There’s a dangerous CEO all over Washington these days, which isn’t really anything new.
But this particular suit is everywhere. And according to the lobbying group behind the commercials he stars in, he’s coming for your prescriptions.
There he is in the pharmacy, cheerfully taking the prescription from the woman’s hands.
There he was in the doctor’s examination room, with a lollipop tucked into his cheek, preventing another patient from using his local pharmacist.
There it is, interrupting your morning bulletins. Blocking your daily Wordle.
The campaign is centered around DC and a number of undisclosed states across the country. With the ads, the Pharmaceutical Research and Manufacturers Association, or PhRMA, managed to at least somewhat introduce a highly unusual policy debate.
The ads that appeared in the roll call, as well as in other publications, are for pharmacy benefit managers, or PBMs, who manage prescription drug benefits for health insurance plans. Most large PBMs are now integrated into companies that own large pharmacy chains or insurance companies.
Drugmakers are currently clashing with PBMs over legislation that would dismantle strategies that PBMs say help keep insurance premiums low.
Lawmakers from both sides of the House and Senate are currently pushing for additional restrictions on PBMs, while the Trump administration has previously tried to rein in their tactics.
Those tactics include negotiating discounts from drug manufacturers that are usually calculated as a percentage of the drug’s list price. Critics say the practice encourages drugmakers to set higher prices.
Those discounts are not usually passed on directly to patients who use the drugs. But PBMs argue that rebates allow health plans to offer lower premiums, and spending analyzes show that plans would increase premiums and therefore government spending if they lost rebate revenue.
PBMs also offer patients better access to drugs at better discounts, which they say helps boost their leverage with drugmakers. But the strategy may also limit patients to certain drugs or pharmacies with which PBMs have better relationships, or in some cases, limit patients to mail-order pharmacies. It may also encourage health plans to offer less coverage for lower-priced drugs if they get a better deal on a more expensive version.
These are the complex issues that PhRMA is trying to convey by having a lollipop actor hijack prescriptions.
Robert Blendon, a health policy professor and policy analyst at Harvard University, said the ads aren’t aimed at the general public because most people outside the health care industry don’t know what a PBM is.
Instead, the goal is to give political operatives opposed to Medicare drug price negotiations, mostly Republicans, an alternative proposal to voters to lower drug prices.
“When there is a popular issue and one party has redress for it, the strategy is not to ignore that issue,” he said. “It’s to come up with an alternative.”
PhRMA is a large, well-funded operation that easily dwarfs its PBM rival, the Pharmaceutical Care Management Association. The group spent roughly $20.7 million on lobbying this year, compared to $10.1 million spent by the PCMA.
“We think it’s important to have a fact-based conversation,” said PhRMA spokeswoman Sarah Ryan. “We’ll do what’s necessary, including reaching out to everyone we can, to make sure we’re diagnosing the right problems and solutions.”
PCMA launched its own seven-figure TV and digital advertising campaign in May, the same month as PhRMA’s campaign. The group largely stuck to a traditional lobbying line, urging consumers to tell Congress to “turn back the big pharma smokescreen” and “protect the benefits of our pharmacies.”
“Big Pharma’s blame game is designed to help them avoid responsibility for their unprecedented anti-competitive patent abuse practices that keep prescription drug prices high and to increase their own profits by undermining the critical role pharmaceutical companies play in providing savings for patients and health plan sponsors , such as employers and unions,” PCMA Senior Vice President of Public Affairs Katie Payne said in a statement.
Jeffrey Pereira, an analyst at marketing intelligence firm Vivvik CMAG, said PhRMA’s campaign marked a shift away from the battle over a 2022 bill requiring Medicare to negotiate prices for some expensive drugs. Instead, PhRMA and its member companies are now challenging the law in court.
“PhRMA has admitted that the messaging war is a good sign that they may believe they have lost public support in the fight against [Inflation Reduction Act]”, he wrote in July. Whether Biden can win this issue in 2024 remains to be seen.
Ryan rejected the characterization, noting that PhRMA has run ads about PBMs for more than six years. Lobbyists also continue to push for specific language changes with lawmakers, such as ending the law’s differential treatment of traditional drugs and newer biologics.
“This is not binary,” Ryan said. “We are still very much focused on the IRA, the threat to innovation and the consequences of putting government bureaucrats between patients and their doctors.”
The man behind the lollipop
The Washington debate, like all Washington debates, is highly charged.
But the actors in lobbying ads, of course, are often quite removed from the politics of the gig. And Peter Fleehan, the man behind the ubiquitous PBM CEO, seems happy to be here.
In fact, he’s happy to be almost anywhere. With two decades of acting under his belt, Fleahan has appeared in a wide variety of videos, commercials, TV shows and indie projects. (Fleehan, who has a contract with PhRMA, did not respond to a request for an interview.)
Here, he merrily struggles with his Amazon PillPack meds, and sling pizzas for Osteo Bi-Flex. He happily stuffs his apothecary ties into a car insurance ad and yells at a tree in a place to vacuum leaves.
He even co-starred with Tom Selleck in the CBS cop drama Blue Bloods and got a few lines in another CBS cop drama, East New York. And he once partied with Sam Smith in a tuxedo in his music video for “Like I Can.”
In real life, the entire Fleahan brand seems to be the opposite of the smiling PBM CEO. It seems very nice.
He shows up early at gigs. He gives advice to fellow actors auditioning for the same roles, in the spirit of “getting the energy going,” according to an interview on a fellow actor’s YouTube show.
“It’s yours to give back,” he said, “and it will come back to you tenfold.”
He is a longtime volunteer firefighter who posts on Instagram when he rescues cats from trees. He’s the house on the block that gives out full-sized candies of the good kind to those who can trick them.
According to his bio, he has a black belt in taekwondo, an open water scuba diving certificate and his own lederhosen. And, according to his Instagram, he’s now a certified clown.
Not winning over the critics
But while bipartisan groups of lawmakers have PBMs in their sights, PhRMA’s campaign isn’t winning over any critics of the pharmaceutical industry.
Senate Health, Education, Labor and Pensions Chairman Bernie Sanders, I-Vt., a longtime pharmaceutical foe, routinely cites the statistic that pharmaceutical lobbyists outnumber members of Congress by more than 3-1.
“The outrageously high cost of prescription drugs in America is a crisis that must be addressed,” he said on the chamber floor earlier this month.
And pharma critics have outnumbered pharma advocates more broadly. This year, lobbying groups spent $13.7 million on TV ads about Medicare price negotiations and PBMs, according to Vivivik CMAG. But only a fraction of the money was spent on ads criticizing the Medicare renegotiation law and PBMs, $1.1 million compared to $12.6 million celebrating the pharmaceutical company’s defeat.
Pro-Biden super PAC Future Forward and the president’s re-election campaign spent the most, dropping a combined $9.1 million on negotiations ads. The coalition group PBM Accountability Project has spent the most on anti-negotiation and anti-PBM ads so far, with $882,000. PhRMA is the second-highest PBM spender at $172,000, according to Vivvik CMAG.
The ultimate success of the campaign, Blendon said, will be measured in how many political candidates run on an anti-PBM platform. If candidates don’t bite, it won’t matter if the ads are handed out “with chocolates.”
“If they pick it up, at least it’s a win for them,” he said. “If they don’t pick it up, the ad campaign is worthless.”
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Image Source : rollcall.com