What is lobbying, properly understood, in the United States, and what strategies and tactics—including and especially those determined by contextual factors, as well as firm characteristics—are commonly employed by corporate lobbies as they operate in our American political environments? Considering this, what are the main strategies and tactics employed by the pharmaceutical lobby, with a particular focus on the Pharmaceutical Manufacturers and Researchers of America, or PhRMA? Finally, what roles did PhRMA play in the development and passage of the Obama administration’s Affordable Care Act, and what can this tell us about the lobbying strategies and tactics utilized by one of the most effective lobbies in modern times, as well as about how their strategies and tactics align, or not, with conventional conceptions of lobbying? Through effective use of key lobbying tactics such as direct lobbying and use of public awareness, PhRMA completed one of the more successful lobbying campaigns in recent history. When the White House came calling, they were first to the table, for they knew that with that seat came a position of leverage. From there, they were able to build both political and public support to complete a deal with the Obama administration that they positioned as necessary to keep the Affordable Care Act alive. This deal would ensure that the pharmaceutical industry would pay a flat rate of support for the act, and was therefore guaranteed protection from future government attempts to set or regulate the prices of their products and medicines. PhRMA played the long game, and they played it well.

This thesis is concerned with assessing the involvement of the pharmaceutical industry with the United States' health system. We will consider the role that the industry plays in the greater system, and how its activities influence the environment around it. This is done through a case study, in the context of the United States experiencing a so-called "opioid epidemic." This crisis is a serious problem for the health system, and society as a whole, which predominantly involves prescription pharmaceuticals. We will undertake an examination of the pharmaceutical industry's relationship with that crisis through a strong reliance on critical discourse analysis, rooted in systems theory. Despite being a critical component in the American health system, and the one directly responsible for the creation of pharmaceuticals, we will see that the industry is predominantly treated as an ally in addressing the opioid epidemic, rather than complicit in its emergence. This indicates that the industry successfully influences the discourse surrounding its role and responsibilities as a component of the health system. Keywords Pharmaceutical industry, lobbying, healthcare, PhRMA, health system, opioid, prescription drugs