PBM legislation again dominates lobbying expenditures in 2024

Spending on healthcare lobbying has ticked up in 2024, with companies and associations in the healthcare sector again spending hundreds of millions and again putting the greatest attention on bills that involve pharmacy benefit managers. 

According to federal data compiled by OpenSecrets and analyzed by Modern Healthcare, lobbyist spending for the first three quarters of 2024 hit $562 million, up from $553 million in the same period last year. 

Related: PBM bill, telehealth extension may ride together in 'lame duck'

Not only has spending this year been similar to last, the bills that attracted the most lobbying have been as well — nearly all involving PBMs, which where 2023's top target.

Of the top 10 most-lobbied bills, only one did not include PBM provisions. Of the rest, seven focused directly on the drug industry middlemen, and two had major related sections.

Of the top 15 bills targeted by lobbyists, 13 had a connection to PBMs, according to the data. No PBM bills have yet passed Congress.

Some provisions restricting PBM compensation might still pass, however, along with another bill that got heavy lobbying, the Telehealth Modernization Act of 2024. Lobbyists filed 58 reports on that measure, which many lawmakers hoped to pass in the lame-duck session of Congress.

The heaviest-lobbied bill of 2024 so far actually passed the House last year — the Lower Costs, More Transparency Act of 2023. Lobbyists filed 174 reports saying they were trying to sway lawmakers on that legislation, according to the data. 

Access the complete survey data here

The flood of paid influencers to that bill reflects its broad scope, with provisions that touch not just on drug pricing, but on most players in the healthcare sector. For instance, the measure includes site-neutral payment provisions that affect hospitals, and transparency measures that affect both providers and insurers.

Still, even there, the PBM issue appeared to be a dominant draw, with drug companies and their trade association, the Pharmaceutical Research and Manufacturers of America, filing 60 reports related to that bill alone. Drug companies have blamed PBMs for rising costs, while PBMs and their trade association, the Pharmaceutical Care Management Association, counter that most PBM legislation will only hamstring PBM firms' ability to negotiate, benefitting drug companies. 

The second-most lobbied bill was the Delinking Revenue from Unfair Gouging Act of 2024, or the DRUG Act, which squarely targets pharmacy benefit management practices. It has not advanced in Congress, but had 111 lobbying reports filed related to it.

The next three bills were all also focused on PBMs. The only heavily lobbied bill in the top 10 that did not have a connection to the drug price negotiators was the Resident Physician Shortage Reduction Act of 2023, which proposes increasing residency positions eligible for payments from Medicare beyond what is currently planned.

Another way to look at the weight organizations place on legislation is how much money they spend. 

The biggest single spender over the first three quarters of 2024 was PhRMA, ladling out $24 million to lobbyists. That's nearly $3 million more than the group spent by the same time in 2023. Several of the group's members are also among the biggest spenders, with Pfizer spending $11.6 million and Amgen spending $8 million, while allied groups Biotechnology Innovation Organization dished out $9.5 million and Roche Holdings unloaded $8.6 million.

The second-biggest single spender was the American Hospital Association, which tallied up $21.3 million, compared with $20.9 million in the first three quarters of 2023. Third on the list was the American Medical Association, which boosted its lobbying expenses in 2024 to $18.1 million from $15.3 million.

The PCMA was fourth on the list, at $12.6 million, followed by America's Health Insurance Plans at $9.2 million. If insurance companies were tallied up as one, they would trail only the pharmaceutical industry, with the Blue Cross Blue Shield Association and its member companies spending more than $20 million combined, while Cigna spent $6.8 million and UnitedHealth Group dropped $5.9 million. Both of the latter companies have major PBM businesses.