One of the biggest political fights brewing in Washington DC is over Medicare potentially changing to direct negotiations with drugmakers over drug pricing for seniors in the entitlement program.
Generally a policy favored on the left, it was also championed by President Trump on the 2016 campaign trail and continues to hold his interest. Conservatives are largely opposed, but in an era where anything with Trump’s name next to it is equated with good conservative policy by many, that may be changing.
What is not is the pharmaceutical industry’s wholesale objection to the policy. And to be clear, they may be on the right side of this argument, philosophically. What’s interesting is none of that, but how the industry– one of the biggest “special interests” in Washington DC– is working to fight Trump and Democrats back on what it sees as an existential threat.
The U.S. Rural Health Network has a slogan on its website that seems obvious: “We’re fighting for rural health.” But it’s not that simple.
The network, which declines to disclose who funds its work, is part of a gaggle of self-styled patient-advocacy groups with murky origins or hidden funders that have cropped up since 2017. With names like the Doctor-Patient Rights Project or the Defenders Coalition, such groups pursue various policy aims that include effectively aiding pharmaceutical companies’ efforts to defeat drug-price proposals. The nonprofits take public positions in newspaper op-eds and letters to Congress while drugmakers—beset by years of negative publicity over price hikes—tend to remain in the background. The groups say they’re independent.
That’s not true for all of them, said Marc Boutin, the chief executive officer of the National Health Council, which has more than 50 patient groups and dozens of drugmakers as members.
“There are a number of groups created by pharma companies that look and act like patient organizations, but they’re 100 percent funded by industry,” said Boutin, who didn’t name any specific examples. “They sound and look like patient organizations, but they take positions that industry wants.”
Nonprofits aren’t required to publicly disclose their donors. Some pharmaceutical companies voluntarily disclose at least some of their funding for patient groups, but the full scope of their giving is far from transparent.
Even among long-established patient organizations—founded years ago to address specific diseases or conditions—disclosure is spotty. Matthew McCoy, a University of Pennsylvania professor who teaches medical ethics, found in a 2017 study of 104 patient-advocacy groups that 83 percent reported receiving money from drugmakers, but only 5 percent disclosed the exact dollar amounts. Kaiser Health News reported last year that 14 major drug companies gave a combined $116 million to patient groups in 2015, far more than the $63 million they spent on federal lobbying.
Much of that money benefits disease sufferers or society at large. Patient groups run support networks for those who’ve received life-altering diagnoses. Some support research to develop new treatments for particular diseases. They also create communities of patients from whom drug companies can learn more about particular ailments and how treatments affect people.
But those communities are also stocked with potential policy advocates. And with no disclosure requirements, it’s often impossible to know whether drugmakers’ contributions are shaping the patient groups’ policy stances, said Susannah Rose, associate chief of patient experience at the Cleveland Clinic.
“We need much greater transparency, not only in funding, but also how the money is used,” Rose said.
Long-established groups bristle at the suggestion that the drug industry sways their positions. “There are times when what’s best for the patient aligns with what industry wants,” said Claire Gill, chief mission officer for the 35-year-old National Osteoporosis Foundation. “And there are times when it doesn’t.”
With regard to Medicare and drug prices, the osteoporosis foundation recently aligned with the industry in an unusual way.
In 2017, the osteoporosis group began running an informal coalition called the Protect Medicare Part D Working Group. It organized a January letter that called on Congress to reject plans for letting Medicare negotiate on drug prices; some 200 organizations signed it, including the U.S. Rural Health Network.
Who’s behind the astroturf efforts, other than the pharmaceutical industry? Here’s where the real fun starts: Democratic public affairs firms, and even former Democratic Senators.
Lobbyists with pharmaceutical industry ties have worked behind the scenes with the Medicare Part D Working Group as it attempts to transition to a new, catchier name: the Defenders Coalition. The osteoporosis foundation won’t be running the new version. Instead, initial work on the changeover was done by a Washington-based lobbying firm called NVG Group, which has worked recently for drugmakers like Merck & Co. Inc., Sanofi and Pfizer Inc., as well as the trade group, PhRMA.
The transition also got an assist from lobbyist and former Democratic Senator Blanche Lincoln. According to a written summary of a January conference call, Lincoln urged members to stick with the coalition and keep fighting “drastic changes” to Medicare. Her company, Lincoln Policy Group, has worked for drugmakers, including AbbVie Inc. and Pfizer, as well as insurers such as Aetna Inc.
Were the lobbying firms paid to help organize the coalition? “You’d have to ask them,” said Gill of the osteoporosis foundation. Irene Bueno, a co-founder of NVG, said in an email that her firm is no longer involved in the effort; she didn’t answer questions about who funded her work. Lincoln Policy Group didn’t respond to several telephone calls and emails seeking comment.
Another patient group that popped up in 2017 shows how one pharmaceutical company tried to downplay its involvement.
The Doctor-Patient Rights Project lists 18 members—including the U.S. Rural Health Network and the drugmaker Amgen—and describes itself as a “nonprofit coalition of doctors, patients, caregivers, companies and advocates.” It publishes detailed policy papers and places scores of op-eds in newspapers around the country, mostly criticizing insurance companies for interjecting themselves into medical decisions and steering patients to cheaper therapies.
An Amgen spokeswoman described an organic beginning for the group. The company heard from physicians and patient groups about people who were unable to get the medicines their doctors prescribed, she said. “As a result, Amgen and other founding members … came together to address the importance of the physician and patient relationship,” she said in a written statement. These founding members, Amgen said, agreed to select a public-relations agency to run the coalition.
But that’s not exactly how it happened. In reality, the Doctor-Patient Rights Project began after a New York-based public-affairs firm called Marathon Strategies pitched the idea to Amgen, according to two people familiar with the group’s beginnings.
Amgen put up the initial money, while Marathon helped recruit other members, built the website, wrote the reports and placed the op-eds in newspapers. The marketing company declined to comment.
Questioned about this timeline, Amgen provided an updated statement, saying the company—and not the coalition’s member groups—selected Marathon based on their past relationship. It added that while Amgen provided the “seed money” to launch the group, other groups and companies have contributed since.
It declined to name them.
For the record, NVG and Marathon Strategies are Democratic public affairs firms.
NVG’s Managing Partner, Andrea LaRue, was according to NVG’s website “Counsel to Democratic Leader Tom Daschle” before starting the firm.
Marathon Strategies was, per its website, founded by Phil Singer, who “work[ed] as Senator Chuck Schumer’s Communications Director for many years and advis[ed] both of Governor Andrew Cuomo’s winning campaigns. He was also a top official for Secretary Hillary Clinton’s 2008 presidential bid and a national spokesperson for the Kerry-Edwards Campaign in 2004.”
Thus, we have the key players in a major special interest’s effort to take down a key Trump policy priority– and something a ton of Democrats are on board with, too: Revolving-door Democrats selling their connections and influence and trying to astroturf their way to a policy outcome favored by some of the biggest companies in the world, who they supposedly consider “adversaries.”
But this is not just happening with regard to the Medicare-direct-negotiation policy debate. It’s happening in other areas of health care policy, too.
Take for example the tiny 340B drug discount program, which is also a target of pharmaceutical company opposition.
Two years ago, Politico reported that “The AIR340B Coalition has added the Council for Citizens Against Government Waste, Genentech, Medical Oncology Association of Southern California Inc., the National Medical Association, National Minority Quality Forum, and the National Council of Asian Pacific Islander Physicians.” AIR340B is a Coalition that wants the drug discount program slashed, just like a slew of pharmaceutical companies do. And it turns out that pharmaceutical companiesfund the Medical Oncology Association of Southern California. Meanwhile, the National Minority Quality Forum has its own astroturf issues.
No doubt AIR340B has a ton of revolving-door players advising it, too, probably including people from the party advocating things like formal price controls for prescription drugs, single payer health care and other policies right out of the Left’s playbook. And to be fair, there are plenty of Republicans working on health care issues, including this one, oftentimes also against what would apparently be their philosophical interest.
But in the realm of policy affecting drugmakers, there is an extra dose of irony in Democrats doing the dirty work of Big Pharma using the same methods their standard-bearers routinely decry.
The bottom line: Don’t listen to Democrats who preach about “draining the swamp.” Their staffers and donors and big consultants are as much in on the game as anyone else.
In the end, we all lost, and unless there’s some 5-dimension chess going on beyond my comprehension, Trump didn’t do himself any favors in tightening the race. Being right, even for Trump, is overrate …