With just weeks to go in its legislative session, Missouri lawmakers are making progress on two different 340B anti-discrimination bills. Last week, a key Senate committee approved SB 26, comprehensive legislation with two key priorities: prohibiting drug manufacturers from placing restrictions on 340B pricing in the contract pharmacy setting and prohibiting pharmacy benefit managers from alleged discriminatory reimbursement practices.
SB 26, introduced by Missouri state Senator Justin Brown (R), was approved by the Senate Banking and Insurance Committee on April 12th. Brown’s bill is modeled on the first-of-its kind law passed in Arkansas in 2021. The Arkansas law is currently being challenged by the drug industry trade group Pharmaceutical Research and Manufacturers of America in federal appeals court in St. Louis.
Meanwhile, a slimmed down bill–HB 442–which passed the House on March 23, received a hearing yesterday in the Senate General Laws Committee. The bill, which was introduced by Rep. Dale Wright (R), seeks to protect health care entities from a lower reimbursement rate due to their 340B status. HB 442 has not yet been voted on in the Senate.
If a 340B provider can’t retain and reinvest the savings from the drug discount program, its services may be limited, Missouri 340B provider advocates argue. Katie Reichard, director of government affairs for the Missouri Primary Care Association, said the 340B program and the savings it creates enables qualifying facilities to provide care and drugs that they otherwise may not be able to offer. She said this keeps many patients — especially those who are chronically ill — healthier and less reliant on emergency rooms.
She said HB 442 would prevent PBMs from “pickpocketing” cost savings from 340B health centers.
Missouri Hospital Association General Counsel and Senior Vice President of Government Relations Jane Drummond said that it’s hard to predict whether the more comprehensive Senate bill will make to the finish line.
Drummond said MHA and its members have invested significant time educating legislators about the Senate bill during this session and, while 340B is a complex topic, she believes these efforts have made lawmakers aware of the importance of the program. She says insurance companies and drug manufacturers are lobbying against the bill.
“Without the program, many hospitals — especially in rural communities — would be required to make hard decisions about service lines, and programs that support low-income patients and the vulnerable,” she said.
Ultimately, Drummond said the protections under either bill would improve the landscape for 340B providers as they deal with payers and pharmacy benefit managers. Missouri is in its final month of its general assembly and while Drummond remains hopeful the protections pass in 2023, she says MHA will remain steadfast in the mission regardless.
“Diverting these discounts would have a material effect on hospitals’ ability to improve care and improve health in the communities they serve. If insurers and pharmaceutical manufacturers don’t share that goal, then they have lost sight of the program’s design — to serve patients, not the bottom line,” Drummond said.