President Biden’s pick to serve as U.S. Health and Human Services (HHS) secretary expressed his support for the recent HHS advisory opinion on contract pharmacy during questions today before a key congressional committee.
California Attorney General Xavier Becerra (D) faced tough questions from Sen. Bill Cassidy (R-La.), a vocal critic of the 340B program. Cassidy asked during a hearing on his nomination today if the terms “contract pharmacy” and “patient” needed to be defined in the 340B statute, and if so, what those definitions should be.
Cassidy told Becerra the question’s purpose was “to let us know the degree to which you’re prepared for this job.” Republican opposition to Becerra serving as HHS secretary has partially focused on the fact that he does not work in health care. Becerra previously served 12 terms in the U.S. House, including on its Ways and Means Committee, and helped write the Affordable Care Act.
Becerra was appearing as a courtesy before the Senate Health, Education, Labor, and Pensions (HELP) Committee. Tomorrow afternoon he will appear before the Senate Finance Committee, which will vote on his nomination.
Cassidy has been deeply engaged with the 340B program for a number of years and usually does not pass up an opportunity to raise his concerns. “You’re a very highly trained attorney,” Cassidy told Becerra. “I’m a physician. What would you as an attorney think if I as a physician were nominated to be United States attorney general? You’d say, ‘The guy’s not qualified. Maybe HHS secretary, maybe not, but certainly not attorney general.’ So you can imagine the kind of concerns I have about your nomination.” Cassidy told Becerra he was seeking “a sense of comfort about the training that you bring.”
“340B is an indispensable program for some of our most underserved communities,” Becerra answered Cassidy. “What we must do is make sure that the law is followed. Your question asks if we should have statutory definition for contract pharmacy or for patient. The first thing we have to do is enforce the laws we have in place.”
“The law currently does not have such statutory definitions,” Cassidy interjected. “So do you think it is important that it have them, and if so, how would you define them?”
“Senator, I’m more than willing to work with you and members of Congress, if I’m so fortunate as to be confirmed, to see if we need to move in that direction,” Becerra said.
Cassidy then said, “I’m asking more than a process question. I’m asking a philosophical or a, ‘Yes, I’m familiar enough with the program to have an opinion about it question.”
Taking another crack at answering, Becerra said, “It was only recently we had an issue arise from the drug makers saying they wanted to change the way [340B] operates. We had the previous administration issue an advisory opinion that said the program should move forward as it is.”
Cassidy next asked Becerra “if we should counter insulin price increases by requiring health plans to pass 100 percent of all rebates to patients.” Cassidy appeared to be referring to the Trump administration’s interim final rule, frozen by the Biden administration, to end drug rebates paid by manufacturers to pharmacy benefit managers and replace them with discounts reflected in the price of the drug at the pharmacy counter.
“I will look into that and I will be more than willing to work with you,” Becerra said. “Right now, I believe we have a proposal that I believe was rushed out that would take sides in this debate, and I think we have to protect the [Medicare] Part D program for our seniors and do it the right way. I’m more than willing to look at this if I’m fortunate to be confirmed and work with you on it.”
Sen. Jerry Moran (R-Kansas) told Becerra he continues to hear of “dire circumstances,” particularly among his state’s community health centers, due to revenue losses stemming “from the 340B issue.”
“If confirmed as secretary, how do you intent to protect the integrity of the 340B program, and make sure that it works for the provider as well as for their patients?”
“The previous administration issued an advisory opinion, and we’ll try to build on the work that’s been done in the past. But what we must not do, is sacrifice patients. They should not be the ones who suffer as a consequence of fights going on here. I will guarantee to you, if I am fortunate enough to be confirmed, I will sit down with you and other who are interested in addressing this issue because, 340B has become an indispensable program for some of these providers who are really helping some of our neediest populations.”
“As you may know, rural hospitals are on the cusp, COVID has not been helpful, they’re always hanging on by a thread, and the 340 program is perhaps one of the most important,” Moran said. “If it disappears in providing resources to hospitals and their patients, we’re going to lose another series of hospitals in Kansas, and I assume in California and across the country.”
“Agreed,” Becerra said.
No HELP Committee Democrats asked Becerra about the 340B program, even though provider groups asked committee members to pose questions advancing providers’ 340B positions. Some in the 340B provider community called it a missed opportunity.
Sen. Bernie Sanders (I-Vt.) asked Becerra what he would do, if confirmed, “to substantially lower the cost of prescription drugs.”
“There is unanimity, bipartisan support, for tackling the high cost of medication,” Becerra said. “That will be one of my priorities, to deal with it swiftly.”
Sanders pressed Becerra for specifics. “Members have been talking about this issue for decades,” Sanders said. “The pharmaceutical industry is enormously powerful. They make huge amounts of campaign contributions. They spend billions on lobbying. They don’t often lose.”
“The price we are paying for some of these prescription drugs is far higher than it should be,” Becerra said. “I took on a number of these drug makers, by trying to go behind the curtain of how they reach their pricing. And we were able to prove that there is collusion, at times going on.”
Democrats can approve Becerra’s nomination in the full Senate with no Republican votes, but only if all members of the Democratic caucus vote for him. Sen. Joe Manchin (D-W.Va.), one of the chamber’s most conservative Democrats, told the conservative publication National Review on Monday he had not yet decided if he will support Becerra’s nomination.
Tomorrow’s Senate Finance Committee hearing could feature more questions for Becerra about 340B. Cassidy, who questioned Becerra today about 340B during the HELP hearing, could pick up where he left off. Other Republicans with questions about 340B could include Sens. Chuck Grassley (Iowa), John Thune (S.D.), and Rob Portman (Ohio). On the Democratic side, Debbie Stabenow (Mich.), Elizabeth Warren (Mass.), or others could ask Becerra about 340B.