Earlier this year, nearly 400 patients' groups signed onto two separate letters criticizing a recent Medicare proposal aimed at bringing down the cost of prescription drugs. Warning that there would be dire consequences for patients if the proposal moves forward, patients' groups including the Partnership to Improve Patient Care and the Quality Cancer Care Alliance urged congressional leaders and the head of the Centers for Medicare and Medical Services to "permanently withdraw" what they viewed as "flawed policy." In doing so, patients' groups had joined bottom-lined focused pharmaceutical companies in their opposition to the plan, a move that appeared to bolster the argument against the proposal.

But a recent Public Citizen report "Patients' Groups and Big Pharma" suggests that the story is more complicated. The report shows that at least three-quarters of the 147 patients' groups who signed on to the letters received funding from the pharmaceutical industry.

Public Citizen combed through websites and documents to determine which patients' organizations had received pharmaceutical dollars. Some groups had websites emblazoned with pharmaceutical sponsors' logos or featured specific companies listed as benefactors in reports, while others were featured in pharmaceutical companies' public disclosures.

"When patients' groups side with the pharmaceutical industry against proposed policy reforms, they lend credibility and a sympathetic voice to industry lobbying efforts," the report says, going on to note that such groups' reliance on industry money "should complicate the view that patients' groups' interest in such policy battles is categorically different from the industry's financial interest."

The patients' groups had warned that discouraging medical professionals from prescribing more costly drugs is a "one-size-fits-all" policy that could force them to prescribe cheaper drugs that are also less effective. Such a policy could even lead to an "abrupt halt" in treatment altogether, they argued. One group also cautioned that the measure would particularly hurt patients with disabilities, who had more diverse treatment needs.

It's not the first time the pharmaceutical industry and patients' groups have worked together fight this Medicare plan. Last month, USA Today reported that the Community Oncology Alliance (a patients' group that signed onto one of the Medicare prescription drug letters) used language nearly identical to talking points disseminated by the Pharmaceutical Research and Manufacturers Association in its public comments on the proposal. The pharmaceutical association is also one of oncology alliance's corporate members.

The Public Citizen report notes that its findings are likely understated, since they are based largely on voluntary disclosures by drug companies and the groups in question. While the Affordable Care Act mandated that drug companies disclose their payments to physicians beginning in 2013, the law did not apply to health advocacy organizations.

The ties between the pharmaceutical industry and patients' groups are well known. After Senator Chuck Grassley, the Iowa Republican, started investigating pharmaceutical companies' links to these organizations in 2009, The New York Times reported that the National Alliance on Mental Illness took in around 75 percent of its donations, or about $23 million, from drug manufacturers from 2006 to 2008, a sum that even the group's executive director admitted was too much.

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Patients' groups rarely talk about high drug prices, a possible consequence of their reliance on industry money. A 2006 study of the issue noted: "Just as gifts (monetary or in kind) may induce feelings of loyalty and indebtedness in physicians which can influence medical decision-making, one may expect patient groups also to be caught between two masters." Smaller organizations that relied heavily on industry donations to help fund their operations were particularly at risk, the study found.

Public Citizen's report comes less than a month after the watchdog group issued a separate report on the matter, which found that members of Congress who criticized the Medicare proposal had received significant contributions from the pharmaceutical industry.