The pharmaceutical industry, which is well known for its well-resourced lobbying campaigns, has a lesser-known tactic for influencing policy: bankrolling ostensibly independent nonprofit organizations to push industry talking points in Washington and across the nation.
One of the strongest examples of this dynamic is found in the National Community Pharmacists Association. The NCPA receives hundreds of thousands of dollars per year from trade associations and corporations within the drug industry. Among its largest supporters are the pharmaceutical giant AmeriSourceBergen and PhRMA, the largest interest group backing the pharmaceutical industry in the United States, each paying the NCPA at least $200,000 per year. The group boasts over a dozen other drug industry corporate sponsors, paying out between $5,000 and $200,000 per year to support the NCPA’s mission.
The NCPA’s mission, according to its website, is to represent the interests of U.S. pharmacists. In service of this goal, the organization advocates increased regulation of pharmacy benefit managers — the middlemen between pharmaceutical manufacturers and retail pharmacies who are responsible for negotiating prices on behalf of insurers. Greater regulatory scrutiny of PBMs has been a longtime goal of the pharmaceutical lobby.
President Donald Trump brought drug prices into focus this week when he vowed to cut medication costs by mandating that pharmaceutical companies sell medication domestically for the lowest price the same drug is sold globally. He made good on his promise Monday by signing an executive order mandating as much, though legal experts say it will be difficult to implement.
“Pharma is also very powerful, and the Democrats have protected Pharma,” the president told reporters Monday.
PhRMA and the NCPA sang similar tunes in responding to the executive order, praising the president’s goal of lowering drug costs while blaming PBMs for inflating prices.
PBMs cut into pharmaceutical companies’ profits by negotiating lower prices. However, some policy analysts and lobbyists argue that much of the savings made by PBMs are retained as revenue rather than passed on to patients, which can lead to increased retail prices.
In service of shaping the policy environment to be more favorable to the pharmaceutical industry, the NCPA provides support to local groups that align with the pharmaceutical industry’s position on PBMs. This includes reposting local op-eds critical of PBMs, partnering with state-level groups to boost their initiatives, and mounting legal efforts alongside aligned local organizations to score wins against drug negotiators. The NCPA has over $100 million in assets, enabling it to deploy immense resources to assist its local partners and expand the drug industry’s influence to state houses across the country.
PBMs “are widely understood to manipulate the health care system — and the truth — to continue obstructing patient access to affordable medications and care, steering patients to their own affiliated pharmacies, deciding how much competing pharmacies will be paid, and more,” an NCPA spokeswoman told the Washington Examiner. “Whether it’s to do with reining in the middlemen or other initiatives that would help independent pharmacies keep their doors open and more easily serve their communities, NCPA is open to partnering with a variety of organizations where our objectives align.”
While some of the local groups the NCPA works with do not receive direct funding from the pharmaceutical industry, many others do. PhRMA pumps hundreds of thousands of dollars into state-level trade groups. Some of the biggest beneficiaries of this patronage have been the Oregon, Washington, and California pharmacists associations, each having received around $150,000 from the District of Columbia-based trade association since 2021.
At the national level, the NCPA coordinates with other Big Pharma-funded groups, notably Pharmacists United for Truth and Transparency and the American Pharmacists Association, to promote PBM regulation. Though independent from one another, the groups frequently promote the others’ campaigns, giving the impression that the reforms they advocate have broader support.
In some cases, the connection between the pharmaceutical industry and the advocacy that it pays for is not clear at first glance.
The NCPA, for instance, ran a “multistate ad campaign targeting PBMs” that encouraged senior citizens to call their congressional offices, according to its annual advocacy report. In this case, the congressional staffers fielding calls from constituents may not have been aware that they were spurred by a Big Pharma-backed messaging campaign. Another example can be found in RetireSafe, a senior advocacy group that brands itself as a “grassroots” organization. Despite the branding, a review of tax documents reveals that the group received roughly one-third of its funding from PhRMA between 2021 and 2023. RetireSafe, like other Big Pharma-funded groups, promotes anti-PBM policy.
The NCPA and RetireSafe did not respond to requests for comment.
The pharmaceutical industry’s influence campaigns extend beyond traditional lobbying and issue messaging. The Washington Examiner reported in February, for instance, that a seemingly small nonprofit organization had managed to get its pro-Big Pharma research cited in large news outlets without those outlets noting its ties to the industry.