It was expected to be a perfunctory statehouse meeting — threelobbyists and a legislator discussing a proposal to educateLouisiana doctors about the price of drugs they prescribe.

The bill seemed like a no-brainer in a country where evendecades-old medicines can cost thousands andconsumers are urged to make smart choices in buying health care. The legislation simplyrequired pharmaceutical sales reps promoting medicinesat doctors’ offices to also reveal a price.

No one expected the industry scrum that materialized.

About 10 pharma lobbyists flooded the room in Baton Rouge’s artdeco state Capitol, some of them hired guns — lobbyists who’d neverrepresented drug companies before, remembers Jeff Drozda, aninsurance lobbyist at the 2016 meeting.

“The message was: We’re going to bring everything at you againstthese bills,” he said.

They did. Pharmaceutical Research and Manufacturers of America,the powerful trade group known as PhRMA, donated directly to morelawmakers in Louisiana than in any other state in 2016, a new IRS filing shows. When discussion of the measure reachedits peak last year, the industry hired a lobbyist for every two legislators.

PhRMA spent thousands entertaining lawmakers at Baton Rougevenues such as Mike Anderson’s Seafood, specializing inshrimp-and-crab gumbo, and the Mestizo Restaurant, home of theDaredevil Margarita, lobbying records show.

“I’ve been in the legislature 10 years. I’ve never in my lifeseen that kind of effort,” said Kirk Talbot, a Republican whosponsored the bill in the Louisiana House.

With federal officials seemingly unwilling or unable to come upwith legislation to control skyrocketing drug prices, that task isincreasingly moving to the states. But so is pharma muscle andmoney opposing the measures, regulatory disclosures and corporatefilings from the last two years show.

State lawmakers are likely to consider drug-price transparencybills this year in Connecticut,Michigan, Oregon, Washington and New Jersey, to name just a few. Many of the measures aresimilar to a new California law that requires drugmakers to justify bigprice increases. (To fight that law, the industry hired 45 lobbying firms.)

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Kaiser Health News is a nonprofit news servicecovering health issues. It is an editorially independent program ofthe Kaiser Family Foundation that is not affiliated with KaiserPermanente.

Meanwhile, activists who backed a 2017 law enabling Maryland officials to challenge“unconscionable” price increases for generic drugs now advocate price regulation for all expensive pharmaceuticals.Policymakers in New Mexico, Massachusetts and Arizona are talking about limiting drug coverage or negotiatingdrug prices under Medicaid.

In Washington, D.C., PhRMA, is widely credited with stalling federal drug-price measures for years, with lobbying,advertising and political contributions.

Now states are getting a dose of the same medicine.

PhRMA set the stage in 2016 by establishing a group thatultimately spent $110 million to defeat a high-profile California ballotinitiative requiring state agencies to pay no more for drugs thandoes the federal Department of Veterans Affairs. A PhRMA-linked group spent more than $50 million to defeat asimilar ballot measure last year in Ohio.

Traditionally well represented in statehouses, PhRMA wrotechecks to hundreds of legislative candidates and political actioncommittees in dozens of states in 2016, newly available IRS filings show. So did many of its membercompanies, according to new data published by the Center for PoliticalAccountability, a nonprofit that works to shed light oncorporate political spending.

Merck, maker of a hepatitis C drug called Zepatier that costs$54,600 according to Truven Health Analytics, gave $19 million toPhRMA in 2016 but also gave about $500,000 to candidates andpolitical committees in some two dozen states, sometimes in checksas small as $100, according to the CPA data, compiled fromvoluntary disclosures on corporate websites.

Amgen, maker of leukemia drug Blincyto, which costs $173,000 foran average treatment, according to the company, donated to morethan 100 statehouse candidates in about a dozen states for the 2016elections. Johnson & Johnson, Pfizer, Bristol-Myers Squibb andAllergan also directly or indirectly supported state candidates in2016, CPA data show.

Pharma companies “definitely have not seen that kind of activityaimed at them at the state level before and have raised theirpresence to address that,” said Leanne Gassaway, top state lobbyistfor America’s Health Insurance Plans, a major insurance tradegroup.

Few states got as much pharma attention the past two years asLouisiana, though the money spent there fell short of the tens ofmillions invested in swaying referenda in California and Ohio. It’scheaper to influence scores of lawmakers than millions ofvoters.

Drug prices are “something that’s completely out of control,”Talbot said, adding that he gets constituent requests to rein inprescription medicine prices.

Neither Talbot, chairman of the House insurance committee, normany others in the conservative state are moving to regulate drugprices. But he and other lawmakers saw promise in an idea from BlueCross and Blue Shield of Louisiana, a big insurer whose premiumshave been driven up partly by rising drug expenses.

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Kaiser Health News is a nonprofit news servicecovering health issues. It is an editorially independent program ofthe Kaiser Family Foundation that is not affiliated with KaiserPermanente.

The proposal, which got little news coverage even in Louisiana,would have required sales reps promoting their latest, greatestmedicines to give doctors the wholesale prices at the same time.Physicians, who are largelyunaware of prescription costs, might think twice about ordering$500 worth of brand-name pills when a $30 generic could deliver thesame benefit, the thinking went.

The measure died in committee after the pharma lobby staged itsflash mob at the 2016 meeting. When the idea came up again lastspring, this time with backing from Talbot and Sen. Fred Mills,Republican chairman of the Senate health committee, the industryshifted into high gear.

Mills got “a tremendous amount of calls” on his cellphone frompharma lobbyists as well as emails and texts almost immediatelyafter his bill landed on a legislative website, he recalled. Firstin line was Pete Martinez, PhRMA’s top Louisiana operative.

“I’ve had this volume” of special-interest pressure “but not thespeed,” said Mills, a small-pharmacy owner from St. Martin Parishwho said he sees the rising price of pills firsthand. Millsrecalled phone calls from “top government affairs people” atPfizer, “telling me the problems with this bill.”

No fewer than 84 lobbyists representing pill companies blanketedBaton Rouge at the height of the legislative session last year,state records show — the most in at least nine years.

In 2016, PhRMA gave directly to about 80 Louisiana statepoliticians, more than those in any other state, the IRS filing shows. PhRMA and individual drug companies havemade more than $600,000 in contributions to Louisiana state andlocal political races in the past three years, according tocampaign finance files.

Martinez did not respond to requests for an interview. Athearings in Louisiana, PhRMA argued that informing doctors ofwholesale drug prices is irrelevant to patients. What matters isconsumers’ out-of-pocket payment, not the rest of the cost that’soften picked up by insurance, they said.

“We are committed to engaging with lawmakers, patients andothers to find solutions that actually help patients,” a PhRMAspokesman said in a statement for this article.

Proponents countered that rising total drug costs are anincreasingly painful burden on taxpayers, employers, workers andeverybody else who pays them indirectly through insurance plans andgovernment programs.

PhRMA’s opposition had an effect.

Instead of making salespeople disclose prices, the legislationthat lawmakerseventually passed and that Gov. John Bel Edwards signed in Junerequires the Louisiana Board of Pharmacy to host a website listingthe information. Rather than ordering drug reps to tell doctorsabout the site, the act says they “may” give prescribers theinternet address if they choose.

The law “is quite watered-down and basically meaningless,” saidAmeet Sarpatwari, an epidemiologist and lawyer at Harvard MedicalSchool who follows pharma laws.

Talbot says he may have lost this battle but will continue thewar.

“I’m going to take another stab at it” this year, he said.“We’re on the front wave of this thing. All the states are jumpingon this bandwagon.”

Kaiser Health News is a nonprofit news servicecovering health issues. It is an editorially independent program ofthe Kaiser Family Foundation that is not affiliated with KaiserPermanente.