December 19, 2024
Six Members of the U.S. House that 340B Stakeholders Should Keep an Eye on in 2025
By Ted Slafsky
There are 435 members of the U.S. House and 100 U.S. Senators, and each one of them can influence the 340B drug discount program. But it is the lawmakers serving on two coveted committees, the House Energy and Commerce Committee (E&C) and the Senate Health, Education, Labor and Pensions (HELP) Committee, that matter most. Except for the House and Senate leadership, which in the past have rarely involved themselves in the minutia of 340B, the members serving on these two committees have more influence on this program than anyone else. This is since the E&C and HELP committees have jurisdiction over the 340B program. Whether it is legislation, hearings or investigations into 340B, the action will occur in these committees.
As the battle over the contract pharmacy program gets more heated and the number of drug manufacturers trying to change 340B from an upfront discount to rebate program grows, you can expect 340B to get plenty of attention from these two committees. Not to mention an ongoing investigation into various 340B stakeholders led by the incoming Senate HELP Committee Chair that you can expect he will expand.
With a program as nuanced and complicated as 340B, you can actually narrow the list of lawmakers that will play a key role in 340B to just a handful. In this column, you will learn about six key players to keep an eye on in the House. In my next column, I will turn my attention to the Senate.
Brett Guthrie (R-KY): The 9-term congressman, who represents a largely rural district in west central Kentucky, was recently elevated by his GOP peers from E&C Health Subcommittee chair to the powerful role of E&C chair. On the positive side for the 340B provider community, the well-liked and low-key lawmaker’s district include seven 340B hospitals and six community health centers. Guthrie has a strong understanding of the 340B program and a good relationship with these providers. On the not so positive side, he has excellent relationships with the pharmaceutical industry and has supported several bills opposed by the 340B provider groups.
Buddy Carter (R-GA): With the retirement of Rep. Larry Bucshon (R-IN.), you can expect Carter, a pharmacist and former owner of a three-store local pharmacy outlet in southeast Georgia, to become the lead advocate for placing various restrictions on the 340B program, particularly on hospitals. During this session of Congress, he was one of three House Republicans to introduce the 340B Access Act, a bill that the American Hospital Association says could result in 75% of urban DSH hospitals losing their 340B eligibility. The bill, which was endorsed by the Pharmaceutical Research and Manufacturers of America (PhRMA) and the National Association of Community Health Centers (NACHC), has been panned by a broad coalition of 340B provider groups including a major health center group. NACHC, interestingly, may be backing off its support of some important provisions of the bill and did not encourage its members to lobby for the bill during a recent Washington, D.C. fly-in largely focused on reauthorizing health center funding.
Carter has been a long-time outspoken critic of what he believes are abuses of the program and has directed most of his concerns with 340B hospitals. His narrow view of 340B’s purpose which he shared during a grilling of a hospital CEO this summer, is that the program is intended “to help low-income and vulnerable patients access affordable medicines.” 340B proponents point out that when Congress created the program they said its purpose was to “enable covered entities to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.” Carter has expressed an interest in serving as Chair of the E&C Health Subcommittee. If he is elected to this post, you can expect even more attention to 340B in the coming year.
Diana Harshbarger (R-TN): Like Carter, Harshbarger is a pharmacist and one of three sponsors of the 340B Access Act. Representing Tennessee’s First Congressional District located in Northeast Tennessee, she and her husband own a compounding pharmacy that is now run by her son Bobby, who was recently elected as a state senator. Harshbarger is relatively new to Congress. She was elected in Nov. 2020 and first served on the E&C Committee during this session of Congress. With the retirement of Bucshon, the other sponsor of the Access Act, she could play more of a leading role in the push for major changes to the 340B program.
Dusty Johnson (R-SD): Johnson, South Dakota’s only House representative, is close to the House leadership and has continued the long South Dakotan tradition of strong support for the 340B program. Like the others in his delegation, he is close to his state’s 340B hospitals and other covered entities. Johnson, who chairs the Main Street Caucus, the House moderate Republican policy group, was the leading Republican behind a recent bipartisan letter signed by close to 190 House members urging HHS Secretary Xavier Becerra to sanction Johnson & Johnson for trying to implement a 340B rebate model for two of its high selling drug products. Johnson and his House colleagues urged the Secretary “to use every enforcement tool at your disposal to protect the communities safety-net hospitals serve from this devastating change to 340B.” Johnson and his Democratic colleague Rep. Abigail Spanberger (D-VA) also are the lead sponsors of the Protect 340B Act, legislation that would prohibit PBMs and insurers from treating 340B providers differently with regards to reimbursement and network participation.
Doris Matsui (D-CA): The Sacramento-based lawmaker, who will begin her 20th year in Congress in January, is a high-ranking Democrat on the E&C Committee. She is the lead sponsor of the 340B Patients Act, a bill that would require drug manufacturers to provide 340B discounts in the contract pharmacy setting without conditions. Matsui, who has been a vocal 340B champion for decades, scolded the National Association of Community Health Centers for partnering with PhRMA on a bill that she said would undermine the program and the safety net. You can expect Matsui to continue to take a leadership role on 340B and to work hard to try to protect the program. Whether she can enlist Republican lawmakers to co-sponsor her bill to protect contract pharmacy relationships remains a big question.
Diana DeGette (D-CO). The second highest ranking Democrat among the incoming E&C Democrats, she is expected to serve as the ranking member on the important E&C health subcommittee. DeGette, who represents the Denver area, is considered one of the House lawmakers most willing to work across the aisle and is best known as the lead Democrat behind the 21st Century Cures Act, which has modernized the nation’s medical research system. Despite her strong relationship with the drug industry, she is considered a reliable supporter of the 340B program and is expected to be a strong advocate for 340B hospitals and other providers during this crucial upcoming Congressional session.
New Leaders?
There are certainly more members of the House that will play an important role on 340B policy in the 119th session of Congress than these six representatives. You can even anticipate some of the over 50 new House members to take a strong interest.
But keep your closest eye on these six members. Stay tuned for my column next month when I take a closer look at the key senators in the 340B debate.
