Lobbyists for drugmakers, insurance companies, hospital chains and others are trying to protect lucrative businesses threatened by U.S. healthcare reforms.

Following are some of the top concerns of the healthcare industry as Senate and House lawmakers prepare a legislative package:


* Oppose requiring lower prescription drug prices for poor, elderly citizens who qualify for both Medicare and Medicaid programs. In 2006, Congress moved drug coverage for dual-eligible citizens from Medicaid to the new Medicare Part D program on the assumption that it would be able to negotiate better prices. Democratic Rep. Henry Waxman criticized the switch as a windfall for drugmakers and said the government paid $3.7 billion more in 2006-2007 for the top 100 drugs used by dual-eligibles than it would have paid under Medicaid.

* Want 12 years to 14 years of exclusivity for new biologic drugs before cheaper, generic versions are approved by the Food and Drug Administration. The Obama administration has endorsed seven years of protection. Biologics are man-made forms of human proteins that are more complicated to make than more traditional, chemical-based medicines. These often-expensive medicines are used to treat conditions ranging from anemia to cancer and are expected to help drive future profit growth for the drug industry.

* Agreed to $80 billion in prescription drug discounts over the next 10 years, in part by reducing the cost of medicines for elderly Medicare patients who find themselves in the so-called doughnut hole and pay the full costs of drugs for a certain period of time.


* Oppose creating a government-run public insurance plan to compete against private insurers. President Obama, along with many Democrats, backs a public option. Insurers say it could drive them out of business and lead employers to drop coverage for their workers.

* Resist payment cuts for Medicare Advantage health plans for the elderly and disabled offered by some companies. Such plans can offer more benefits than traditional fee-for-service Medicare coverage but cost the government $12 billion more, according to the independent Medicare Payment Advisory Commission (MedPac).


* Opposed the Obama administration's original proposal for $220 billion in payment cuts, but have agreed to $155 billion in cuts over 10 years, in part from reduced Medicare and Medicaid payments. Also oppose reduced payments for long-term care and rehabilitation hospitals, saying that could prevent better care coordination for patients.

* Oppose a public health insurance plan that would pay providers at the same rates as Medicare and Medicaid.

* Want a Medicaid drug rebate expanded to more hospitals as well as in-patient services.

* Want funding assistance expanded for hospitals treating large numbers of undocumented immigrants.


* Oppose paring the use of various medical technologies or related reimbursement rates, especially for imaging tests.