The China biotech crackdown and lawmakers' continued interest in site-neutral payment reforms helped drive health care interests to shell out millions on lobbying in the second quarter, Victoria reports from the latest federal disclosures.

Why it matters: Drugmakers, hospitals and their allies continue to push for their priorities — or to fight envisioned crackdowns — with an eye toward a possible lame duck health package.

By the numbers: There was an uptick in activity surrounding the Biosecure Act, which could freeze out select Chinese contract manufacturing firms from U.S. markets starting in 2032 and which is being eyed for inclusion in the annual defense authorization bill.

• WuXi AppTec, one of the targeted companies, more than doubled its spending from the first quarter of 2024, to $210,000. An affiliated company also named in the legislation, WuXi Biologics, spent $125,000 in Q2.
• Pharma interests that rely on the companies for testing, raw materials and other services also weighed in on the legislation. Among the big Q2 spenders listing the Biosecure Act as an issue were Amgen ($2.7 million), Biogen ($1.7 million), GlaxoSmithKline ($1.5 million) Takeda Pharmaceuticals ($1.1 million) and Vertex Pharmaceuticals ($980,000).
• The Biotechnology Innovation Organization (BIO), which originally lobbied against the Biosecure Act but then switched its stance, spent $1.8 million in Q2, about the same as in the first quarter of this year.

The American Hospital Association had among the biggest increases in Q2 spending among health interests — likely a reflection of the industry's continued wariness of potential Medicare payment reforms that could change how facilities are compensated for outpatient care.

• AHA spent $9.1 million in Q2 2024, up from $6.4 million in Q2 2023.
• The House's transparency package that passed on the floor last year included some narrow site-neutral measures, but the Senate hasn't taken much action in the policy area.

PhRMA, which consistently tops quarterly spending lists, laid out almost $7 million in Q2, up from $6.3 million a year ago.

• The American Medical Association spent $5.1 million in the second quarter of 2024, compared with $4.8 million in Q2 2023.
• The Pharmaceutical Care Management Association spent $3.6 million in Q2, compared with $3.4 million in Q2 2023.
• AHIP's lobbying dropped off slightly, to $2.4 million from $2.8 million in Q2 2023.

Between the lines: Both drugmakers behind the blockbuster GLP-1 anti-obesity drugs Wegovy and Zepbound increased their spending from a year ago.

• The activity came while the House Ways and Means Committee approved a narrow version of the Treat and Reduce Obesity Act that would reverse a long-standing prohibition on Medicare covering the treatments for weight loss.
• Novo Nordisk spent $1.1 million in the second quarter of 2024, up from $846,000 in the same period in 2023. The company also spent $2.2 million in Q1 2024.
• Eli Lilly spent almost $2.5 million in Q2 2024, up from $1.6 million in Q2 2023. And in Q1 2024 the company spent $1.7 million.

Executives of the three biggest PBMs faced tough questions from both sides of the aisle at a House Oversight Committee hearing today, as scrutiny of the sector's business practices ramps up, Peter reports.

Why it matters: The hearing demonstrated the range of areas lawmakers are looking to address, from steering patients to certain pharmacies to not fully passing discounts on to patients.

What they're saying: Chair James Comer pushed back on efforts from Adam Kautzner of Express Scripts, David Joyner of CVS Caremark and Patrick Conway of OptumRx to blame drug manufacturers for high drug prices.

• "We hear that you're the problem," he said. "There's a credibility issue with the PBMs, there's a transparency issue with the PBMs."
• Ranking Member Jamie Raskin blamed both drug manufacturers and PBMs for high costs.

Raskin pressed the executives on why a patient with insurance would sometimes need to pay more for a drug than if they paid out of pocket.

• Joyner appeared to acknowledge some room for improvement on that front. "I am trying to change and transform the marketplace, which is in large part why we introduced True Cost," he responded, pointing to a CVS program aiming to provide more transparency.
• He said that program would "actually eliminate many of the headlines that you're referencing."
• Raskin expressed some frustration at the complexity of the drug supply chain and the executives' responses. "I feel like the more I hear, the less I understand," he said.

The other side: The executives defended their role as helping keep drug costs down for insurance plans and covered individuals.

• "Last year alone we saved our clients $64 billion, and we kept patient out-of-pocket costs on a per-prescription basis at just $15, despite brand manufacturers raising drug prices on 60% of those products," Kautzner said. "It's hard work to keep those costs down for patients and clients."
• Comer, though, also raised concerns from independent pharmacies, and asked the executives to commit not to steer patients to their own pharmacies.
• "I'm going to take that as an answer [that] you're going to continue to steer patients away from independent pharmacies," he said, expressing dissatisfaction with the responses.

1. Harris' moment: Vice President Kamala Harris is poised to be the Democrats' standard bearer at a time when transformations in health care are establishing a new era of policymaking, Peter and Victoria report with Caitlin Owens.

2. BARDA's mission: Bird flu vaccine development is putting HHS' Biomedical Advanced Research and Development Authority back in the spotlight, PharmaVoice reports.

3. Change lawsuit: Community pharmacists and dozens of providers are suing UnitedHealth Group, saying they're still facing financial disruption from the cyberattack on Change Healthcare, HealthcareDive reports.