By Megan R. Wilson

In today’s issue:

• Health care’s biggest lobbying spenders pulled back overall in the first half of 2026, though more individual organizations increased their advocacy than cut it
• Drugmakers remained the dominant lobbying force, while devicemakers and clinical labs ramped up spending and some big hospitals scaled back
• Exclusive: State finance officials push lawmakers to enact price transparency legislation

Hello, and welcome to Health Brief! I’m off to the Michigan Association of Health Plans conference this week — say hello if you’re going to be there! Send your health policy intel to megan.wilson@washpost.com, or message me securely on Signal at megan.434.

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Lobbyists across the health sector are already pivoting toward a year-end spending package, hoping to attach their policy priorities before Congress adjourns.

The largest health care lobbying spenders spent about 3 percent less overall in the first half of 2026 versus the year before, according to a review of lobbying disclosures updated this week — even as spending diverged sharply across different parts of the industry.

The top 100 health care lobbying spenders doled out nearly $285 million in the first six months of 2026, compared with about $293 million a year earlier. While overall spending among these players decreased in total, a larger number of individual health care companies and groups increased their spending over the previous year, according to my review of lobbying filings.

→ In order to make the cut for the top 100, an organization had to spend approximately $1 million on lobbying from January through June.

The Pharmaceutical Research and Manufacturers of America, or PhRMA, slightly decreased its advocacy spending in the first half of 2026 while maintaining its spot atop the list of health lobbying spenders.

Drugmakers as a whole once again dominated the rankings, with 42 companies and groups in the top 100 health advocacy spenders. Many of the industry’s largest companies — including Amgen, Bristol Myers Squibb and Merck — saw decreases in spending over last year.

But the industry overall was split: Half increased their advocacy spending in 2026, while spending by the other half appeared to dip.

→ Some companies tell me that the fluctuations can sometimes be attributed to a difference in when payments occur. For example, should a drugmaker or insurer pay their trade association dues in June (during the second quarter) in one year and in July (the third quarter) the next, it could easily skew the numbers to look like a decrease in advocacy.

What’s next: PhRMA President and CEO Steve Ubl touted the pharmaceutical industry’s work in pushing regulators and policymakers to rein in the 340B discount drug program, which allows certain hospitals to purchase highly discounted drugs in exchange for taking care of a large number of lower-income patients.

“And let me just say — as a point of pride — that we’re no longer talking about whether the 340B program needs to be reformed; we’re talking about how and when,” Ubl told reporters at the group’s offices Tuesday.

The program, which has grown to about $100 billion in annual discount drug purchases, helps some hospitals stay afloat.

However, it has drawn criticism from drugmakers and some key lawmakers amid concerns that hospitals aren’t passing savings on to patients. Hospitals have pushed back on those claims, saying that the program serves as a lifeline in order to take care of patients.

→ Meanwhile, players in the hospital sector, broadly, decreased their spending so far in 2026. There are 11 hospitals and hospital industry groups in the top 100 health lobbying spenders, and just four of them spent more in the first half of 2026 than they did in the same period the year before.

The American Hospital Association spent more than $10.5 million on lobbying in the first half of 2026, 20 percent less than a year earlier.

Although Congress has ramped up its scrutiny of hospitals — particularly nonprofit ones — the association’s advocacy decreased by 27 percent in the second quarter of this year when compared to the same period of 2025. The association declined to comment on its advocacy spending.

Drew Griffin, chair of the health care practice group at Invariant, tells me that companies are engaging more as lawmakers move to update the laws that set fees paid to the FDA by drug and medical device manufacturers, which support the agency’s programs. Those bills can also serve as a vehicle for provisions to implement FDA reforms.

Companies and groups “are bringing their ideas to policymakers to show how entrenched government regulatory processes can be improved and modernized,” Griffin said. “The focus on bringing medical innovation to patients in faster, safer and more accessible ways has created a moment for innovators to engage with Washington.”

→ The medical device, health tech, and diagnostics companies and groups have overwhelmingly ramped up their lobbying spending this year.

AdvaMed — which represents companies including Siemens Healthineers, ResMed and Abbott — spent about $2 million lobbying in the first half of 2026, a slight increase over what it spent during the first half in 2025.

One of its members, Medtronic — which makes products including insulin pumps, continuous glucose monitors and cardiac pacemakers — increased its lobbying 31 percent in the first half of 2026 compared to the same period a year before.

A spokesperson for AdvaMed tells me that the Trump administration’s work on trade and Medicare payment policies has kept the industry busy, adding that conversations the group has had have been “productive.”

The group has been lobbying for exemptions to tariffs floated by the administration. In April, the industry cheered an initiative to help speed Medicare coverage for medical devices following a successful review by the Food and Drug Administration as a “positive step,” acknowledging there is more work to be done.

→ For the clinical laboratory industry, there’s been a focus on drumming up support for legislation that would bolster Medicare reimbursements.

A spokesperson for the American Clinical Laboratory Association said its top priority is pushing legislation called the RESULTS Act, which supporters say would fix flaws in Medicare’s lab payment system by using more representative pricing data to set reimbursement rates — replacing a methodology they argue has resulted in years of payment cuts.

The group spent nearly $1.6 million on lobbying in the first six months of 2026, a 42 percent increase from the year before. Its advocacy portfolio is wide-ranging, including work on artificial intelligence, telehealth access and addressing prior authorization.

What’s next: Much of the health care ecosystem has pivoted its focus to a potential year-end package — and what they may be able to attach to a larger government spending bill, several lobbyists tell me. This will be the big focus in the coming weeks and months.

State financial officers are pressing key lawmakers to enact price transparency requirements, arguing that plan sponsors often lack the information needed to uncover overpayments and police rising health care costs.

Fifteen treasurers, auditors and a comptroller from both Republican and Democratic-led states sent a letter, which was obtained by Health Brief, on Tuesday to the GOP and Democratic leaders of House and Senate committees with jurisdiction over health issues.

Why it matters: The letter comes as lawmakers on Capitol Hill discuss several bipartisan health care price transparency measures. The signers don’t represent the usual suspects when it comes to health care advocacy. Rather, they oversee state pension funds, Medicaid programs and state employee health plans, giving them influence as both major health care purchasers and investors in public companies.

By framing price transparency as a fiduciary obligation that protects taxpayers, shareholders and public benefit programs, the financial officers are adding another influential constituency behind legislation that’s already drawing interest from both chambers of Congress.

→ The letter stops short of endorsing a specific bill, but lays out several principles the authors say lawmakers should include, including guaranteed access to transaction-level claims data, stronger audit rights and standardized, machine-readable data.

“Novo Sues Rival Lilly Over Alleged False Advertising in Weight-Loss Ads,” Alex Janin reports at the Wall Street Journal.

“Gilead, Merck weekly HIV pill keeps virus suppressed in late-stage trials,” reports Padmanabhan Ananthan at Reuters.

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