Hospitals and PBMs spent much of last year on the congressional hot seat and amped up their lobbying budgets playing defense, Victoria reports, based on a review of latest round of federal lobbying disclosures.

Why it matters: Hospitals forestalled site-neutral payment policies while PBMs avoided a bicameral effort aimed at overhauling their business practices and increasing transparency.

• But those proposals remain very much in play for the second session of the 118th Congress.

By the numbers: PCMA, the trade association for PBMs, almost doubled its spending in 2023, to $15.4 million from $8.7 million in 2022.

• A lot of that was concentrated in Q4, when the group doled out $5.3 million. The House in December passed its health cost transparency bill that included new reporting requirements on PBMs, which critics accuse of helping to drive up drug prices.
• The American Hospital Association also boosted its lobbying expenditures last year, laying out $25.2 million — a $3 million increase over 2022.
• The big hospital trade group also concentrated on the year-end legislative push, spending $8.1 million in Q4, the most it's spent in any quarter in the last two years.
• Hospitals have been fending off Medicare site-neutral payment proposals that would pay the same for outpatient services regardless of whether they're delivered in hospital outpatient departments or doctors' offices. A limited version made it into the House-passed transparency package.

While the drug industry went through its share of upheaval, the big trade group PhRMA spent slightly less on lobbying in 2023 — $27.1 million, down from $28.3 million the year before.

• The American Medical Association spent $20.6 million, virtually unchanged from 2022.
• AHIP also spent about the same: $13.1 million, down from $13.3 million in 2022.
• And BIO spent $4 million less on lobbying last year: $9 million, compared with $13.3 million in 2022.

Zoom in: The drug companies behind blockbuster anti-obesity treatments didn't spend significantly more on lobbying last year — even though there was considerable discussion about the Treat and Reduce Obesity Act, which would usher in Medicare coverage of the drugs for weight loss.

• Novo Nordisk, which makes Ozempic and Wegovy, spent $4.2 million in 2023, compared with $4.6 million in 2022.
• Eli Lilly, which makes Mounjaro, spent $7.9 million in 2023, up from $6.8 million in 2022.
• A who's who of interest groups rallied for TROA last year, including Amgen, the National Kidney Foundation, AHIP, the American Gastroenterological Association and Boehringer Ingelheim.

Of note: Both Lilly and Novo also make insulin products. Beyond weight loss drugs, Novo said it was lobbying on "insulin pricing and affordability" while Lilly focused on the "INSULIN Act" and the "Affordable Insulin Now Act."

The intrigue: Two of the other top hospital trade associations that also lobby against site-neutral policies, the Federation of American Hospitals and America's Essential Hospitals, had noteworthy spending patterns.

• Similar to AHA, America's Essential Hospitals also spent more in Q4 of 2023 than in any other quarter of the last two years and wound up devoting a total of $1.8 million to lobbying last year, compared with $1.6 million in 2022.
• The Federation of American Hospitals spent less in 2023 than in 2022: $2.4 million, down from $2.8 million.

Senate HELP Chair Bernie Sanders went before the mics this morning to tout an upcoming subpoena vote for the CEOs of Merck and Johnson & Johnson to testify before his panel about high drug prices, Peter reports.

Driving the news: It's hardly a secret that Sanders is not a fan of the pharmaceutical industry, but here are a few things that caught our eye.

• Asked if he has the votes to agree to the subpoenas, Sanders replied, "You're never totally confident of anything, but yes, I think [they will be agreed to]."
• Asked if he is seeking to pressure the companies to lower their prices without having to pass legislation, Sanders said he has not given up on legislation but noted that "it won't shock anybody here, the pharmaceutical industry is an enormously powerful political force in America."
• "One of the tools that we have is public pressure," he added, citing the pledge make by Eli Lilly's CEO at a HELP hearing last year not to raise the price of insulin.

What to watch for: In a taste of what's to come, Sanders stood in front of posters showing higher drug prices in the U.S. than in other countries, where there often are government cost controls.

The other side: HELP Ranking Member Bill Cassidy previously said the subpoena effort is simply a way to publicly punish CEOs and said he would instead prefer a "bipartisan effort that could result in meaningful legislation."

• Cassidy said that the companies offered to send lower-level officials who more directly oversee prices. Sanders today noted that the CEOs are the ones ultimately responsible, so he wants to hear from them.