Several health care trade groups and businesses upped their lobbying expenditures in the opening stretch of 2019, with the pharmaceutical industry reporting the highest expenditures as lawmakers focus on rising drug prices.

The Pharmaceutical Care Management Association, which represents the pharmacy benefit managers that have emerged as a bogeyman in the drug pricing debate, more than doubled its lobbying expenditures in the first quarter of the year compared to the equivalent period in 2018. So far this year, the group has spent $1.49 million on lobbying, compared to last year’s first quarter sum of $741,557.

“We’re committed to defending and promoting the industry to ensure that PBMs remain the advocates for consumers to keep prescription drug costs affordable and accessible,” Charles Cote, the group’s vice president for strategic communication, said in an email.

Meanwhile, the PBMs’ rivals — drugmakers represented by the Pharmaceutical Research and Manufacturers of America — reported spending $9.91 million during the opening three months of the year. That’s just slightly less than the $9.96 million the group spent on lobbying in the first quarter of a record-breaking 2018.

Three of the seven drugmakers that testified in February before the Senate Finance Committee — AstraZeneca, Bristol-Myers Squibb, and Johnson & Johnson — increased their spending on lobbying. The other four — Merck & Co., AbbVie, Sanofi and Pfizer — spent slightly less than during the same stretch of time last year.

AstraZeneca and Bristol-Myers Squibb did so greatly, the first increasing by $460,000 to $1.06 million and the latter by $400,000 to $1.2 million. Those increases more closely aligned them with the higher levels spent by the other five companies. All seven companies averaged $2.14 million on lobbying in the first quarter.

The Campaign for Sustainable Rx Pricing, an organization made up of health trade groups, insurers and provider groups, criticized the pharmaceutical industry and noted that PhRMA spent nearly $4 million more in the first quarter of 2019 than it did in the closing months of 2018.

“Big Pharma is clearly feeling the heat as policymakers on both sides of the aisle rally behind common-sense, market-based solutions to crack down on the industry’s anti-competitive tactics in order to lower the growing price of prescription drugs,” Jon Conradi, a spokesman for the group, said in a statement.

According to PhRMA’s disclosure, the group lobbied on dozens of bills related to exclusivity periods, patent settlements, price transparency, the Food and Drug Administration’s drug approval process and drug rebates, among other issues. The group also lobbied Congress and the administration on several proposed rules.

Lowering prescription drug prices is seen as one of the few issues that unite Democrats in the House with Senate Republicans and President Donald Trump.

While some individual bills are expected to pass this year, and the House could vote on a half-dozen bipartisan measures mostly meant to increase generic competition as soon as next month, lawmakers are still debating what a larger package would look like. In the Senate, Finance Chairman Charles E. Grassley of Iowa has said he hopes the panel will consider a drug pricing package by this summer.

Gerard Anderson, a health policy professor at Johns Hopkins University, said it wasn’t surprising that PBMs had dramatically increased their spending, since the pharmaceutical industry has sought to shift the blame for high costs to them.

Drug companies may quietly spend even more on advocacy efforts by giving funds to patient advocacy groups that don’t have to disclose their spending or funding sources, he said, noting he has forthcoming research on the issue.

“They’ve always, they being pharma, have always invested heavily in lobbying,” Anderson said. “So this is just sort of more of the same of their activities. When we looked at it, we saw that lobbying was a small portion of their advocacy efforts, when we considered that they gave a lot of money to various patient advocacy groups.”

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Other health industry groups

The amount of money the pharmaceutical industry is spending on lobbying efforts far outpaces other sectors of the health care industry, at a time when lawmakers on both sides of the aisle say they are committed to lowering prescription drug prices.

For example, America’s Health Insurance Plans spent $2.28 million during the first quarter. The American Hospital Association and the Federation of American Hospitals spent $5.31 million and $690,000, respectively. All three groups spent more this year than they did during the first quarter of 2018.

Drug pricing issues were a concern for all groups, according to their disclosures.

AHIP reported lobbying on bills that would implement a single-payer system or expand Medicare or Medicaid eligibility, which are seen more as issues for the campaign trail rather than on Capitol Hill, given that Republicans control the Senate. The FAH similarly said it was monitoring single-payer bills, known as “Medicare for All” legislation, offered in the House and Senate.

All three groups also said they lobbied on surprise medical bills, which a patient might receive for out-of-network care at an in-network hospital or similar situation. Lawmakers in both chambers are negotiating over ways to resolve disputes between providers and insurers. Legislation will likely be introduced later this year.

The American Medical Association spent $6.77 million on lobbying in the first quarter of the year, slightly more than in the same period of 2018. The group said it lobbied on a dozen bills to lower drug costs and shore up the 2010 health care law that the Energy and Commerce Committee approved and the House may debate on the floor as soon as next month.

The group also weighed in on other topics that Congress could legislate on this year, like surprise medical bills and lowering health care costs. It also lobbied on different gun violence prevention issues, which the AMA has recently been vocal on.

The Partnership for America’s Health Care Future also registered to lobby as a client of the lobbying firm Forbes Tate, effective April 1. The group, which represents trade groups representing insurers, hospitals and pharmaceutical companies and other health care groups, opposes “Medicare for All.”