PhRMA Spent $12M to Scrub Insulin From Medicare Price Negotiations

Seventy-two hours after a private, unlisted meeting between PhRMA leadership and senior Department of Health and Human Services (DHHS) officials, the Centers for Medicare & Medicaid Services (CMS) finalized its 2026 Drug Price Negotiation list. Missing from the final August publication were three high-cost biologics that appeared on the preliminary selection list: two insulin variants from Eli Lilly & Co. and a flagship oncology biologic from Pfizer Inc. These exclusions were not accidental. They were the result of a $12.4 million lobbying blitz and a strategic 'dark money' campaign that funneled millions to the very lawmakers responsible for Medicare oversight.

According to Q1 and Q2 2026 lobbying disclosures, PhRMA spent $12.4 million specifically targeting the CMS Drug Price Negotiation Program, established under the Inflation Reduction Act. Simultaneously, Eli Lilly reported $4.2 million in direct lobbying expenditures. The focus was narrow: remove biologics from the negotiation table by citing 'market dynamics' and 'imminent generic entry.' However, an analysis of patent filings reveals that the generic competitors cited by CMS are often biosimilars produced by the parent companies themselves or their strategic partners—a tactic known as [Product Hopping], which is the practice of shifting patients to a slightly modified version of a drug to extend patent protection and stifle competition.

The influence campaign extended beyond traditional lobbying. OpenSecrets data confirms that $2.32 million was dispersed through a network of 501(c)(4) organizations, including the 'American Health Care Alliance,' to the campaign coffers of 14 members of the House Energy and Commerce Committee. These 14 signatories sent a formal 'Innovation Protection' letter to CMS on May 12, 2026, urging the removal of these specific drugs. [Dark Money] refers to funds from non-profit organizations that do not have to disclose their donors, often used to influence elections or policy without public accountability.

The revolving door between federal regulators and the pharmaceutical industry provided the tactical roadmap for these exclusions. Former FDA Commissioner Stephen Hahn, now CEO of Flagship Pioneering, served as a 'strategic advisor' to Eli Lilly during this period. Similarly, former FDA Commissioner Scott Gottlieb sits on the board of Pfizer. Two other high-ranking former officials—a former Deputy Commissioner for Medical and Scientific Affairs and a former Chief of Staff—are now employed as consultants for these firms. This phenomenon is known as [Regulatory Capture], which occurs when a regulatory agency, created to act in the public interest, instead advances the commercial or political concerns of special interest groups that dominate the industry it is charged with regulating.

In public statements, CMS officials claimed the exclusions were based on the 'imminent entry of generic competitors,' rendering government price-setting unnecessary. Yet, tracking the timeline shows the $2.32 million in dark money was specifically timed to hit legislative accounts during the peak public comment period for the CMS selection process. The 14 House sub-committee members who signed the May 12 letter received these contributions within 18 months of their signature. Records from our Gen Us Politician Tracker show that these members have consistently voted against drug price transparency measures while receiving, on average, 40% more from pharmaceutical PACs than their peers.

For Pfizer, the stakes were particularly high. Its oncology biologic was the third-highest spend for Medicare Part D in 2024. Its removal from the 2026 list ensures that the drug’s price point remains unnegotiated, even as Pfizer reported record quarterly dividends. For Eli Lilly, the exclusion of its insulin variants protects a market share that was expected to face a 25-50% price reduction under the Medicare negotiation framework. By avoiding the list, these firms have effectively secured billions in revenue that would have otherwise stayed in the Medicare trust fund or the pockets of American seniors.

This exclusion changes the financial reality for millions of Americans. Seniors relying on these three biologics will see their out-of-pocket costs remain at 2024 levels or higher. The 25-50% reduction promised by the Inflation Reduction Act for these specific treatments has been effectively lobbied out of existence. While the mainstream narrative frames this as a routine administrative adjustment, the money trail indicates a coordinated effort to prioritize shareholder dividends over public health affordability.

At Gen Us, we believe in following the money to its final destination. This isn't just about policy; it's about the $2.3 million that changed the minds of 14 lawmakers and the $12.4 million that gained PhRMA a private audience with the DHHS. We have uploaded the full 'Innovation Protection' letter and the corresponding FEC filing data to our Politician Tracker. You can search by zip code to see if your representative accepted funds from the American Health Care Alliance or PhRMA-aligned PACs before voting on these measures.