By Megan R. Wilson

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In today’s issue: Drugmakers are scoring a policy victory in the government funding bill. What’s next for them? … Take a look at the health care industry’s top lobbying spenders.

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The White House is pushing Congress to codify the most-favored nation deals it made with drugmakers. This could put the industry on defense. (Demetrius Freeman/The Washington Post)

	The Lead Brief

Congress is poised to finally enact reforms to pharmaceutical intermediaries called pharmacy benefit managers, or PBMs, across the finish line after years of trying. Taking on PBMs has been a rare area of bipartisan consensus on Capitol Hill — and the subject of a multimillion-dollar advocacy campaign from drugmakers.

The policies would increase transparency requirements for PBMs and curtail certain ways they make money, such as requiring them to “pass through” any rebates on medications that they receive from drugmakers to the commercial health plans they contract with.

→ But now that the pharmaceutical industry is likely about to score a policy victory against one of its adversaries, where does the health industry’s largest lobbying spender go from here?

The Pharmaceutical Research and Manufacturers of America, better known as PhRMA, represents brand-name drugmakers. In 2025, it spent almost $38 million to lobby the federal government — a record-high amount for the group, according to lobbying disclosures.

→ Only the U.S. Chamber of Commerce and the National Association of Realtors — which each represent millions of members — spent more on lobbying over the last two years.

PhRMA, which represents 34 member companies, is laser-focused on a small portfolio of issues at the federal level, directing much of its firepower at PBMs in recent years.

Some of PhRMA’s policy asks — including a provision to separate a PBM’s revenue from the price of medicines it selects for Medicare Part D plans to cover — are in the House-passed government funding legislation.

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Critics have argued that PBMs have an incentive to choose higher-priced drugs so they can exact larger discounts from pharmaceutical companies and pocket the difference, a claim the industry has denied. Instead, the legislation would allow PBMs to collect a “bona fide” fee for the service they provide.

The Senate is expected to approve the bill next week.

→ Although other groups — including ones representing pharmacies and employers — helped push the PBM reform issue along, none could match drugmakers’ advocacy war chest and wide-ranging advertising campaigns that blanketed podcasts, television networks and the internet.

The ads blamed PBMs for high drug prices and argued the industry — which negotiates discounts on drugs and selects which medications an insurance plan will cover — had become too consolidated. The largest PBMs are owned by insurance companies — Cigna owns Express Scripts, CVS Health owns CVS Caremark, and UnitedHealth Group owns Optum Rx — and many have their own affiliated pharmacies.

Meanwhile, the industry group representing PBMs, called the Pharmaceutical Care Management Association (PCMA), launched its own seven-figure ad buys to push back, arguing that the rebates they negotiate with drugmakers help keep costs down. However, momentum behind reform proposals continued gaining on Capitol Hill.

→ Now PCMA says the PBM policies in the government-funding legislation will “make health care more expensive.”

The House “has sided with Big Pharma over American families facing a painful affordability challenge,” said new PCMA President and CEO David Marin, who started earlier this week. Marin urged the Senate to reject the bill, though doing so is unlikely to happen, in part because it would likely trigger a government shutdown.

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“This policy is a gift to the pharmaceutical industry, which has long sought to tie the hands of PBMs. That’s because PBMs exist to fight back against drugmakers’ egregiously high prices,” Marin said, arguing that lawmakers should keep the focus on the pharmaceutical industry itself. “If the Senate does not reject this policy, lawmakers will come to regret these costly mandates.”

WHAT’S NEXT

Congress could theoretically go further on PBMs in the future, but the industry would likely engage in even stronger pushback that could complicate any future efforts. Lawmakers, drugmakers and other industry players that have long pushed for reforms are likely to consider these changes, if enacted, as a major victory.

→ So, what does that mean for PhRMA’s advocacy agenda? The group won’t show its cards. But it’s likely to turn more of its efforts on hospitals as it lobbies policymakers to curtail the 340B discount drug program that compels pharmaceutical manufacturers to give hospitals that serve low-income and uninsured patients massive markdowns on medications.

As talk of affordability grows in Washington, PhRMA may also need to double down on defense. In President Donald Trump’s “Great Healthcare Plan,” he calls on Congress to codify the most-favored nation (MFN) drug pricing deals the administration made with 16 drug companies. The deals, which are confidential, involve lowering prices on medicines in the U.S. to match prices in other wealthy nations.

→ Fifteen of PhRMA’s members have cut deals with the Trump administration — with most proudly announcing them in flashy White House press conferences — but the industry broadly is worried about pushing MFN policies further.

Following the plan’s release, Alex Schriver, a spokesperson for PhRMA, cautioned against price controls for the pharmaceutical industry.

“Imposing broad-based price controls does nothing to address insurance barriers and would instead threaten access to breakthrough treatments and undermine critical investments that strengthen the U.S. economy,” Schriver said.

	Chart check

PhRMA tops the list of health care lobbying spenders — but how did other big industry players spend their cash last year?

Here’s a chart of the top 25 health care lobbying spenders, almost all of whom boosted their advocacy in 2025 compared to the year before:

Lobbying spending tends to increase during the first year of a new presidential administration or new Congress as industries move to shape legislative and regulatory priorities.

→ The list is dominated by the pharmaceutical industry, representing half of the top spenders. Eight of them cut MFN drug-pricing deals with the Trump administration.

Republicans control the White House and both chambers on Capitol Hill, thereby driving policy and regulations that have kept the industries engaged. Last year, the GOP’s sprawling tax-and-domestic-policy law set sweeping Medicaid cuts into motion despite opposition from hospitals, providers, insurers and public interest groups.

Health Secretary Robert F. Kennedy Jr. has moved to reshape the health agency and companies seeking to advance his Make America Healthy Again agenda — focused on preventing chronic illness — have been working to weigh in. 

Industry players have also been trying to maneuver through changes at the Food and Drug Administration, including updates to food labeling and the administration’s approach to how medications are approved. Others have pushed back against the Trump administration’s cuts to research funding.

Meanwhile, insurers have confronted potential changes to the Medicare Advantage program and urged Congress to extend enhanced premium subsidies for people with Affordable Care Act plans, which ultimately expired on Dec. 31.

Some organizations — including the American Medical Association and PCMA — calculate lobbying spending using a more expansive method that includes other types of advocacy, including advertising spending and state-level lobbying. For that reason, organizations that use this method tend to report higher lobbying spending in election years. 

	What We’re Reading

“Formal U.S. withdrawal from WHO is decried as ‘scientifically reckless,’” Lena H. Sun writes for The Washington Post.

“Frustration over U.S. health costs erupts at congressional hearing,” The Washington Post’s Peter Whoriskey reports.

“NIH says it will stop funding research using human fetal tissue,” The Washington Post’s Carolyn Y. Johnson reports.

“Abortion opponents demand more as Trump targets Planned Parenthood, foreign aid and fetal tissue research,” Alice Miranda Ollstein writes at Politico.