An Analysis of Pharmaceutical Lobbying and the Lack of Affordable Prescription Bills

The pharmaceutical industry reported a revenue of approximately $1.7 trillion in 2024, which is comparable to the entire GDP of Spain or South Korea (Statista). The industry is divided into two main divisions, selling pharmaceutical drugs and selling medical devices. The emphasis of this paper will focus on the former. Prescription drugs are engrained into everyday life; the CDC reports that as of this year, somewhere between 68–70% of American adults utilize prescription medications every day. There are currently 15 pharmaceutical companies in the Fortune 500, the 500 most valuable companies in the entire world. Needless to say, business is booming. With continued demand from consumers, often from necessary medications people need daily, the industry can continue to markup drugs well above manufacturing price, a practice preserved by the lobbying efforts of these companies and their subsidiaries.

The issue of lobbying is nowhere close to a new one, with lobbying existing since before the United States was a sovereign nation. The word comes from the lobbies of the British Parliament where the action of influencing legislation occurred (Open Secrets 2025). In 1792, the first recorded lobbyist, William Hull, was hired by Virginian veterans to lobby the brand-new Congress for additional pay (Open Secrets 2025). The practice at this point was very unrestricted and lawless. A man named Sam Ward pioneered "social lobbying" and cemented himself as the proclaimed "King of the Lobby" in 1875 by swooning officials with gifts and expensive dinners (Allamong 2024). It is important to note that he was tried and convicted of bribery for these same actions.

Even so, lobbying has always been a pillar of the legislative process, blurring the lines between the influence of the people and that of private wealth. Post Ward-era lobbying saw a crackdown and the beginning of written laws and restrictions regarding the practice. Congress slammed their fist down on foreign campaign financing, created laws to promote openness in finances, and set the landscape for the most important court case to define lobbying in the United States.

Citizens United vs FEC was sought to answer the question on whether it was within the first amendment right for Citizens United to spend money to create a film to dissuade American voters from supporting Hilary Clinton, a presidential candidate. In a 5-4 ruling, the Supreme Court ruled that restricting the production and promotion of the film was in violation of first amendment rights. But the issues examined in this paper come from the rest of the ruling, where the Supreme Court overturned rules regarding "independent" political spending, which is any political spending that does not directly go to a candidate. This allowed for the formation of Political Action Committees, or PACs, who dominate most of the lobbying that Americans are familiar with today. The judges concluded that "independent" spending did not have the capability to create a corrupt environment due to existing transparency rules and lack of PAC affiliation with established political parties (Weiner 2025). Despite this, in the current state of lobbying, it is not untrue to say that certain PACs are aligned and almost partnered with political parties. As well as existing legal loopholes which allow donors to remain anonymous despite transparency rules. This is essential to establishing the baseline of this paper's hypothesis, that pharmaceutical lobbying is directly responsible for the lack of passage of affordable prescription bills in Congress, despite voter and constituent priorities.

Throughout the 111^th Congress (2009/10) to the 119^th Congress (2024/25), there have been 8,725 bills introduced regarding prescription affordability and/or government price setting for prescription drugs. Out of the 8,725 bills, only 91 were signed into law, creating a passage rate of 1.04%. Compared to the average passage rate of around 4.5%, this means affordable prescription bills have a passage rate of 4 times less another bill would (Emory 2024).

When a certain type of bill is consistently below the average passage rate over a time, it points to bipartisan collaboration to deter these bills from passing. From the 111^th Congress to the 119^th, the House of Representatives majority has been as follows, Democratic (2009/10), Republican (2011/12), Republican (2013/14), Republican (2015/16), Republican (2017/18), Democratic (2019/20), Democratic (2021/2022), Republican (2023/24), and Republican (2025) (United States Congress). This totals 6 years of Republican control and 3 years of Democratic control, respectively. For the Senate, the list is as follows: Democratic (2009/10), Democratic (2011/12), Democratic (2013/14), Republican (2015/16), Republican (2017/18), Republican (2019/20), Democratic (2021/22), Democratic (2023/24) and Republican (2025). This totals to 4 years of Republican majority and 5 years of Democratic majority, respectively. Throughout this data, Republicans held both the House and Senate majority 3 times in 2015/16, 2017/18, and 2025, while Democrats have held majority of both for 2 years in 2009/10 and 2021/2022. This leaves 4 years where the Senate and Congress were split between two parties. Essentially showing that there were bipartisan efforts to ensure affordable prescription bills do not pass. Regarding seats, Republicans have held 50.9% of seats from 2009/10 to 2024/25, with Democrats holding the remaining 49.1%. Practically even representation from both parties and equally even voting regarding affordable prescription bills.

Funding is relatively even between the two parties, with the increase towards Republicans being attributed to the more seats held during this time. Focusing on 2009–2024, the trend follows this pattern, with more funding going to the party holding the majority. The increases in spending are also seeing this same bipartisan trend, with spending increasing at a similar rate for both parties between 2009–2024. Bipartisan support from the pharmaceutical lobbying industry allows for total dominance in bills that potentially hurt revenue streams for these companies.

Under examination of the 2003 Medicare Modernization Act, these trends are evident. Upon proposal of the bill, Congress created Medicare Part D, a Medicare plan designed to help cover the costs of prescription medications (Medicare 2025). Within this proposal was a "non-interference" clause which prevents Medicare from negotiating lower drug prices directly and instead leaves it to private insurers to negotiate lower prices in a "market oriented" approach (United States Senate Committee on Finance). This leaves the negotiations at the hand of the pharmaceutical market, which is dominated by pharmaceutical manufacturers rather than the consumer. This clause was heavily backed by George W. Bush and his administration in 2003. According to the Center for Public Integrity, Bush received over $1 million dollars from various interest groups that protect the interests of these corporations such as the Pharmaceutical Researchers and Manufacturers of America, the current largest pro-pharmaceutical lobbying and interest group in the United States. Regardless of the amount, Bush received the most funding from drug interest groups during his campaign in 2000 (Center for Public Integrity, 2005) out of all the presidential candidates in that election cycle, including $1.7 million for inauguration festivities on top of campaign donations.

A more recent case to examine is the pushback from pharmaceutical manufacturers in response to the Inflation Reduction Act (IRA) of 2022. The act outlines certain changes to the non-interference clause mentioned above. This included the ability for Medicare to negotiate drug prices on certain high-cost drugs. One of these drugs, insulin, will be capped at $35 for Medicare and a $2,000 out of pocket cap for prescriptions for Medicare Part D were also outlined in the act. In response, major firms including Johnson and Johnson, Novartis, and Pharmaceutical Researchers and Manufacturers of America all increased lobbying efforts to propose three bills into Congress. These bills, the ORPHAN Cures Act, MINI Act, and the EPIC Act, all seek to diminish these stipulations put into effect by the IRA by increasing the period allowed to negotiate, limiting which drugs could be negotiated based on the class of ailment they are designed for, and overall decrease the ability for Medicare to negotiate lower prices for target drugs. During this time of lobbying, the three firms mentioned above contributed 149 lobbyists to support and lobby for these bills, another example of the power the pharmaceutical lobbying industry uses to demote the progress toward affordable prescription bills.

Lobbying exists in every industry and is not specific to pharmaceuticals, the issue that lies within this industry is the blatant gap between what voters and constituents want and what is then passed in Congress. Utilizing polling data from KFF, an independent polling service specializing in healthcare, the data provides trends that show that Americans want affordable prescriptions and government price setting in some form. According to KFF, healthcare costs are now the number one financial concern for Americans as of 2024. While the term healthcare is broad and includes many costs other than prescriptions, the basis that up to 70% of American adults use prescription medications every day emphasizes that prescription costs are regular costs for everyday consumers. Alongside of this, 4 out of 10 Americans say that drug affordability influences who they vote for (KFF 2024). 40% of Americans are swayed in their votes due to this issue, and the proposed legislation to combat these worries is blocked due to the influence private money has on affordable prescription legislation. Voters value this issue, and despite what party a person aligns with, there is no progress from either side to fix it. This issue is bipartisan, and it has bipartisan support with 88% of Americans being in favor of some form of government price setting for prescription drugs.

The data shows that the pharmaceutical industry and the accompanying lobby efforts diminish the power and voices of voters, allowing officials elected by these same people to vote against the wishes of those who elected them. This issue can be solved through a series of legislative changes to narrow the power lobbying has in legislation. One proposal is closing the "revolving door". The term refers to the practice in which elected officials transition from office to lobbying and have the connections and access to promote agendas that the regular American cannot compete with. Closing the revolving door can be achieved through a legislative process, involving laws preventing elected officials from immediately transitioning into working for a lobbying firm. This can come as a hold period, where officials must wait a certain amount of time before being hired or contracted by a registered lobbying firm. More radical solutions include a total ban on working in the lobbying industry after serving a term in office, other solutions can include a temporary ban, where the ban length is determined by the length of time an individual served in office.

Alongside closing the revolving door, another proposed solution is capping the amount of money contributed by PACs. Specifics could include a ban on contributions during an active legislation session. This prevents real-time contributions from affecting real-time deliberations and voting, a practice that is currently not outlawed. This would mean that when an affordable prescription bill is being discussed in Congress, any pharmaceutical related companies cannot contribute during this period. Other solutions could include a cap on contribution amounts during an election cycle, where there is a flat limit of the amount that can be contributed during a designated election cycle (presidential or congressional). As opposed to a flat limit, the limit imposed could be linear to the value of the company contributing. A higher value company would only be able to contribute a certain percentage of their yearly revenue in that given year towards lobbying efforts. A combination of the two could allow for more fairness in contributions across all companies and firms and promote a fairer field in an industry dominated by endless wallets.

Regarding transparency, efforts can be taken to present Americans with a clearer picture of the movement of money and lobbying throughout the government. The first step is to eliminate legal loopholes used to obscure the source of contribution money. The first is changing disclosure laws for non-profits. A common loophole used to hide the source donation is through a donor contributing money to a non-profit usually under a 501(c)(4) or a 501(c)(6) to allow non-profits to designate themselves as trade associations or social welfare groups. The money contributed from the donor is then used by the non-profit to contribute on the non-profit's behalf and does not disclose the source of the money the lobbying firm has contributed. The firm Pharmaceutical Manufactures and Researchers of American is an example of a firm that utilizes this practice. By changing laws around financial reporting, these non-profits can be bound by law to disclose the source of the money they are using for their contributions, creating a transparent trail of money from source to politician. A different approach could target the on the ground lobbying done by the lobbyist themselves. A live-reporting bill could propose that lobbying firms must disclose in a certain amount of time that they met with a politician, the issues or specific bills discussed, the amount spent on this issue or bill, and related contributions made to Congressmen regarding the issue or bill. This promotes transparency in a format that doesn't allow for obscurity due to time. Diversifying this approach, stricter definitions of what lobbying is, including a legislatively backed definition, will promote transparency about what groups are lobbying and the issue they lobby for. The current loose definition allows for loopholes for what groups qualify as a lobbying firm, allowing workarounds against the restrictions put in place for transparency in the industry. Allocating more power to government agencies can also achieve the same goal, specifically the Federal Election Commission (FEC). As of now, the FEC cannot criminally charge firms or people and can only provide civil penalties including fines, while the DOJ handles criminal prosecution. Giving an agency such as the FEC the power to criminally prosecute allows experts in the industry to enforce harsher punishments for breaking the law rather than just fining the firms who have the money to pay.

In the format of an official bill, the proposal would be to enact the Pharmacutical Lobbying Transparency Act, which would have five main pillars to begin to enact the proposed changes above. The first is a 48-hour disclosure window for lobbying firms to disclose who they met with, the bills discussed, and the money contributed to this politician. The second would be a 7-year ban on "revolvers" from working for any registered lobbying firms. The third would be a politician transparency article, where all politicians proposing pharmaceutical bills must disclose all contributions from pharma-related firms or individuals. The fourth would be a contribution ban during legislative sessions discussing drug pricing to prevent influence during a congressional session. The fifth and final would be granting the FEC the ability to criminally charge individuals who do not obey lobbying laws and restrictions, to push for harsher punishment. The idea is to even the playing field for regular Americans to leverage their wants against those of corporations. Lobbying has muddled line between politicians acting on behalf of their constituents and acting on the behalf of corporations. The current state of pharmaceutical lobbying is not feasible for Americans who struggle with prescription costs to ever achieve a market where they are charged fairly for the medications that some require to live.

Accountability needs to be held both by the lobbying firms and the corporations they back, and the politicians who have the power to enact favorable legislation for everyday consumers over the priorities of large corporations.

There are critiques of this bill regarding the ability for it to be realistically implemented as it requires strong changes of long-standing precedents. The idea of barring someone from a specific job is one of these. The economic system in which the United States functions upon is at its core, against this principle. Alongside this, the idea of government price setting itself is an un-capitalistic approach for affordability, and some may argue that lower pricing can come from competition. While this is true for some markets, the pharmaceutical industry is unique in the severity of patent protection for intellectual property and drugs themselves. This makes it extremely hard for competitors to produce similar drugs on the market without facing patent issues. Humira for example, was a first in its class drug for treating everyday hinderances caused by a panel of autoimmune diseases that served as a breakthrough for treatment options. Due to severe patent protection, there was no suitable drug on the market that was even close to the effectiveness of Humira, which allowed AbbVie, the manufacturer, to ramp up prices until a competitor joined the market. The current model of competition to lower prices for consumers just is not applicable in this industry.

Regardless, the pharmaceutical lobbying industry has the money to influence policy changes in the United States that actively oppose the wishes of constituents. The long history of lobbying rooted in bribery scandals has allowed for loopholes for firms to avoid the current restrictions in place to promote transparency through relaxed legislation. Proposed reforms for this issue include transparency changes, expansion of FEC power, and financial restrictions to counter the power large corporations have to empower constituent voices regarding affordable prescription bills, a necessity for 88% of American voters (KFF 2024). The importance of the change impacts a broader landscape of American politics, and the data collected shows the blatant correlation between politicians siding with corporations over individuals.