Drug ads often seem ubiquitous during regular TV programming. However, one time they definitely are not is during the advertising event of the year: the Super Bowl.

This year’s Super Bowl advertiser roster is a familiar lineup, packed with the usual snack, beer, car, and technology brands, an an occasional public service announcement. Brands in those categories have far fewer regulatory guidelines for ads and more freedom to produce silly, moving, or eye-catching spots, whereas pharma brands are usually much more cautious.

“I don’t think it’s a lack of people or agencies presenting ideas of how to get into the Super Bowl [resulting in a lack of drug ads],” says Kevin McHale, MD and executive creative director at FCB Health’s Neon. “There are a lot of clever pharmaceutical advertisements that have great consumer appeal in recent years in the U.S., so we’re seeing a great evolution of healthcare advertising.”

Despite this progression, the drug industry is still on a different page from the typical Super Bowl ad that aims to entertain as much as promote a product. Airing a drug ad, which lists dangerous and ominous side effects, during the big game doesn’t fit alongside quirky Skittles spots or flashy car commercials.

“There is a seriousness to most of the disease categories out there, even in those big brand categories, that tone may be an issue,” McHale explains. “People want to laugh. They’ve come to expect to laugh, come to expect to see the craziest thing. I don’t think that healthcare necessarily fits into that.”

The high cost of a Super Bowl ad—$5 million for a 30-second spot—is also detering pharma and healthcare organizations from participating, says Erin Byrne, CEO of greyhealth group. And while big pharma does spend an astounding amount on advertising each year, with one media tracking firm estimating it exceeded $6 billion collectively in 2016, many marketers don’t see a Super Bowl ad as the best use of their money.

Pharma brands need to state safety information in advertising for prescription drugs, making the price of an ad even more unthinkable when considering that safety information may take up 30 seconds on its own. That would leave only 20 to 30 seconds of messaging for a $10 million price tag.

“Most pharma products have a very defined audience and a lot of the advertising is targeted to have the best chance of reaching that audience,” Byrne says. “Advertising in the Super Bowl would potentially build awareness among a general audience, but pharma marketers have such a deep passion for doing what’s right for the patients that the wastefulness of [the cost of] a Super Bowl ad could be seen as irresponsible.”

While a surprise appearance is a possibility, no healthcare companies have bought spots, according to lists of Super Bowl XLII ads from Advertising Age, AdWeek, and iSpot.tv. However, pharma companies have tried their luck during the big game. Jublia, a prescription toenail fungus drug, bought a spot in two recent Super Bowls, using NFL legends and animated football imagery to tie its brand to the game.

AstraZeneca’s 2015 opioid-induced constipation disease awareness ad tried to bring out the clever side of a health issue, but promoted backlash for making light of a serious problem.

“You have to be careful when you use humor because, to a person who has illness or disease, it can be very personal,” Byrne says.”People can be very sensitive and a couple angry patients on social media can create a groundswell of support against a product and can have social and PR implications [for the brand].”

Over the past year, one consumer drug brand has made a habit of jumping into sports headlines. Excedrin provided tickets to a New York Mets fan whose train derailed and kept him from making the team’s opening day game last season, and the over-the-counter brand also supported a lighthearted parade for the winless Cleveland Browns last year. Scott Yacovino, Excedrin senior brand manager, explains that sports are an effective way to get the brand into a national conversation.

“We’re not specifically targeting sports; it really comes down to us looking for platforms or opportunities that are a strategic fit for us,” he says. “Particularly for Excedrin, we look for shared cultural moments, headache-inducing moments, where there’s a mass understanding of what a particular topic is, and sports can be a great venue for that.”

Excedrin has never run a Super Bowl ad, but that doesn’t mean it wouldn’t jump at an opportunity if a headache-inducing situation arises on social media or in real life.

“If you’re going to use the Super Bowl, it has to align with what your doing strategically,” Yacovino says. “It makes the brand come across as disingenuous if it’s trying too hard. Ad campaigns need to have a natural, seamless fit.”

This story first appeared on prweek.com.