In the Senate, Keep an Eye on Two Powerful Lawmakers with Very Different Views on 340B

By Ted Slafsky

As I mentioned in my last column, the 119^th Congress includes hundreds of members of the U.S. House of Representatives and 100 U.S. Senators, but only a handful will play an key role in determining the future of the 340B drug discount program.

While it is imperative to engage with your local congressional delegation, about half a dozen lawmakers in the House, and even fewer in the Senate, will play an outsized role on 340B-related issues. Last month, I highlighted six key House lawmakers in the 340B world. Today, I will focus my attention on two big players in the Senate.

As a friendly reminder, the lawmakers serving on two coveted committees, the House Energy and Commerce (E&C) Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee, have the most influence when it comes to 340B policy—except for the congressional leadership, which historically rarely involves themselves in the minutia of 340B. That’s because the E&C and HELP Committees have jurisdiction over the 340B program. Whether it is legislation, hearings or investigations into 340B, the action typically will occur in these committees.

It is also important to understand the unique nature of the two chambers.

In the House, the majority party has a disproportionate share of power. In the past (things may be a bit different this year due to the GOP’s historically small majority), the controlling party not only determined the agenda, but did not need to worry about getting support or input from the minority party. As a result, bills that passed the House were often not the byproduct of bipartisan compromise or consensus. These partisan bills often hit a roadblock in the Senate, where most legislation requires 60 votes.

Even when Senate leadership uses a procedure called “reconciliation” to pass a bill with 51 votes—or 50 if the vice president breaks a tie—a few moderate majority party members can make it very difficult to pass legislation.

Unique Role of U.S Senate

The framers of the Constitution purposely created the two congressional chambers in that fashion. According to Senate lore, George Washington reportedly told Thomas Jefferson that the framers had created the Senate to “cool” House legislation, similar to how a saucer was used to cool a hot cup of tea.

With that in mind, bipartisanship will be critical to getting a 340B bill through the Senate.

Two Republican lawmakers with very different views of the 340B program—Senate Majority Leader John Thune (R-S.D.) and Sen. Bill Cassidy (R-La.)—will very likely need to forge a compromise with Democratic lawmakers to get their different versions of 340B reform through the upper chamber. Here’s a primer on both senators and their views on 340B:

Thune: Senate Republicans recently selected Thune to serve as majority leader, the most powerful position in the Senate. The tall, telegenic senator, who played college basketball, is well-liked on both sides of the aisle. He won the leadership position despite opposition from Elon Musk, who is working with President-elect Donald Trump’s incoming administration, and some of the more conservative GOP senators.

Thune is the first congressional leader in my three decades of experience in Washington to have an intimate knowledge of the 340B program. He has a personal relationship with the hospitals and health centers in his state. During my time leading the trade group 340B Health, the senator personally met with me and the South Dakota hospitals each time they came to the U.S. Capitol. Even after he was elevated to the second-highest ranking GOP member in Senate leadership, you could count on a friendly greeting from the senator, who grew up in the small town of Murdo, South Dakota, and still has his Midwestern sensibilities.

Despite his many duties as the former deputy to then-Senate GOP leader Mitch McConnell (R-Ky.), Thune has remained deeply engaged on 340B policy. He led the bipartisan “Group of Six” Senators in trying to come up with a comprehensive solution to the many challenges to the 340B program: from providers’ concerns about contract pharmacy restrictions to the drug industry’s concerns about duplicate discounts. The group was ultimately not able to come up with a final bill in the last session of Congress, but you can expect it’s yet-to-be-released SUSTAIN 340B Act to serve as the framework of any final bill that makes it to Trump’s desk.

Cassidy: Senate Republicans selected Cassidy, a gastroenterologist by training, to chair the HELP Committee in the 119^th Congress. Unlike many previous chairpersons of the HELP and E&C committees, Cassidy is deeply engaged with the 340B program and its intricacies. He’s been a longtime critic of the program, particularly its growth, as well as what he believes is hospitals’ and contract pharmacies’ misuse of the program, You can expect the new HELP Committee chairman to expand his previous investigation into 340B stakeholders’ use of the program. And now he will have subpoena power, which increases his influence.

This tough exchange between Cassidy and representatives of the 340B hospital and pharmacy sectors from March 2018 illustrates what policy watchers can expect when the new chairman calls his first hearing on the 340B program.

Thune v. Cassidy

Thune and Cassidy’s differing viewpoints on 340B are striking.

When President Joe Biden selected Xavier Becerra to serve as Health and Human Services secretary in 2021, Thune pressed the nominee to demonstrate his commitment to the 340B program and 340B providers during his confirmation hearing. Becerra pledged his strong support and criticized drug manufacturers for placing restrictions on the program.

By contrast, Cassidy grilled Becerra on whether contract pharmacies and patient definition are even referenced in the 340B statute. He later cited Becerra’s “lack of a firm grasp” on 340B as one of his reasons for opposing the nomination.

It will be imperative to watch Cassidy’s work and the agenda he sets before the HELP Committee. Thune recently announced the 11 GOP senators who will serve alongside Cassidy on the committee. Senate Democratic Leader Chuck Schumer (D-N.Y.) announced the 10 Democrats who will serve along with HELP Ranking Member Bernie Sanders (I-Vt). If you are from the states represented by these senators, you will want to work closely with them and their staff.

The bottom line? Be prepared for a very busy time in the 340B policy world in Washington this year and next!

Ted Slafsky is the Publisher and CEO of 340B Report, the only news and intelligence service exclusively covering the 340B program.  Slafsky, who has over 25 years of leadership experience with the 340B program, is also Founder and Principal of Wexford Solutions. 

Ted can be reached at ted.slafsky@340Breport.com.

Disclaimer: The views and opinions expressed in this blog are those of the authors. They do not necessarily reflect the official policy or position of any other agency, organization, employer, or company.