARP lobbyist, tweeted last month. “We’re a good-sized advocacy organization, so I don’t always use the analogy,” Nancy LeaMond, AARP’s top lobbyist, said in an interview last week. “But it’s certainly true that in this case, PhRMA is Goliath and we may be David.”

The middlemen

PhRMA has countered that it's easy for insurers and other parts of the health care system to support reforms that don’t target them in the same way (and in some ways could help them). The Campaign for Sustainable Rx Pricing, for instance, a coalition that's backing the bill's drug-pricing reforms, has spent more than $1 million on ads and hundreds of thousands of dollars more on lobbying. Its members include health insurance companies and the Pharmaceutical Care Management Association, which represents pharmacy benefit managers (PBMs) — companies that manage drug benefits on behalf of insurers and others. “Democrats and Republicans recognize the central role insurance companies and middlemen play in determining what patients pay at the pharmacy, yet through a campaign of misinformation these powerful industries have managed to block any real accountability in this bill,” Brian Newell, a PhRMA spokesman, told The Early in a statement.

The argument that middlemen and insurers are being spared has gotten as least some sympathy from Democrats. “I think if we want to tackle prescription drug pricing we’ve got to go after PBMs, we’ve got to go after insurers, we’ve got to go after providers,” Sen. Tim Kaine (D-Va.) said last month. “Because it’s often not just the manufacturer that is responsible for the sticker shock that people are experiencing when they go to the pharmacy counter.”

Asked whether Kaine planned to push for changes to the drug-pricing measures in the bill, a spokeswoman said the senator believes changes to the system "should include reforms affecting all parties who contribute to artificially high prices” and that the bill’s details “are still being negotiated.” The Campaign for Sustainable Rx Pricing, meanwhile, says PhRMA is pointing at others “to deflect accountability.” “The fact is, brand name drug companies are solely responsible for setting and hiking list prices on their products and Congress must remain focused on solutions that hold Big Pharma accountable to lower drug prices for the American people,” executive director Lauren Aronson said in a statement.

The Senate test

Democrats clashed for months over drug pricing before reaching a compromise that could pass the House. As the bill heads to the Senate, AARP and other groups are fighting to ensure it isn’t scaled back or stripped out.

“We sort of view it like a Jenga tower,” said David Mitchell, the founder of Patients for Affordable Drugs. “We're concerned that if we pull out something, the thing will collapse. … And so our position is don't change anything, pass what the House passed intact, for fear that we upset this delicate balance.” Mitchell and his allies have some reason for optimism. The three Democratic senators viewed as most skeptical of allowing Medicare to negotiate drug prices — Sens. Kyrsten Sinema (Ariz.), Robert Menendez (N.J.) and Tom Carper (Del.) — have all said they back the current compromise language. (AARP nevertheless held a town hall with Carper last week to make sure the issue remained on his mind.) Instead, the bigger threat might be the Senate parliamentarian, who could rule some of the House language is barred under reconciliation rules. Or the entire effort to pass the bill could collapse, taking drug pricing down with it. “At this point, honestly, I think my concerns are less about the drug-pricing provisions … and more about getting the whole package across the finish line,” said Bari Talente, a lobbyist for the National Multiple Sclerosis Society, which is advocating on the issue.


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