Last week, the Senate Committee on Health, Education, Labor, and Pensions held a hearing entitled "The 340B Program: Examining Its Growth and Impact on Patients." Witnesses included Michelle Rosenberg, director of health care for the U.S. Government Accountability Office (GAO); Aditi Sen, PhD, chief of the Health Policy Studies Unit in the Congressional Budget Office; and William Feldman, a physician and health policy researcher at the University of California, Los Angeles.
Throughout the hearing, many senators advocated for changes to the 340B program, even while supporting the original intent. Specifically, Sens. Susan Collins (R-Maine), Tommy Tuberville (R-Ala.), and Lisa Murkowski (R-Alaska) noted the importance of the program for rural hospitals in their states. Other senators sought to link the discussion to larger issues with health care affordability, with Democrats, including Sens. Patty Murray (D-Wash.), Ed Markey (D-Mass.), and Angela Alsobrooks (D-Md.), spending much of their time discussing the expiring ACA premium tax subsidies and the ongoing government shutdown.
Sen. Tammy Baldwin (D-Wis.) said she is working on draft legislation to make changes to the program, in collaboration with a bipartisan group of other senators. As a reminder, Reps. Buddy Carter (R-Ga.) and Diana Harshbarger (R-Tenn.) introduced the "340B Access Act" in the House in mid-September. Language has not been released for Baldwin's proposal, so it is unclear whether there would be overlap between the two bills.
Sens. Roger Marshall (R-Kan.) and Josh Hawley (R-Mo.) brought up the role of PBMs in the program and the larger health care space. Marshall talked about his belief in the importance of transparency requirements in reform of the program, asking Rosenberg, "You would agree that PBMs are taking a chunk of this money?" Rosenberg replied that GAO has not "looked specifically at PBMs … we have looked at third-party administrators, and they do get paid."
Hawley asked Feldman, "Do you have a view on the rapid consolidation of pharmacies, the loss of independent pharmacies in this country? PBMs buying them up — pharmacies — left, right and center; PBMs buying up doctor's practices, buying up hospitals, integrating all of them. Basic economics would tell us when you have that kind of integration, that kind of vertical integration, you're going to get an increase in prices. Do you think that has anything to do with the increase in drug prices that we've seen, and can we do something about it?"
Feldman replied, "For sure, I think that having these big, consolidated entities that control all aspects of care is not a good idea. And I think that efforts to restrict that would be helpful."
Hawley finished his questioning by noting that while Missouri used to have the most independent pharmacies in the U.S., it now has among the fewest, with two counties having no pharmacies. He finished with a memorable statement: "And yet, these big companies, these big PBMs, they make more money than ever before. It's a racket."
