Partisan control of Congress for the final two years of President Biden’s term in office was still undecided this morning, two days after Tuesday’s midterm elections.
Major national news organizations say Republicans are favored to take control of the House, although not by the large margin that some anticipated. Control of the Senate could come down to the winner of a December runoff election in Georgia.
If the GOP wins the House majority, Rep. Cathy McMorris Rodgers (R-Wash.) would replace Frank Pallone (D-N.J.) as chair of the Energy & Commerce Committee with jurisdiction over the 340B program, Medicare, and Medicaid. Rep. Bret Guthrie (R-Ky.) would be in line to become the new Health Subcommittee chair, replacing Rep. Anna Eshoo (D-Calif.).
The committee could hold hearings and consider legislation about the 340B program under Republican control, as occurred when the GOP last controlled the House from 2016 to 2018.
McMorris Rodgers was a strong ally of 340B health care providers a decade ago, but she has said little about the program publicly in recent years. She was one of the requestors of a Government Accountability Office study about the 340B program now in progress. It focuses on the law that enables hospitals to maintain or regain their 340B eligibility despite having fallen below the minimum required Medicare disproportionate share (DSH) adjustment percentage due to COVID-related changes in patient mix.
As part of the GAO study, the watchdog agency wants to know if 340B hospitals give low-income uninsured patients a break on drug prices at their contract and in-house pharmacies.
Why the GAO study is asking hospitals about sharing 340B drug savings with poor patients without insurance is unknown. Lowering what such patients pay for drugs is not a 340B program requirement (although many 340B covered entities say they do so). Nor is it a condition for a hospital to get its 340B eligibility restored through the end of this year under the new law.
It is possible that McMorris Rodgers and the other requestor of the study—Richard Burr (N.C.), the current Republican leader of the Senate Health, Education, Labor, and Pensions Committee (HELP)—asked GAO to look into this matter.
Big Changes in Senate Committee Leadership
Burr did not seek re-election this year. If the GOP wins control of the Senate, Rand Paul (Ky.) is in line to chair the HELP Committee, which has jurisdiction over the 340B program. However, Paul may choose to chair the Homeland Security and Governmental Affairs Committee. If that is the case, Sen. Bill Cassidy (R-Louis.) is likely to chair the HELP commitee. Cassidy has raised serious concerns with the 340B program and has introduced legislation in the past to place various restrictions on the program. Paul, on the other hand, has been relatively quiet on the 340B program and it is unclear where he stands.
If the Democrats retain the Senate, Senator Bernie Sanders (D-VT) is expected to chair the HELP Committee with Senator Patty Murray (D-WA) moving over to chair the Senate Appropriations Committee. If the Democrats lose the Senate, Sanders is expected to serve as the ranking HELP Committee member and Murray will be ranking at Appropriations.
Changes Among 340B Champions
In recent years in both the House and Senate, bipartisan groups of six members emerged as leaders on 340B matters.
In the House, the members are Reps. Abigail Spanberger (D-Va.), Cindy Axne (D-Iowa), Doris Matsui (D-Calif.), David McKinley (R-W.Va.), John Katko (R-N.Y.), and Dusty Johnson (R-S.D.). Spanberger, Matsui, and Johnson are returning for the next session of Congress but Axne, McKinley, and Katko are not. McKinley, who served on the E&C Committee for several terms, was one of the most vocal Republican supporters of the 340B program. Last year he introduced the 340B PROTECT Act with Spanberger. The bill has 114 co-sponsors.
Spanberger’s race was one of the most hotly contested in the country and she won her purple Northern Virginia district over Prince William County supervisor Yesli Vega 52-48%. The race was not called until 10:30 in the evening and Vega led most of the night. Axne lost in a nailbiter in Iowa’s third district to Republican Zach Nunn. With 95% of the vote, Nunn was leading 50.3% to 49.7%.
In the Senate, the six leading 340B champions are Sens. Tammy Baldwin (D-Wis.), Debbie Stabenow (D-Mich.), Ben Cardin (D-Md.), John Thune (R-S.D.), Rob Portman (R-Ohio), and Shelly Moore Capito (R-W.Va.). Only Portman is not returning. Thune is expected to continue to serve as the second ranking Republican in the Senate and has been a consistent supporter of the 340B program.
It is not known whether Congress will act on the 340B program during its lame duck session. The National Association of Community Health Centers has said centers “need Congress to move urgently to protect and strengthen the 340B program” from drug manufacturers that refuse to ship 340B-priced drugs to covered entities’ contract pharmacies. NACHC and others that represent 340B providers also want Congress to pass legislation stopping pharmacy benefit managers and payers from discriminating against covered entities regarding drug reimbursement, network access, and other terms and conditions.
Drug manufacturers say they want Congress to ensure that patients benefit more directly from 340B discounts. They want a new 340B patient definition, reporting requirements for entities, increased oversight of entities, and reconsideration of the 340B contract pharmacy policy.