2021 could be the runner up to 2018 in terms of 340B lobbying intensity, as measured by citations on lobbying disclosure forms.

340B Lobbying Intensifies on Capitol Hill and in Federal Agencies

2021 is on track to rival peak year 2018 in lobbying intensity on the 340B drug pricing program.

Attention on health care lobbying in Washington today focuses on the huge sums the drug industry is spending fighting Democratic drug price negotiation and related proposals. But off the radar, drug companies and their trade groups, health systems and their associations, insurance companies, drug distributors, group purchasing organizations, and others increasingly are lobbying about 340B.

According to the U.S. House’s lobbying disclosure database, 340B has been cited 740 times in lobbying disclosure forms through the first three quarters of 2021. The forms cover lobbying directed at the House and Senate, the executive branch, and federal agencies. If 340B continues to be mentioned in disclosure forms at the same pace as it has so far this year, the program will have been cited close to a thousand times by the year’s end.

That would make 2021 the runner up to 2018 in terms of 340B lobbying intensity, as measured by citations on lobbying disclosure forms. In 2018, 340B was cited 1,229 times on lobbying disclosure forms. 2018 was the first year of the ongoing major cut in hospitals’ Medicare Part B reimbursement for 340B purchased drugs. It also was the year that congressional Republicans made their strongest push to date to make major changes to 340B supported by the pharmaceutical industry.

Last year, 340B was cited on lobbying disclosure forms 919 times. 2020 and 2021 have been two of the most pivotal years in 340B’s history, marked by the existential fight over 340B contract pharmacy.

Citations of 340B on lobbying disclosure forms have risen since 2009, when 340B was mentioned on just one form, according to the House database (the form was filed by White House Consulting, Inc. lobbying on behalf of 340B third party administrator SunRx). This is the number of 340B citations per year since then:

YearNumber of 340B Citations
2021 (through 3Q)740

During the third quarter of 2021 (July 1 through Sept. 30, the most recent calendar quarter for which data are available), 241 disclosure forms were filed that cited 340B as a subject of lobbying.

It is impossible to tell from these lobbying disclosure reports how much money an organization or individual spent lobbying on a discrete issue such as 340B. For example, a report filed by an organization disclosing lobbying on its own behalf will state a grand total spent on all lobbying activities for the period. Although the forms list specific lobbying issues, they do not break down lobbying expenses by issue.

Drug Industry Lobbying

Pharmaceutical Research and Manufacturers of America (PhRMA) reported spending $7.44 million during 3Q 2021 on all lobbying on all subjects on its own behalf, including on “340B drug discount program policy issues” and 340B-related provisions in several bills before Congress.

(Note: PhRMA did not spend $7.44 million during the third quarter lobbying on 340B issues. 340B issues made up an undisclosed fraction of the association’s lobbying expenditures. The same is true for the other examples below.)

Biotechnology Innovation Organization (BIO) reported spending $3.36 million on lobbying during 3Q 2021, including on 340B implementation and oversight and on legislation pertaining to 340B.

Seven of the eight drug manufacturers that deny or impose conditions on 340B pricing when covered entities use contract pharmacies disclosed lobbying about 340B issues during 3Q 2021: AstraZeneca ($1.02 million in total lobbying expenses), Boehringer Ingelheim ($1.05 million), Lilly ($1.32 million), Merck ($1.7 million), Novartis ($1.27 million), Novo Nordisk ($470,000), and Sanofi ($1.3 million). United Therapeutics was the only one of the eight that did not disclose lobbying expenses that encompassed 340B.

Other drug manufacturers that disclosed 340B as a specific lobbying issue during 3Q 2021 include Amgen, Baxter, Biogen, BMS, EMD Serono, Exelixis, Gilead, Genentech, GlaxoSmithKline, Horizon Therapeutics, Johnson & Johnson, and Takeda.

According to Nicholas Florko of the health care news publication STAT, “Horizon Therapeutics, which markets a handful of rare disease drugs here in the U.S.,” spent “a whopping $3.49 million on lobbying over the last three months. That’s nearly $1 million dollars more than any other pharmaceutical company spent this quarter.”

Hospital Sector Lobbying

The American Hospital Association spent $4.47 million on lobbying during 3Q 2021, including on 340B-related matters. Other hospital associations that disclosed lobbying on 340B include the Association of American Medical Colleges ($1.06 million in total lobbying expenses), Children’s Hospital Association ($790,000), American Society of Health-System Pharmacists ($530,000), America’s Essential Hospitals ($310,000), and 340B Health ($293,586).

Major health systems and state hospital associations that disclosed lobbying on 340B during the last quarter include Ascension Health, Atrium Health, Catholic Health Association, California Hospital Association, Greater New York Hospital Association, Healthcare Association of New York State, Iowa Hospital Association, Missouri Hospital Association, Nebraska Hospital Association, Hospital & Health System Association of Pennsylvania, Trinity Health, West Virginia Hospital Association, and Wisconsin Hospital Association.

Other Stakeholder Lobbying

Other major institutions with a stake in 340B that disclosed lobbying on the program during the third quarter include Cigna, McKesson and its affiliate U.S. Oncology, National Community Pharmacists Association, National Rural Health Association, and Vizient.

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