By Chelsea Cirruzzo and Ben Leonard

Drugmakers ramped up their K Street spending this year. | J. Scott Applewhite/AP

DRUGMAKERS DOMINATE TOP LOBBYING SPENDERS — The pharmaceutical industry bolstered its lobbying spending in the first three months of 2024 compared with the same period in 2023, according to newly filed disclosures, POLITICO’s Megan R. Wilson reports.

Crunching the numbers: Megan found that 17 of the 29 pharmaceutical companies and groups that spent $500,000 or more in the first quarter boosted their advocacy dollars this year.

For example, industry group PhRMA’s advocacy spending grew 20 percent in Q1 2024 compared with Q1 2023. Novartis spent 44 percent more on lobbying last quarter than in 2023, surging into the top 10 health lobbying spenders for the first time in years.

Neither would comment about what drove the increases, but disclosures note the industry was working on a number of issues advancing in Congress — including reforming the 340B discount drug program, alleviating supply chain issues and reining in pharmacy benefit managers, which negotiate discounts on drugs and choose which medicines insurance plans will cover.

Momentum behind PBM policy has prompted lobbying boosts over the last several quarters, but it came to a head during negotiations over a pair of March government funding bills when some lawmakers pushed for policies to change how PBMs operate — a major policy goal for drug manufacturers that’s garnered bipartisan support in Congress.

As a result, the Pharmaceutical Care Management Association, which represents PBMs, increased its lobbying spending by 74 percent compared with last year. Negotiations over policy riders, including PBM reforms, ultimately fell apart.

“Congress rightly declined to rush through misguided policies targeting pharmacy benefits,” said Katie Payne, a spokesperson for the group, which argues its members drive medicine costs down.

However, another showdown on Capitol Hill over the policies is likely, so this could be just the beginning.

Here are the top 10 health care lobbying spenders in the first quarter of 2024 versus the same period a year ago.

1. PhRMA: $9.6 million vs. $7.99 million 
2. The American Medical Association: $7.28 million vs. $6.7 million 
3. The American Hospital Association: $6.01 million vs. $5.61 million 
4. PCMA: $4.8 million vs. $2.76 million
5. AARP: $4.37 million vs. 3.85 million 
6. AHIP: $4.21 million vs. $4.74 million
7. Pfizer: $3.55 million vs. $4.6 million
8. Novartis: $3.51 million vs. $2.44 million
9. Genentech: $3.34 million vs. $3.1 million 
10. Amgen: $3.33 million vs. $2.8 million

WELCOME TO WEDNESDAY PULSE. D.C. readers: How were you affected by the Great Foxtrot Closure of 2024? For me, that means finding a new spot for source coffees! Want to grab coffee and talk about health policy with us? Email us at [email protected] and [email protected] and follow along @ChelseaCirruzzo and @_BenLeonard_.

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The Supreme Court will hear arguments today on whether Idaho's abortion ban is constitutional. | Andrew Caballero-Reynolds/AFP via Getty Images

EMERGENCY ABORTIONS BEFORE HIGH COURT — The U.S. Supreme Court justices who overturned Roe said at the time that it wasn’t appropriate for “unelected members of this Court” to “override the democratic process” and set national abortion law.

But that’s exactly what they’re poised to do, again, with a case they’re hearing Wednesday on whether hospitals that take Medicare can turn away pregnant patients who need an emergency abortion, POLITICO’s Alice Miranda Ollstein and Josh Gerstein report.

The arguments will focus on the tension between a Reagan-era federal law mandating emergency treatment, including abortion, and Idaho’s push to enforce its near-total prohibition on the procedure, including in medical emergencies. The Biden administration says the law requires doctors to perform abortions to stabilize patients in crisis.

Idaho officials argue that the Biden administration’s interpretation of the Emergency Medical Treatment and Labor Act, known as EMTALA, undermines the state’s ban and would make it too easy for patients to get a medically unnecessary abortion. The federal government counters that EMTALA’s protections preempt state law and prevent patient dumping by unscrupulous hospitals.

Health and legal experts also warn that a ruling for Idaho could encourage states and individual hospitals around the country to test the bounds of EMTALA for care unrelated to abortion.

“If Idaho was allowed to do what it wants to do, then essentially that is green-lighting states to go after EMTALA for any disfavored population, or treatment or condition,” warned Sara Rosenbaum, the founding chair of the Department of Health Policy at George Washington University, on a call with reporters last week.

“Whether it is barring all but terminal emergency care for people with HIV-AIDS, whether it is barring all but terminal emergency care for people who’ve been in auto accidents on the grounds that somehow having access to an emergency department encourages unsafe driving, the list goes on and on and on,” she added.

BIRD FLU FRAGMENTS IN MILK — The FDA said Tuesday evening that the commercial milk supply is safe after industry groups told lawmakers on Capitol Hill that bird flu virus fragments have been detected in retail milk samples, according to three people familiar with the matter, POLITICO’s Meredith Lee Hill reports.

The FDA confirmed “some of the samples collected have indicated the presence” of bird flu “particles” under certain testing, but the agency maintained that “pasteurization is likely to inactivate the virus.”

The FDA said it would make additional test results available in the coming days.

Trade groups quickly mobilized to reiterate the FDA’s assessment that commercial milk is safe, following a report from The Washington Post on the viral detection.

The National Milk Producers Federation said in a statement that “viral fragments detected after pasteurization are nothing more than evidence that the virus is dead; they have zero impact on human health.”

As of Tuesday, avian flu had been detected in 33 dairy herds across eight states, according to the latest USDA data.

MORE WEGOVY COVERAGE — One in 4 Medicare beneficiaries who are overweight or obese might be eligible for coverage of Wegovy now that it’s approved to reduce heart attack and stroke risk, according to a KFF analysis out today.

The FDA approved Novo Nordisk’s weight-loss drug Wegovy earlier this year to reduce the risk of major cardiovascular deaths in people with heart disease. CMS followed up by announcing in March that Medicare would reimburse older Americans prescribed Wegovy under those conditions.

According to a KFF analysis of 2020 data, 3.6 million people on Medicare could be eligible for coverage of Wegovy. Twenty percent of Medicare beneficiaries, or 10 million people, had cardiovascular disease in 2020, while 27 percent, or 13.7 million people, were obese or overweight.

Despite the huge popularity of weight-loss drugs, Medicare is prohibited by law from covering them solely for obesity.

How it could impact spending: The KFF analysis says Medicare spending impacts depend on how Part D plans add coverage for Wegovy, the extent of prior authorization and the number of people who use the drug.

Beneficiaries could face out-of-pocket costs of $325-$430 a month if they have to pay a percentage of the drug’s $1,300 list price — though the Part D out-of-pocket spending limit would restrict what beneficiaries pay in a year.

HOSPITALS VS. NONCOMPETE RULE — Hospital groups are expected to challenge a Federal Trade Commission rule finalized Tuesday that bans noncompete agreements for all workers, POLITICO’s Erin Schumaker reports.

The rule declares noncompetes an unfair method of competition. Provisions in noncompete agreements bar or restrict workers from quitting and joining rivals, and hospitals have used them widely to prevent their doctors from leaving.

Doctors will benefit from the decision since a large share of them — 45 percent in group practices and likely many more in other areas of medicine — are bound by noncompetes. The rule will allow many of them to leave their jobs for rival organizations without penalty.

Hospital groups, however, call the rule bad policy. House Republicans called it a “power grab” and a “top-down, one-size-fits-all approach that violates basic American principles” in a letter to FTC commissioners last year.

What’s next? The U.S. Chamber of Commerce and other groups are expected to sue, with the Chamber saying it would challenge the FTC’s authority to issue the rule as soon as Wednesday.

Teal Baker has joined the Better Medicare Alliance as chief operating officer. She previously served as executive vice president and chief operating officer at Invariant, a government relations firm.

Reuters reports on how doctors’ skepticism is slowing prescriptions of the Alzheimer’s drug Leqembi.

STAT reports on the health policy issues a second Trump administration wants to put its stamp on.

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