DPC Urges North Dakota Senators to Reject 340B Expansion

The Domestic Policy Caucus wrote to members of the North Dakota Senate today, urging them to vote against HB1473, which would expand the flawed federal 340B program.

In the letter, DPC wrote, in part,

North Dakota’s unique pharmacy ownership rules are just another reason you should have serious concerns about HB1473. According to the Pioneer Institute, 51% of current 340B contract pharmacies are located outside of North Dakota (of the 254 contract pharmacies, 129 are outside North Dakota). Supporting this bill will mean there will be unlimited contracts with the likes of CVS and Walgreens in Moorhead or East Grand Forks--or as far away as Hawaii. Meaning, those 340B funds meant to help North Dakotans are leaving the state. Layer that on top of what we heard in earlier testimony on this bill some days ago, where one hospital system official talked about using North Dakota's 340B funds to provide a variety of services in Minnesota...

Disappointingly, HB1473 does not have any transparency provisions, which House members had said they wanted added to the bill when they voted it out of the first chamber...

Read the full letter here.

DPC Testifies Against 340B Expansion Bill before North Dakota Senate Human Services Committee

Domestic Policy Caucus Secretary/Treasurer Kent Kaiser, Ph.D., testified virtually before the North Dakota Senate Human Services Committee on March 12 to oppose House Bill 1473, which would expand the federal 340B program in the state.

Among other points, Kaiser said, "...North Dakota's unique pharmacy ownership rules are just another reason you should have serious concerns about HB1473. According to the Pioneer Institute, 51% of current 340B contract pharmacies are located outside of North Dakota (of the 254 contract pharmacies, 129 are outside North Dakota). Supporting this bill will mean there will be unlimited contracts with the likes of CVS and Walgreens in Moorhead or East Grand Forks--or as far away as Hawaii. Meaning, those 340B funds meant to help North Dakotans are leaving the state. Layer that on top of what we heard in earlier testimony on this bill some days ago, where one hospital system official talked about using North Dakota's 340B funds to provide a variety of services in Minnesota..."

Listen to the full hearing here, with DPC testimony beginning at about 10:22:15 AM.

DPC Requests Fiscal Note on South Dakota HB154 340B Expansion 

DPC wrote to members of the South Dakota House of Representatives, requesting that a fiscal note be attached to proposed legislation, House Bill 154, which ais to expand the federal 340B program in the state.

DPC wrote: 

SB154, which aims to expand the 340B drug pricing program in South Dakota, has often been touted as cost-free to taxpayers, but this is totally false.

South Dakota taxpayers deserve a fiscal note for SB 154 to understand the full and true impact this legislation would have on small business owners as well as on the state health plan.

Every time someone in the State Employees Health Benefits Program fills a 340B-eligible prescription, the taxpayers pay. Any amount that the pharmacy or hospital charges the State Health Plan above the cost to acquire the drug is a windfall provided by tax dollars. South Dakotans deserve to know exactly what their contribution is to support the 340B program in the state.

Last year, the North Carolina State Treasurer released a report finding North Carolina 340B hospitals overcharged state employees for cancer drugs and reaped thousands of dollars per claim—all at taxpayer expense. There, 340B hospitals billed the State Health Plan 5.4 times their discounted acquisition costs, collecting as much as $6,026 in average profits per claim by charging up to 12.7 times their 340B acquisition costs for oncology drugs. South Dakota taxpayers should know whether they are being similarly gouged to support the 340B program in their state.

DPC Testifies Against HB154 340B Expansion in South Dakota

Today, Domestic Policy Caucus Secretary/Treasurer Kent Kaiser, Ph.D., testified against South Dakota House Bill 154, which would expand the flawed federal 340B drug pricing program in that state, before the House Health & Human Services Committee.

In part, Kaiser testified, "The 340B program has been in existence for about 35 years. So, simply ask your constituents whether they think they enjoy more affordable prescriptions today and more help paying for their copays and coinsurance now as compared to 25 or 30 years ago. Or do they think any benefits meant for them have been diverted into other programs and things. Ask them if they have more drug store options, closer to home, to buy their medicines. Or, does it seem like they have fewer drug store options, and that they have to travel farther from home to get their prescriptions filled? Ask them if they think they receive more personal care from their pharmacy today than they did 25 or 30 years ago. Or do they think their pharmacy is more impersonal and corporate. If you receive generally negative responses to these questions, then you know that the 340B program is not working the way it was intended and that it needs to be reformed on the federal level, way before it is expanded on the state level."

Listen to the full committee hearing here (DPC testimony starts at ~41:55).

DPC Appears on WZFG Radio to Discuss HB1473 in North Dakota

On February 27, Domestic Policy Caucus Secretary/Treasurer Kent Kaiser, Ph.D., appeared on WZFG radio's "What's on Your Mind" show to discuss why North Dakota House Bill 1473, which aims to expand the federal 340B drug pricing program, should be opposed.

Show host Scott Hennen and Kaiser discussed how the federal 340B program needs to be reformed so that the financial benefits flow to patients in the form of lower drug prices and help paying prescription drug copays and coinsurance, instead of to large hospital systems and national pharmacy chains.

Listen to the show below.

The Oklahoman op-ed: “This bill was supposed to help OK patients. It fattens hospital wallets instead.”

In The Oklahoman of Oklahoma City today, Domestic Policy Caucus Secretary/Treasurer Kent Kaiser, Ph.D., has an op-ed published, asking lawmakers to reject legislation that aims to expand the federal 340B program. 

In part, DPC wrote, "[A] loophole in the law allows hospital systems and pharmacy chains to keep for themselves the financial benefits that are meant for patients. Obviously, this well-intentioned but seriously flawed program needs to be fixed, and expanding it is not the answer to prescription drug affordability in Oklahoma."

Read the op-ed here.

New Domestic Policy Podcast Episode: The Folly of 340B Expansion in North Dakota

In a new Domestic Policy Podcast episode released February 20, Dr. Kent Kaiser and North Dakota Watchdog Network Managing Director Dustin Gawrylow discuss the folly of North Dakota House Bill 1473. The bill aims to expand the federal 340B drug pricing program in the state.

During the episode, Gawrylow said, in part, “Like most government programs, this is one of those that had a good initial intention, but government is really bad at making sure that the programs that it develops actually benefit the people it intends to benefit. This is definitely one of those where there's not a lot of accountability and oversight on ensuring that the intended beneficiaries of the program actually see that benefit.”

Listen to the full episode here.

DPC Writes to Oklahoma Legislators to Request a "No" Vote on 340B Expansion

Domestic Policy Caucus Secretary/Treasurer Kent Kaiser, Ph.D., today wrote to members of the Oklahoma House of Representatives Civil Judiciary Committee to request a "no" vote on House Bill 2048, which would expand the 340B drug pricing program in the state.

In part, DPC wrote, "Before it is ever expanded, the 340B program needs to be reformed. You should pursue reforms that include oversight and transparency so that hospitals and pharmacies must report exactly how much revenue they generate from the 340B program and exactly how much of that money is used to provide prescription drug discounts to patients like the original law intended. You should also define exactly who is a 340B patient, and you should require that patients be notified if they are designated as 340B patients. This would be a good start before ever thinking about expanding the 340B program in Oklahoma... Please vote “no” on expanding 340B. Oppose HB2048."

Read the full letter here.

DPC Testifies in Opposition to 340B Expansion in North Dakota

On February 10, Domestic Policy Caucus Secretary/Treasurer Kent Kaiser, Ph.D., testified virtually before the North Dakota State House Committee on Industry, Business, and Labor in opposition to HB1473, which aims to expand the federal 340B drug pricing program in the state. 

In part, Kaiser testified, "Making a flawed program bigger is not the answer. The 340B program should be fixed before there’s any discussion about expanding it. You should provide oversight to hold covered entities responsible for delivering on 340B’s stated purpose. Simply defining who is a 340B patient and ensuring the money flows to those eligible patients—instead of big box pharmacies and hospital systems—is a commonsense first step."

"In addition, you should require entities receiving 340B windfalls to notify the people whom they consider to be 340B patients so those patients know they should be receiving discounts on their prescriptions. Finally, you have an opportunity to inject accountability and transparency into the system by requiring entities that receive 340B money to report exactly how much they receive and exactly where that money flows—specifically, to report exactly how much actually goes towards providing discounted medicines to patients like it was supposed to," Kaiser said.

Watch the full committee hearing here, (DPC testimony begins at ~3:50:00).

DPC Appears on Open Range Podcast to Discuss 340B Drug Legislation in North Dakota

Domestic Policy Caucus Secretary/Treasurer Kent Kaiser, Ph.D., recently appeared on the Open Range podcast with host Dustin Gawrylow to discuss the folly of legislation to expand the program in North Dakota. 

Gawrylow and Kaiser discussed what the 340B drug pricing program is and the need for reform of the program before it is expanded anywhere. They specifically encouraged North Dakota legislators to work towards injecting accountability and transparency into the program rather than pushing forward with an expansion of 340B, as contained in HB1473 currently under consideration in the legislature. 

Watch the full podcast here.

DPC Urges North Dakota Legislators to Oppose HB1473 Expansion of 340B Program

The Domestic Policy Caucus today wrote to members of the North Dakota House of Representatives Committee on Industry, Business, and Labor to urge rejection of House Bill 1473, which would expand the 340B drug pricing program in the state.

In the letter, DPC Secretary/Treasurer Kent Kaiser, Ph.D., wrote, "Haven’t the likes of Walmart and Walgreens done enough to harm main streets across North Dakota? An expansion of 340B would create an economic environment in which incentives would be put in place to encourage even more consolidation of healthcare systems, to put healthcare farther out of reach of rural North Dakotans, and to imperil the ability of underserved residents to receive the medications they need, all while lining the pockets of big healthcare systems and giant chain pharmacies. Meanwhile, it would do nothing to reduce healthcare costs, which is what everyone really wants. Indeed, it probably would actually increase costs while resulting in poorer health outcomes."

Read the full letter here.

DPC Calls on South Dakota Senators to Oppose SB154 340B Expansion

DPC Urges Nebraska Legislature to Oppose LB168 340B Program Expansion

New Domestic Policy Podcast Episode: The 340B Prescription Drug Program: Reforms Needed

In a new Domestic Policy Podcast episode released January 24, Dr. Kent Kaiser explains what the federal 340B prescription drug program is, why it needs to be reformed, and what the Domestic Policy Caucus is doing through the organization’s Fix340B initiative.

During the episode, Dr Kaiser said, in part, “The problem really began as for profit hospitals started purchasing the 340B covered entities in order to gain access to the 340B prices. And the problem really exploded as those hospitals began contracting with multiple pharmacies that also were qualified for the 340B discount through their association. Many of those pharmacies and hospitals turn around and charge Medicare or Medicaid, and private insurance companies, the full price for a medicine that is acquired at the 340B discount, and unfortunately, they don’t let the patient know about the discount, they don't let the patient know that they even are a 340B patient.

Listen to the full episode here.

DPC Urges Thoughtful Amendment of 340B Expansion in Michigan

Today, the Domestic Policy Caucus wrote to members of the Michigan House of Representatives, urging them to adopt an amendment proposed by Senator Sylvia Santana.

Sen. Santana’s amendment would strengthen the 340B program in Michigan by injecting some transparency and oversight provisions into the program so legislators can hold covered entities responsible for delivering on 340B’s stated purpose, which is to help low-income people afford their medicines.

“We strongly encourage you to adopt Sen. Santana’s thoughtful, common sense amendment to SB1179,” DPC wrote.

Read the complete letter here.

DPC Testifies Against Expansion of 340B in Michigan

Today, Domestic Policy Caucus Secretary/Treasurer Kent Kaiser, Ph.D., delivered a testimony to the Michigan Senate Committee on Oversight opposing the expansion of 340B, the federal law on prescription drugs, in Michigan, as contained in SB1179.

Kaiser wrote, in part, “Making a bad program bigger is not the answer. The 340B program should be fixed before there’s any discussion of expanding it. You should provide oversight to hold covered entities responsible for delivering on 340B’s stated purpose. Simply defining who is a 340B patient and ensuring the money flows to those eligible patients – instead of big box pharmacies and hospital systems – is a commonsense first step.”

Read the full testimony here.

DPC Urges Michigan Legislators to Oppose 340B Expansion

DPC Appears on KY3 Missouri Opposing 340B Expansion

On Thursday, Missouri Governor Mike Parson opted out of taking action on a bill, SB 751, aimed at expanding the out-of-control 340B program in the state.

Following the Governor’s decision, DPC said this, “While the required discounts are supposed to be passed on to low-income consumers, instead what happens is the hospitals charge the normal price to your insurance or to the patient and keep that money.” DPC stands firm in its support of better access to medicines for people in need, especially in rural Missouri.

The governor’s inaction means the bill will become law by default and take effect August 28.

Learn more here.

DPC Urges Missouri Governor to Veto 340B Expansion

The Domestic Policy Caucus today wrote to Missouri Governor Mike Parson, urging him to veto an expansion of 340B, as contained in S.B. 751, which has been sent to his desk.

In part, DPC wrote, "Disparities in access to care and health outcomes for rural, underserved, and minority populations have long been significant issues. Any policy that could further restrict the availability of medicines to these populations--or force them to travel farther to obtain them--needs to take the issue of health equity into consideration. There should be much more discussion, analysis, and debate before determining whether to head down this uncertain and troubling policy path."

Read the full letter here.

DPC Applauds No. Carolina State Treasurer Report for Exposing 340B Overcharges

North Carolina State Treasurer Dale R. Folwell, CPA, recently released a report finding that 340B hospitals billed state employees an average price markup of 5.4 times their discounted acquisition costs for oncology drugs. Hospitals generated average spread profits as high as $13,617 per claim on cancer drugs paid for by the North Carolina State Health Plan for Teachers and State Employees.

The Domestic Policy Caucus applauds Treasurer Folwell’s efforts to expose 340B program overcharges and abuse. Like Folwell, we are calling on state and federal lawmakers to reform the 340B Drug Pricing Program and to provide hospital price relief to state employees and taxpayers. We also call on state officials in every state to conduct 340B program reviews like the one that was performed in North Carolina.

Read the treasurer's full report.

DPC Urges Kansas Governor to Sign Budget Bill to Protect 340B Program from Misuse

Today, the Domestic Policy Caucus wrote to Kansas Governor Laura Kelly, urging her to sign the state's budget bill, which includes a provision to protect the 340B program from further misuse in the state.

In the letter, DPC wrote in part, "By signing the budget bill, you will avoid creating an economic environment in which incentives would be put in place to encourage even more consolidation of healthcare systems, putting healthcare farther out of reach of rural Kansans, and imperiling the ability of underserved Kansans to receive the medications they need."

Read the full letter here.

DPC Urges Mississippi Governor to Veto 340B Expansion

Today, the Domestic Policy Caucus wrote to Mississippi Governor Tate Reeves, urging him to veto H.B. 728, a bill that would expand 340B in the state.

DPC wrote, “H.B. 728 would create an economic environment in which incentives would be put in place to encourage even more consolidation of healthcare systems, to put healthcare farther out of reach of rural Mississippians, and to imperil the ability of underserved Mississippians to receive the medications they need, all while lining the pockets of big healthcare systems and giant chain pharmacies… The number of independently owned retail pharmacies declined by 16 percent in the United States between 2003 and 2021. That has contributed to the appearance of what are called “pharmacy deserts… Only Stone County has no pharmacy desert, and in more than 20 Mississippi counties, 100% of the residents live more than 15 minutes from the three closest pharmacies.

Read the full letter here.

DPC Urges Missouri Senators to Oppose 340B Expansion

The Domestic Policy Caucus wrote to Missouri Senate Leaders to vote against the expansion of 340B, the federal law on prescription drugs, which S.B. 751 currently under consideration would create in Missouri.

DPC wrote, “S.B. 751 would create an economic environment in which incentives would be put in place to encourage even more consolidation of healthcare systems, to put healthcare farther out of reach of rural Missourians, and to imperil the ability of underserved Missourians to receive the medications they need, all while lining the pockets of big healthcare systems and giant chain pharmacies. Meanwhile, it would do nothing to reduce healthcare costs, which is what everyone really wants. Indeed, it probably would actually increase costs while resulting in poorer health outcomes… There should be much more discussion, analysis, and debate before determining whether to head down this uncertain and troubling healthcare policy path.

Read the full letter here.

DPC Urges West Virginia Governor to Veto 340B Expansion

The Domestic Policy Caucus today wrote to West Virginia Governor Jim Justice, urging him to veto SB 325, a bill that would expand the 340B federal prescription drug mandate in the state.

In the letter, DPC wrote, "Pharmacies are essential to the communities they serve. But in West Virginia and throughout America, rural independent drugstores are struggling. In a 2022 policy brief, the Rural Policy Research Institute reported this troubling fact: The number of independently owned retail pharmacies declined by 16 percent in the United States between 2003 and 2021. That has contributed to the appearance of what are called “pharmacy deserts”—areas where residents must drive more than 15 minutes to a drugstore. West Virginia Public Radio has reported that pharmacy deserts exist in Wirt, Ritchie, Doddridge, Pocahontas, and Pendleton Counties. S.B. 325 would exacerbate the problem for West Virginians."

Read the full letter here.

DPC Pens Letter to Kansas Legislative Leaders to Urge Opposition to 340B Expansion

340B Program Expansion Threatens Rural Healthcare

Pharmacies are essential to the communities they serve. Yet throughout America, rural independent drugstores are struggling.

This month, the Rural Policy Research Institute reported this troubling fact: The number of independently owned retail pharmacies declined by 16 percent in the United States between 2003 and 2021. According to NPR radio, that has contributed to the appearance of what are called “pharmacy deserts” across rural America—areas where residents must drive more than 15 minutes to a drugstore. A 2021 report issued by Good Rx called “Mapping Credit Deserts” provides a graphic representation of the counties having insufficient access to a drugstore.

Disparities in access to care and health outcomes for rural, underserved, and minority populations have long been significant issues. Any policy that could further restrict the availability of medicines to these populations—or force them to travel farther to obtain them—needs to take the issue of health equity into consideration.

Unfortunately, there has been a massive expansion in recent years of a program that exacerbates the pharmacy desert phenomenon.

The program, known as 340B after a section of the 1992 federal law containing it, has grown by leaps and bounds in just the past few years.

Here’s how the program works: Hospitals and pharmacies are allowed to buy prescription drugs at a big discount, as mandated by the law, and they are reimbursed by insurance companies—and by Medicare and Medicaid—at the full price of the drugs.

The law was meant to help low-income people afford their medicines. Unfortunately, “The financial benefits of the 340B discounts are accruing almost entirely to hospitals, clinics, and physicians; and patients’ out-of-pocket costs and total cost of care are being increased,” according to a 2013 JAMA article. Indeed, the profit has become a major revenue source for for-profit healthcare providers.

340B has bestowed more and more economic power to the already-monstrous, national chain pharmacies that have driven so many local, mom-and-pop pharmacies out of business over the past several years. It creates an economic environment in which incentives encourage consolidation of healthcare systems, put healthcare farther out of reach of rural Americans, and imperil the ability of underserved Americans to receive the medications they need. All this, while also lining the pockets of big healthcare systems and giant chain pharmacies. Meanwhile, it does little or nothing to reduce healthcare costs, which is what everyone really wants. Indeed, it probably increases costs while resulting in poorer health outcomes.

That’s why the Domestic Policy Caucus is urging Members of Congress and state officials to oppose 340B expansion and refocus the policy on its original intent of lowering the price of medicines for underserved Americans and achieving health equity.