A smarmy executive is all over Washington these days, which is really nothing 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 a pharmacy, gleefully plucking a prescription out of a woman’s hands.
There he is in a doctor’s exam room, lollipop tucked in cheek, keeping another patient from using her local pharmacist.
There he is, interrupting your morning newsletters. Blocking your daily Wordle.
The campaign is focused in D.C. and a number of undisclosed states across the country. With the ads, the Pharmaceutical Research and Manufacturers Association, or PhRMA, has succeeded in taking a very wonky policy debate mainstream — at least somewhat.
The ads, which have appeared in Roll Call as well as other publications, center on pharmacy benefit managers, or PBMs, that manage prescription drug benefits for health insurance plans. Most of the major PBMs are now integrated into the companies that own large pharmacy chains or insurance companies.
Drugmakers are currently warring with PBMs over legislation that would crack down on strategies that PBMs say help keep insurance premiums low.
Lawmakers on both sides of the aisle in the House and Senate are currently pushing for more restrictions on PBMs, while the Trump administration previously tried to rein in their tactics.
Those tactics include negotiating rebates from drugmakers that are typically calculated as a percentage of the drug’s list price. Critics say that practice encourages drugmakers to set higher prices.
Those discounts are usually not passed directly to patients who use the drugs. But PBMs argue the rebates allow health plans to offer lower premiums, and spending analyses show that plans would raise premiums — and therefore government spending — if they lose rebate revenue.
PBMs also offer patients better access to drugs with better rebates, which they say helps strengthen their leverage with drugmakers. But the strategy can also limit patients to certain drugs or pharmacies that PBMs have better relationships with, or in some cases, restrict patients to mail-order pharmacies. It can also prompt health plans to offer less coverage for drugs with cheaper list prices if they get a better deal on the more expensive version.
These are the complex issues that PhRMA is attempting to convey by having an actor with a lollipop snatch away prescriptions.
Robert Blendon, a health policy professor and political analyst at Harvard University, said the ads aren’t aimed at the general public, since most people outside of the health care industry don’t know what a PBM is.
The aim instead is to give political operatives opposed to Medicare drug price negotiation, mostly Republicans, an alternative pitch to voters on lowering drug prices.
“When there’s a popular issue and one party has a redress for it, the strategy is not to ignore the issue,” he said. “It’s to come up with an alternative.”
PhRMA is a large, well-funded operation that easily outspends its PBM rival, the Pharmaceutical Care Management Association. The group has spent roughly $20.7 million on lobbying so far this year, compared to $10.1 million spent by PCMA.
“We think it’s important to have a fact-based conversation,” PhRMA spokesperson Sarah Ryan said. “We are going to do what it takes, including reaching everyone we can, to make sure we are diagnosing the right problems and solutions.”
PCMA launched its own seven-figure TV and digital ad campaign in May, the same month as PhRMA’s campaign. The group mostly stuck to the traditional lobbying playbook, urging consumers to tell Congress to “reject the big pharma smokescreen” and “protect our pharmacy benefits.”
“Big Pharma’s blame game is designed to help them avoid accountability for their egregious anti-competitive patent abuse practices that keep prescription drug prices high and to increase their own profits by undermining the critical role pharmacy benefit companies play securing savings for patients and health plan sponsors, like employers and unions,” PCMA Senior Vice President of Public Affairs Katie Payne said in a statement.
Geoffrey Pereira, an analyst with marketing intelligence firm Vivvix CMAG, said PhRMA’s campaign marked a shift away from the battle over a 2022 law requiring Medicare to negotiate prices for some expensive drugs. PhRMA and its member companies are now challenging the law in the courts instead.
“PhRMA has conceded the messaging war — a good sign that they may believe they’ve lost public support in their battle against the [Inflation Reduction Act],” he wrote in July. “Whether [President Joe] Biden can ride this issue to victory in 2024 still remains to be seen.”
Ryan dismissed the characterization, noting PhRMA has run ads about PBMs for more than six years. Lobbyists are also still pushing for specific changes in the language with lawmakers, such as undoing the law’s differential treatment of traditional drugs and newer biologics.
“This isn’t 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 pretty far removed from the politics of the gig. And Peter Flihan, the man behind the ubiquitous PBM exec, just seems happy to be here.
In fact, he’s happy to be just about everywhere. With two decades of acting under his belt, Flihan has appeared in a wide range of voice-over spots, commercials, TV shows and indie projects. (Flihan, who is under contract with PhRMA, did not respond to a request for an interview.)
Here he is cheerfully struggling with his medications for Amazon PillPack, and slinging pizzas for Osteo Bi-Flex. He happily skewers his pharma ties in a car insurance ad, and yells at a tree in a spot for a leaf vacuum.
He’s even brushed shoulders with Tom Selleck on the CBS cop drama “Blue Bloods” and landed a few lines in the other CBS cop drama, “East New York.” And he once palled around with Sam Smith in a tuxedo in his music video for “Like I Can.”
In real life, Flihan’s entire brand appears to be the opposite of the smirking PBM exec. He seems very … nice.
He shows up to gigs early. He gives tips to fellow actors auditioning for the same roles, in the spirit of “moving the energy,” according to an interview on a fellow actor’s YouTube show.
“It’s yours to give back out,” he said, “and it comes back to you tenfold.”
He’s a longtime volunteer firefighter who posts on Instagram when he saves cats from trees. He’s the house on the block that gives out full-size candy bars — the good ones — to trick-or-treaters.
According to his résumé, he has a black belt in taekwondo, an open-water diving certificate and his own lederhosen. And, according to his Instagram, he’s now a certified clown.
Not winning over critics
But while bipartisan groups of lawmakers have PBMs in their crosshairs, PhRMA’s campaign is not winning over any drug industry critics.
Senate Health, Education, Labor and Pensions Chairman Bernie Sanders, I-Vt., a longtime pharma foe, routinely cites a statistic that pharma lobbyists outnumber members of Congress by more than 3-1.
“The outrageously high cost of prescription drugs in America is a crisis situation that must be addressed,” he said on the chamber floor earlier this month.
And pharma critics have outspent pharma advocates on a broader scale. This year, lobby groups have spent $13.7 million on TV ads about Medicare price negotiation and PBMs, according to Vivvix CMAG. But only a fraction of the money was spent on ads critical of the Medicare negotiation law and PBMs: $1.1 million compared with $12.6 million celebrating pharma’s defeat.
Pro-Biden super PAC Future Forward and the president’s reelection campaign have spent the most, dropping a combined $9.1 million on pro-negotiation ads. Coalition group PBM Accountability Project has spent the most on anti-negotiation and anti-PBM ads to date, at $882,000. PhRMA is the second top PBM critic at $172,000, according to Vivvix CMAG.
The campaign’s ultimate success, Blendon said, will be measured in how many political candidates run on an anti-PBM platform. If the candidates don’t bite, it won’t matter if the ads are handed out “with chocolate bars.”
“If they pick it up, it’s a win for them at least,” he said. “If they don’t pick it up, the ad campaign isn’t worth anything.”