The twofold focus of this blog is on recognizing the strength of your individual voice and broadly increasing pharmacist engagement with grassroots advocacy. We firmly believe that the most significant change occurs when more individuals are involved and politically active. Through grassroots advocacy, we ensure our elected leaders know our perspectives on important healthcare issues and that these constituent opinions can influence their votes. However, we recognize that the average pharmacist may not be involved with grassroots advocacy efforts. This leaves us to question: If the views of constituent pharmacists are not being shared with elected leaders, how are elected leaders making informed decisions on pharmacy and healthcare issues? This comes back to the people and organizations whose job it is to advocate on your behalf or against it. In an effort to help explain the importance of grassroots advocacy, pharmacists need to understand the role and power of political action committees (PACs) and lobbyists.
Political Action Committees & Lobbying Expenditures
PACs have gotten a lot of press over the past several years as more of the public have become aware of their influence over the policies of elected leaders. However, this narrow understanding does not encompass the true purpose of PACs. PACs are simply organizations that are formed in order to make donations for the purpose of supporting or defeating political candidates. They are frequently made by businesses or organizations to support candidates that align with their interests. Many state and national pharmacy associations have PACs, as do many of the businesses that we work for. Information on PAC donations is often available through annual reports of associations or through the Center for Responsive Politics. We have summarized PAC donations data and lobbying expenditures for the associations that are members of the Joint Commission of Pharmacy Practitioners (JCPP) below.
The amount of money spent on lobbyists is another important marker for the political engagement of an organization or business. Lobbying expenditures are frequently spent on the salaries of lobbyists. Within our national pharmacy associations, some may only make minimal contributions to candidates through PACs but may spend hundreds of thousands to millions on lobbying expenditures.
Pharmacy Benefit Managers
We frequently see on social media the posts of frustrated pharmacists who are disappointed that more legislative and regulatory action is not being taken to further oversee the business practices of PBMs. The sentiment of many of these posts is, the evidence is out there, so why is action not being taken? This reminds us similarly to the tobacco industry, which, despite evidence being available for years showcasing the harms of tobacco products, Congress was slow to regulate. This may have been because of the lobbying efforts of the tobacco industry, which successfully persuaded elected leaders not to install drastic regulations over the industry. Similarly, despite there being evidence showcasing patient harm due to PBM business practices, Congress has been slow to react.
You may be thinking, Well, pharmacy associations fund hundreds of thousands in PAC donations and spend millions on lobbyists so we can fight against the PBM efforts. Unfortunately, by looking at the numbers, you will see that the pharmacy associations are not even in the same ballpark as PBMs. We pulled data from the top three PBMs (Caremark/CVS Health, Express Scripts, OptumRx/UnitedHealth Group) and the Pharmaceutical Care Management Association, which are represented in the PBM column of the below graph, and compared it to the sum of all national pharmacy associations in JCPP.
The Defense for Grassroots Advocacy
As you can see from this graph, the national pharmacy associations advocating on behalf of the profession do not have comparable resources as the PBM industry when it comes to PAC donations and lobbyists. You naturally could come to two conclusions from this fact: either 1) resign to the fact that we cannot impact these issues and stop complaining on social media; or 2) realize that we can make a difference, but we must take action rather than assume action will be taken on our behalf.
If the latter resonates with you, as it does with us, then there are a few ways we can help to overcome the influence gap created by the larger wallets of the PBM industry. An easy way to overcome this is by joining pharmacy associations that are politically active and donating to their PACs. Of course, prior to donating, we recommend reviewing the most recent annual report of the organization to ensure you are aware of how PAC donations are utilized. Other than trying to close the gap with money, the best way to fill the influence gap is through grassroots advocacy.
The Congressional Management Foundation has found through research that the most effective form of political influence comes from personal constituent meetings and/or correspondence. Through their research they found that this is more effective than visits from lobbyists. If we cannot compete on the same playing field with cash, we need to use what has been proven to be more effective: our individual voices. Through grassroots advocacy, we can overcome this influence gap, and overcome the confusing and often shady fundraising of PAC donations and lobbying expenditures.