Some top Medicare beneficiaries spend heavily to lobby

Corrections and clarifications: An earlier version of the report should have said that the Medicare Payment Advisory Commission discussed, but did not formally recommend, changing Medicare policy on drug reimbursements to the "effective-but-cheaper" rate.

WASHINGTON — The 10 drug companies that make the most money from doctors using their products on Medicare patients spent more than $236 million to lobby Congress and the executive branch between 2009 and 2013, according to lobbying records compiled by the Center for Responsive Politics and new federal data.

Those efforts came as lawmakers crafted the sweeping Affordable Care Act and as federal regulators have sought new ways to contain costs in Medicare, the federal insurance program for seniors.

The biggest recipient: Health-care company Roche and its subsidiary Genentech, which together took in at least $1.65 billion — nearly 28% of what Medicare paid in 2012 for medications and vaccines administered by doctors or other health professionals under Medicare Part B, a USA TODAY analysis shows.

Roche's divisions and Genentech spent nearly $30 million on federal lobbying efforts over the five-year period, according to federal data compiled by the non-partisan Center for Responsive Politics. Genentech has drawn public attention over Lucentis, the company's medication used to treat age-related macular degeneration and other diseases of the retina.

Medicare paid more than $956 million in 2012 to Genentech for Lucentis, more than any other drug — even as many retina specialists, backed by a two-year federal study — say that Avastin, another drug produced by the company approved to treat cancer, is as effective as Lucentis at treating the eye disorder. The disease is a leading cause of blindness in people older than 60.

Lucentis costs nearly $2,000 per injection; Avastin, about $50.

Roche, a big manufacturer of cancer drugs, and its subsidiaries have lobbied on a wide array of issues during the period examined, ranging from an unsuccessful measure introduced last year to shield Medicare reimbursements for cancer drugs from across-the-board budget cuts to federal regulators' discussions on Lucentis and Avastin and the 2010 health care law, records show.

The company's lobbying efforts "involve discussions with policymakers to encourage and support scientific innovation in the United States, including domestic R&D and domestic manufacturing," Genentech spokeswoman Charlotte Arnold said in an email."We also work to ensure patients who need our medicines have access to them."

Amgen, the world's largest biotechnology company by revenue, had the biggest lobbying bill during the period examined. It spent more than $51 million, the center's data show. It also was one of the top three recipients of drug reimbursements from Medicare Part B, receiving at least $816 million, according to the USA TODAY tally.

Last year, the Senate delayed price restraints on Medicare drugs used by patients going through kidney dialysis, including Amgen's Sensipar, after Congress changed dialysis to a bundled-payment system for dialysis — rather than a fee-for-service system for each procedure and medication involved in dialysis. That change was made in the January 2013 fiscal cliff deal.

Drug companies, such as Amgen, also have lobbied about changes in the Affordable Care Act that allow potentially less expensive biological medications to come onto the market as "biosimilars" — or interchangeable to existing medications if data show the product is highly similar to an already-approved biological medication.

This is key as many of the medications injected by physicians and covered by Medicare Part B came off patent in 2013, such as Amgen's Neupogen, or are coming off soon. Once a drug's parent expires, cheaper, generic versions of the drug can be sold.

Amgen officials say they are a proponent of biosimilars and that they are, in fact, developing a few of their own to better compete as drugs come off-patent.

"As a developer of both originator biologics and biosimilars, Amgen supports the ability of prescribers and payers to make appropriate decisions to substitute lower cost therapies, including biosimilars,," the company said in a statement.

USA TODAY used newly released data from Medicare to determine which drugs administered by medical professionals received the highest reimbursements. Payments for vaccines and injectable drugs accounted for more than $6 billion of the $77 billion paid to medical professionals in 2012.

The lobbying figures include spending by firms' parent companies on a wide range of issues. Companies aren't required to disclose precisely how much of their lobbying spending is devoted to a particular bill or single issue, such as Medicare reimbursements.

Overall, the pharmaceutical industry consistently is among the biggest forces in lobbying, racking up more than $225 million in bills last year to influence policy on Capitol Hill and at federal agencies, the center's data show. The industry's spending hit a high of $274 million in 2009 as Congress debated the Affordable Care Act.

Federal regulators have tried to rein in drug costs over the years.

From 1995 to 2005, for drugs that treat the same condition and produce the same outcome, the Medicare payment rate was based on the least costly drug. A beneficiary challenged the policy, saying it should be based on an average cost as stated in Medicare guidelines. The courts agreed.

Since then, the Medicare Payment Advisory Commission, which advises Congress on Medicare and Medicaid payment issues, discussed recommending that Congress craft a law to change the policy back to the effective-but-cheaper rate. The commission, known as MedPAC, did not make a formal recommendation. d.

Had the policy been implemented in one Part B drug class between April 2010 and December 2012, taxpayers would have saved as much as $122 million, MedPAC analysts found.

Genentech has emerged as the biggest recipient of Medicare Part B drug payments because Lucentis is used so widely — more than 3 million times on roughly 140,000 Medicare Part B patients in 2012, the data show. Ophthalmologists administered Avastin nearly 600,000 times.

The money adds up. A 2011 federal audit concluded that Medicare and its beneficiaries would have saved about $1.1 billion had Avastin been used for all macular degeneration treatments over the two-year period examined.

Genentech does not support the use of Avastin beyond its FDA approved use as a cancer drug, Arnold said.

"Lucentis and Avastin were designed for different purposes and may have different safety profiles when used in the eye," she said. "Patient safety is our primary concern."

Some top Medicare beneficiaries spend very little on lobbying.

Regeneron, a New York company that won FDA approval in late 2011 for its drug Eylea used to treat macular degeneration and another eye disease, first hired a lobbying firm in 2012, It has spent $230,000 during the period examined.

Total revenue has soared from $446 million in 2011 to $2.1 billion last year. "The modest lobbying presence is a reflection of the fact that we've been a very small company," spokesman Peter Dworkin said. "Now that we are larger ... it's important to have some presence in Washington."