The escalating price of prescription drugs has sparked a crisis of affordability for American patients. As pressure grew on Washington to lower drug prices, brand name drugmakers ratcheted up a blame game campaign targeting others in the drug supply chain in an effort to deflect attention and scrutiny. At the end of January 2019, the U.S. Department of Health and Human Services (HHS) announced a proposed regulation called the Rebate Rule that represented the culmination of the pharmaceutical industry’s strategy. The rule, considered a top priority for Secretary Alex Azar, took aim at little understood entities called pharmacy benefit managers (PBMs) that work to bring down health care costs by negotiating with drugmakers for lower prices through concessions called rebates. Part of the challenge in defeating the Rebate Rule was going up against the unlimited resources of the pharmaceutical industry and its extensive network of astroturf surrogate organizations. To successfully define the Rebate Rule as politically toxic, our campaign had to have a stronger, more incisive and more compelling message than the drug industry, had to win the battle to control the conversation around the proposed rule in the press and had to make our tactics count with highly targeted, effective deliverables.


To defeat the Rebate Rule, PLUS designed and executed a sustained, comprehensive campaign – research, grassroots advocacy, online engagement, and earned and paid media – that positioned CSRxP as the leading voice in opposition to the Rebate Rule. Our campaign sought to define the proposed rule as a win for Big Pharma paid for on the backs of seniors and taxpayers. PLUS quickly mobilized to conduct rigorous reporter education, create opportunities and capitalize on every opening to generate earned media in key targets’ home states, Washington, D.C. and in health care outlets. PLUS also worked to get lawmakers to question and oppose the rule – both in private conversations with conference leaders and the administration, and on-the-record in the public domain. To do this, CSRxP’s grassroots teams in 17 states targeted 23 members of Congress and focused on recruiting surrogates and third-party voices who would hold the most credibility with target members. PLUS also launched a national digital advertising campaign against the Rebate Rule, “declaring it would amount to a ‘Big Pharma Bailout’ and seizing ‘upon the administration’s own admission that the proposal could raise Medicare premiums.’”


Less than six months after its introduction, the administration withdrew the Rebate Rule – citing the key messages from our campaign in their decision. In less than five months, PLUS secured 145 earned media hits, engaged more than 160 third-party voices, secured 79 target meetings, intercepts and events, generated nearly 9,600 constituent-to-member contacts and notched 32 million digital advertising impressions. In May 2020, PLUS and CSRxP were recognized with a Gold SABRE Award for “Best in Associations” for the Rebate Rule campaign.

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