[Congressional Record Volume 168, Number 97 (Tuesday, June 7, 2022)]
[House]
[Pages H5325-H5330]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  COMMEMORATING THE 30TH ANNIVERSARY OF THE 340B DISCOUNT DRUG PROGRAM

  The SPEAKER pro tempore (Mrs. Cherfilus-McCormick). Under the 
Speaker's announced policy of January 4, 2021, the gentlewoman from 
Virginia (Ms. Spanberger) is recognized for 60 minutes as the designee 
of the majority leader.


                             General Leave

  Ms. SPANBERGER. Madam Speaker, I ask unanimous consent that all 
Members have 5 legislative days to revise and extend their remarks and 
include extraneous material on the subject of this Special Order.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Virginia?
  There was no objection.
  Ms. SPANBERGER. Madam Speaker, I rise today to speak about the 340B 
program. I rise today to commemorate the 30th anniversary of the 340B 
drug discount program, which has supported health providers in their 
mission to care for the most vulnerable and low-income patients in our 
communities, all at no additional cost to the taxpayer.
  Tonight, the House will hear stories from both Democrats and 
Republicans about how 340B supports the healthcare safety net in 
districts across the country, including in Virginia's Seventh District.
  In 1992, Congress started the 340B program with a simple goal. The 
340B program has helped hospitals, community health centers, and 
Federal grantees stretch their scarce resources as far as possible, 
helping them reach more eligible patients and provide more 
comprehensive services.
  The way it works is simple: 340B requires pharmaceutical companies to 
make drugs more affordable for healthcare providers serving vulnerable 
communities and low-income patients. By discounting the drugs, these 
providers can stretch their resources further and reach even more 
patients.
  The 340B program is especially important for providers in rural 
America. In these areas, lower incomes lead to higher rates of 
uncompensated care and a disproportionate number of patients with 
Medicare and Medicaid. Hospitals struggle to maintain costly services 
such as maternity wards and trauma centers, and patients at federally 
qualified health centers lack the resources to access high-cost drugs 
for HIV/AIDS, hemophilia, or diabetes.
  Unfortunately, since the summer of 2020, at least 16 pharmaceutical 
companies have announced or implemented restrictions on 340B pricing. 
Both the current Biden administration and the previous Trump 
administration have found these restrictions to be unlawful, yet HHS 
has taken no serious enforcement action to prevent or penalize these 
illegal actions.
  Let me be very clear: Every time a pharmaceutical company withholds a 
340B discount from an eligible pharmacy, that company is unlawfully 
overcharging the healthcare safety net and withholding resources from 
the most vulnerable patients in our communities. And, in response, we 
need to defend 340B.
  I commend HHS for its commitment to protecting the integrity of the 
340B program, but I urge the agency to penalize the companies that 
refuse to comply with Federal law. It is the right thing to do for the 
people we serve.
  Madam Speaker, I yield to my colleague from Tennessee (Mr. Rose).

                              {time}  1945

  Mr. ROSE. Madam Speaker, I thank the gentlewoman from Virginia for 
yielding me time to speak on this very important and lifesaving program 
as we commemorate the 30th anniversary of the creation of the 340B 
program.
  I applaud the gentlewoman from Virginia for her leadership on this 
issue and for organizing this opportunity for Members on both sides to 
speak about how important this issue is to each of our districts.
  I also thank the other Members here tonight and those who routinely 
support the 340B program. More than 220 Members of the House recently 
joined a letter to Health and Human Services, urging the Department to 
crack down on drug companies denying 340B discounts. By having such a 
large group of Members in support of that letter, to which I proudly 
lent my name, we demonstrated the broad bipartisan support the 340B 
program enjoys across the entire country.
  Madam Speaker, I include the text of that letter in the Record.
                                    Congress of the United States,


                                     House of Representatives,

                                Washington, DC, February 26, 2021.
     Acting Secretary Cochran,
     Department of Health and Human Services,
     Washington, DC.
       Dear Acting Secretary Cochran: We write today as leading 
     congressional proponents of the 340B drug discount program to 
     ask you to take immediate action to ensure that manufacturers 
     are prohibited from imposing unilateral changes to the 
     program in direct conflict with congressional intent and 
     decades of written guidance.
       We were pleased to see 28 attorneys general urge former HHS 
     Secretary Azar to protect the 340B programs. We believe that 
     letter and the Department's Office of General Counsel's 
     advisory opinion, released on December 30 and described 
     below, represent some of the most compelling legal arguments 
     for the actions we ask you to take.
       As you know, Congress enacted the 340B Drug Pricing Program 
     in 1992 following the creation of the Medicaid Drug Rebate 
     Program. In order for their drugs to be covered by Medicaid, 
     manufacturers are required to offer discounts to certain 
     public and nonprofit health care organizations known as 
     covered entities, including Federally Qualified Health 
     Centers, Ryan White HIV/AIDS Clinics, Medicare/Medicaid 
     Disproportionate Share hospitals, rural hospitals, and 
     children's hospitals. According to the legislative history, 
     Congress's intent in creating the discount program was to 
     ``stretch scarce federal resources to reach more eligible 
     patients and provide more comprehensive services.''
       The 340B statute requires drug manufacturers to ``offer 
     each covered entity covered outpatient drugs for purchase at 
     or below the applicable ceiling price.'' There are no 
     provisions in the statute that allow manufacturers to set 
     conditions or otherwise impede a provider's ability to access 
     340B discounts. The Health Resources and Services 
     Administration (HRSA), which oversees the program, has 
     indicated on multiple occasions, dating back to the early 
     years of the program, that the 340B statute requires 
     manufacturers to provide 340B discounts to covered entities 
     when covered entities purchase drugs to be dispensed through 
     contract pharmacies on a covered entity's behalf.
       Beginning in the summer of 2020, several drug manufacturers 
     began to announce a range of actions to avoid honoring 340B 
     discounts for certain drugs, many with the highest prices, 
     delivered to covered entities' contract pharmacies. Some 
     manufacturers have announced they will no longer ship 
     discounted drugs to contract pharmacies; others will ship to 
     only one contract pharmacy per covered entity.
       HHS has reviewed manufacturers' refusals to provide 340B 
     discounts to covered entities' contract pharmacies and found 
     them to be unlawful. In a December 30th 2020 advisory 
     opinion, then-general counsel Robert Charrow wrote, ``[T]he 
     core requirement of the 340B statute . . . is that 
     manufacturers must ``offer'' covered outpatient drugs at or 
     below the ceiling price for ``purchase by'' covered entities. 
     This fundamental requirement is not qualified, restricted, or 
     dependent on how the covered entity chooses to distribute the 
     covered outpatient drugs.''
       Unfortunately, publishing the advisory opinion has not 
     deterred manufacturers from continuing with unlawful price 
     hikes. Many covered entities are struggling with severe 
     financial losses as a result of the COVID-19 pandemic. They 
     cannot afford to be unfairly targeted by large pharmaceutical 
     corporations or be forced to pay higher up-front costs for 
     the drugs their patients need.
       Furthermore, an information technology company has allied 
     with manufacturers to change the 340B program from one of 
     upfront discounts to post-sale rebates, a change that would 
     greatly increase costs for covered entities and give 
     manufacturers tremendous leverage over covered entities. Such 
     action is inconsistent with HRSA's long-standing guidance 
     that the 340B program is an up-front discount program.''
       The December 14th letter from the attorneys general called 
     on HHS to ``address drug manufacturers' unlawful refusal to 
     provide critical drug discounts to covered entities.'' 
     Consistent with that letter, we urge you to:
       1. Begin assessing civil monetary penalties on 
     manufacturers that deny 340B pricing to

[[Page H5326]]

     covered entities in violation of their obligations under the 
     340B statute;
       2. Require manufacturers to refund covered entities the 
     discounts they have unlawfully withheld since 2020;
       3. Halt, through guidance or other means, any attempt to 
     unilaterally change 340B upfront discounts to post sale 
     rebates; and
       4. Immediately seat the Administrative Dispute Resolution 
     Panel to begin processing disputes within the program.
       As the attorneys general stated in their December 14th 
     letter, ``Each day that drug manufacturers violate their 
     statutory obligations, vulnerable patients and their health 
     care centers are deprived of the essential healthcare 
     resources Congress intended to provide.'' Thank you very much 
     for your prompt consideration of these important matters.

  Mr. ROSE. Madam Speaker, even though the 340B program has received 
such overwhelming support from Members of Congress, multiple 
administrations, hospitals, doctors, pharmacists, and patients, it 
still finds itself struggling to survive from relentless efforts to 
undermine its existence by some pharmaceutical companies refusing to 
abide by the law. HHS must take immediate enforcement action against 
all of these noncompliant drug companies.
  As many of us here tonight understand, the 340B program is an 
important avenue for offering lower drug prices for our most vulnerable 
citizens. It is often a lifeline of financial support for the small, 
rural hospitals in middle Tennessee and across the country. These very 
same hospitals are often the only source of care for communities in 
expansive geographic areas.
  I have no other word to describe it other than ``unconscionable'' 
that companies founded to help sick patients by providing lifesaving 
medication deliberately undermine a law to increase affordable access 
to their lifesaving medications. It is truly disgraceful.
  Tonight, we are going to hear more about this malpractice. I hope by 
highlighting this issue here on the floor of the U.S. House of 
Representatives, we will encourage other Members of the House and the 
Senate to take immediate and decisive action to protect the 340B 
program.
  Ms. SPANBERGER. Madam Speaker, I thank the gentleman from Tennessee 
for his comments. Certainly, his comments focus so much on the 
importance of the 340B program. We know that rural hospitals are the 
lifeblood of their communities. They often serve as the largest 
employer in a town and a way to keep and attract young people to that 
community.
  Rural hospitals are already in crisis, and since 2005, more than 180 
rural hospitals have closed their doors. One reason why that number is 
not higher is the 340B program.
  Savings from 340B discounts and community pharmacies are half of all 
the savings for rural hospitals. If these losses are allowed to stand 
and grow bigger, we will face a real crisis across rural America.
  Recent actions by the pharmaceutical companies threaten the ability 
of rural hospitals to stay open, costing them, on average, $229,000.
  Madam Speaker, I yield to the gentleman from Arizona (Mr. 
O'Halleran).
  Mr. O'HALLERAN. Madam Speaker, I thank Congresswoman Spanberger, 
along with the gentleman from Pennsylvania, for organizing this Special 
Order hour on the importance of rural health outcomes and the programs 
that support them.
  Together, our bipartisan group rises today to speak in support of the 
340B drug discount pricing program. The 340B program enables community 
health centers to purchase outpatient drugs at reduced prices, allowing 
them to ensure that low-income patients have access to affordable 
prescription drugs, along with rural hospitals.
  The dollars this program saves must also be reinvested directly into 
the health centers themselves, creating an influx of much-needed 
funding that our rural-serving institutions so often lack--way too 
often lack.
  There are eight different 340B hospitals in Arizona's First 
Congressional District, more than any other district in our State. In 
2018, studies found that 340B program hospitals accounted for 84 
percent of all hospital care provided to Medicaid patients in Arizona.
  From Casa Grande all the way up to Page, these hospitals need our 
help now. That is because, currently, several drug manufacturers are 
unlawfully withholding or limiting discounts from 340B-covered 
entities--I personally do not understand this at all--including safety-
net hospitals and community health centers.
  Anybody that lives in rural Arizona knows the critical need for 
hospitals and community healthcare centers and that they are suffering.
  Today, I am standing with my colleagues on both sides of the aisle to 
support this program and in support of the PROTECT 340B Act. Our 
legislation would prohibit pharmaceutical entities from discriminatory 
practices against 340B healthcare centers and hospitals.
  Last year, we sent a letter demanding HHS take immediate action 
against manufacturers that refuse to comply with their obligation--I 
repeat, ``their obligation''--to provide CHCs and rural hospital 
providers with discounted drugs and require manufacturers to refund the 
providers for months of unlawful overcharges. Today, we are speaking in 
support of these asks yet again.
  In my district, the families that receive care at Banner Casa Grande 
Medical Center, Cobre Valley Medical Center, Flagstaff Medical Center, 
Little Colorado Medical Center, Mt. Graham Regional Medical Center, 
Page Hospital, Summit Healthcare Regional Medical Hospital, and White 
Mountain Regional Hospital are counting on us to get this done.
  CMS should understand that this is required to get done. I am 
confident we can if we work together.
  Ms. SPANBERGER. Madam Speaker, I thank my colleague from Arizona for 
speaking about this important program and the value that it has across 
his district.
  I am now grateful for the opportunity to yield to my colleague from 
Pennsylvania.
  Mr. THOMPSON of Pennsylvania. Madam Speaker, first of all, I thank my 
colleague from Virginia for hosting and coordinating this time tonight 
on an incredibly important issue for rural America.
  Madam Speaker, this year marks the 30th anniversary of the 340B 
Federal drug pricing program. I am very familiar with this program, 
having worked for 28 years in rural hospitals where this 340B program 
was incredibly important for consumers, for patients, to be able to get 
access to the medications that they require but also equally important 
as a lifeline for our rural hospitals.
  Rural hospitals today, in my experience, having worked within these 
facilities for almost three decades, most hospitals are lucky to break 
even, especially rural hospitals. It is very challenging financially, 
but we know how important they are.

  We know that these tend to be the economic engines within our rural 
communities. These are the source of great jobs. This is access to 
quality healthcare. When these rural hospitals close, the economic 
impacts, the healthcare impacts, the health impacts are significant and 
negative for those communities.
  I can't tell you how many times, Madam Speaker, I have seen the 340B 
program be the difference between a red, losing year, where you bleed 
money, you lose money--and you can do that for only so long until a 
hospital has to shutter its doors and lay people off--and perhaps 
breaking even or even just a slight margin.
  In rural healthcare, a rural hospital, a 1 to 2 percent margin is a 
banner year. It is a great year. That is hardly enough to invest in 
modern, lifesaving technology or to invest in your staff to recruit and 
retain those qualified providers that are the key part of all 
healthcare. It really comes down to the providers, having those folks 
and retaining them.
  The 340B program, I can tell you in all the decades of my healthcare 
experience where I have seen it, has made the difference of having a 
margin to be able to keep the lights on; to be able to invest in 
lifesaving advances, technology, equipment; and, quite frankly, retain 
and recruit the best and the brightest.
  This was enacted in 1992, originally. The 340B drug pricing program 
requires pharmaceutical companies to provide certain healthcare 
organizations, like federally qualified health centers and rural 
hospitals, discounts on their drugs in exchange for having their drugs 
covered by Medicaid.

[[Page H5327]]

  The program was created with a purpose to ``stretch scarce Federal 
resources to reach more eligible patients and provide more 
comprehensive services''--a worthy cause, a worthy mission.
  As the Member representing Pennsylvania's 15th Congressional 
District--it includes 14 counties, nearly 25 percent of the land mass 
of the Commonwealth--I am a strong advocate for the 340B program as it 
is a lifeline to many of my constituents. As I said before, I have 
worked within those systems. I have seen it firsthand.
  Sadly, the 340B program is under attack. Some drug manufacturers have 
stopped honoring the 340B discounts. In other words, if a health center 
receives 340B savings, it is usually unable to keep them because third 
parties have found creative ways to pick the 340B savings out of the 
center's pockets. This is simply unacceptable and hurts those who truly 
need these medications.
  For these reasons, I am proud to be a cosponsor of H.R. 4390, the 
PROTECT 340B Act, which prohibits these types of practices and ensures 
340B savings remain where Congress meant them to go: with the safety-
net providers and the medically underserved patients that they care 
for.
  Madam Speaker, I am going to continue to support policies that 
strengthen the 340B program. I am going to work to ensure any 
developments that threaten the ability of safety-net providers to 
provide critical health services, including the many in my 
congressional district, are stopped in their tracks.
  I really very much appreciate the gentlewoman from Virginia for her 
leadership on this and all of my colleagues who have come together 
tonight to defend a program that is about access for healthcare 
consumers and access to healthcare in rural America.
  Ms. SPANBERGER. Madam Speaker, I thank my colleague from Pennsylvania 
for his comments. They are so important because he was talking about 
the impact that we see when pharmaceutical companies do not abide by 
the 340B program.
  We know that hospitals that serve more urban areas report that, on 
average, they have lost nearly a quarter of the 340B resources they 
receive through partnerships with community pharmacies. That is a 
median loss of $1 million.
  For critical access hospitals that are the only source of hospital 
care for their remote, rural communities, this loss is nearly 40 
percent, and the median loss is $220,000.
  These losses of millions of dollars are harmful to hospitals with 
razor-thin operating margins, especially the more than half that 
operate in the red even with 340B support, echoing and illustrating the 
point made by my colleague from Pennsylvania.
  To be clear, these losses are going to drug companies that continue 
to report excellent results to their shareholders, many of whom report 
double-digit profit margins. We know that that impacts hospitals across 
our communities and their ability to serve patients and provide care.
  I am now pleased to yield time to the gentleman from New Hampshire 
(Mr. Pappas).
  Mr. PAPPAS. Madam Speaker, I thank the Representative for her 
leadership in organizing this bipartisan Special Order hour.
  It is important for us to be together here to commemorate the 30th 
anniversary of the 340B program. We know that it has helped to ensure 
that rural communities and low-income individuals in districts like 
mine and across the country have access to the lifesaving healthcare 
and prescription drugs that they need.
  I am also here in strong opposition to what these drug companies are 
doing. They are undermining the 340B discounts. I believe it is a 
violation of the law, and it is hurting families in my district.
  There are at least 13 pharmaceutical companies right now that are 
unlawfully withholding or limiting discounts under the 340B program, 
and it impacts providers and patients in New Hampshire, including our 
hospitals, our community health centers, and other providers who serve 
our most vulnerable neighbors.
  I have heard about this from my constituents who have talked about 
the importance of this program, and I think their words tell a pretty 
powerful story.
  In Rockingham County in my district, one of my constituents requires 
daily medication. Without 340B, not only would she not be able to 
afford her medication, but she would also be forced to choose between 
affording her home or affording her own health.

                              {time}  2000

  In Strafford County, in my district, there is another New Hampshire 
resident who uses the 340B program for insulin for their diabetes. They 
pay just $45 a month for three vials of insulin instead of $400 a month 
for just one vial. According to them, ``Everything would get turned 
upside down for me if the program ended.''
  And because of the 340B program, staff at a community health center 
in my district have been able to reduce the cost of treatments 
significantly. Specifically, for one patient who has lived with a 
condition since they were 12 years old, costs were reduced from $400 to 
just about $100. They shared this with me: ``I can't imagine what I 
would do if it weren't for the 340B program helping with the price of 
my medication. Please do everything you can to protect this.''
  Last year, I signed a letter with over 220 House Members to protect 
the 340B program and oppose the actions of these drug companies. We 
called on HHS to take action to stop these companies from denying these 
340B discounts.
  In February, I was very proud to join so many of my colleagues in 
cosponsoring the PROTECT 340B Act. This would stop health insurers and 
pharmacy benefit managers from discriminating against 340B providers, 
and it would protect the health and well-being of my constituents and 
so many others across this country that depend on this program.
  At a time when pharmaceutical companies are reaping record profits, 
when the cost of prescription drugs continues to skyrocket, it is just 
unconscionable that there are corporate actors who continue to ignore 
the law and stick it to our consumers, our constituents, the patients 
across this country and hand them an astronomical bill.
  We have all got to join together and commit ourselves to fighting to 
lower the cost of prescription drugs. This is one area where I think 
Republicans and Democrats can come together and pass something 
meaningful. I hope our colleagues will heed the stories they have heard 
here tonight. I thank Representative Spanberger for her leadership.
  Ms. SPANBERGER. Madam Speaker, I thank Mr. Pappas for sharing the 
stories that he is hearing directly from his district.
  When I asked pharmacists about how this program works in practice, we 
were overwhelmed with responses related to how patients have been able 
to access care through the 340B program. I will just give one example 
as follow-up to Mr. Pappas' comments.
  We had a pharmacist say, ``I have countless numbers of patients who 
are now able to get their insulin and control their diabetes because of 
the 340B program.'' When their local pharmacy prices put their insulin 
costs into the range of hundreds of dollars each month, this 
pharmacist, because of the 340B program, is able to meet the needs of 
these community members with diabetes who otherwise would not be able 
to afford their lifesaving medication.
  We have story after story from pharmacists who recognize the value of 
this program and depend on it in order to serve patients throughout 
Virginia, New Hampshire, and throughout the country.
  Madam Speaker, I yield to the gentleman from Illinois (Mr. Danny K. 
Davis).
  Mr. DANNY K. DAVIS of Illinois. Madam Speaker, I commend and thank my 
colleague from Virginia for organizing this Special Order.
  I am pleased to join with all of my colleagues who have spoken 
strongly in favor of revitalizing, reenergizing, making sure that the 
340B program is implemented in a very serious way.
  I welcomed a young intern to my office this afternoon, and he was 
coming from Tufts University. I shared with him the fact that it was 
Tufts University in Mound Bayou, Mississippi, that started the first of 
the federally qualified health centers and that he was in

[[Page H5328]]

a good place. I worked with 2 of them personally, and there were only 
10 in the country at the time. Now, of course, we have more than 2,000, 
and they are practically in every State, every community, wherever you 
are.
  I represent a large, urban, low-income community with 23 hospitals, 
many of which are safety net. I think I may have more hospitals than 
any single area. A discount for the individuals who use these 
institutions will be more than helpful to them, so I urge that we 
continue the program, but I really urge that we enforce and make sure 
that they do what they were designed to do.
  Ms. SPANBERGER. Madam Speaker, I thank Mr. Davis for his comments and 
certainly for bringing up the important role that federally qualified 
health centers raise in providing care. We know that they stretch their 
scarce resources. In fact, one of the federally qualified health 
centers in my district in Louisa County has shared with us some stories 
about the impact of this program.
  Louisa County is one of the most rural counties in my district, and 
the Louisa County Health and Wellness Center is a federally qualified 
health center, and it is an invaluable resource for Louisa County and 
our local community.
  Discounts through the 340B program allows the Central Virginia Health 
Services and the Louisa County Health and Wellness Center to offset the 
costs of providing nonprofitable services, such as dental and 
behavioral health. The savings from 340B allows Central Virginia Health 
Services to have a strong clinical pharmacy team that provides 
extensive support with Medicare annual wellness visits, medication 
compliance with complex patients, managing its hepatitis C program, and 
overseeing diabetic initiatives. Most importantly, the 340B savings 
allows Central Virginia Health Services and other federally qualified 
health centers to offer substantial sliding fee discounts to patients 
regardless of whether or not they have insurance.
  The Federal grant only covers about 40 percent of the cost of 
treating a patient, and the rest comes from 340B savings. So let me be 
clear on that: It is the savings that federally qualified health 
centers receive because they are able to participate in this program. 
Because the drugs that they are prescribing and giving to their 
patients cost less, those savings they are able to invest elsewhere. In 
the case of Louisa County, they are putting those dollars into dental 
and behavioral health.

  The intent of the 340B program for the past 30 years has been to help 
stretch Federal resources for the benefit of the taxpayer, and this is 
a great example of exactly how that is happening back home in 
Virginia's Seventh District.
  Madam Speaker, I yield to the gentleman from Illinois (Mr. Garcia) to 
speak on this important program.
  Mr. GARCIA of Illinois. Madam Speaker, I thank Representative 
Spanberger for organizing this Special Order.
  I, like the previous speakers, rise in support of the 340B drug 
pricing program. This little-known program represents only about 3 
percent of the total drug sales in our country, but it is one of the 
most far-reaching health programs, especially for folks in my district.
  Let me share a story of an elderly patient at Erie Family Health 
Centers, which is based in my district. She had no insurance and 
struggled to afford her diabetes medication. Sadly, this is far too 
common in my district. The price jumped to $200, and she could not 
access her pharmacy during the COVID-19 crisis. But thanks to the 340B 
program, this patient now pays $9 for her medication, and it is 
delivered for free, straight to her home.
  This patient is not alone. Many Erie patients would not be able to 
obtain their insulin without the 340B discount. Unfortunately, this 
program is currently under assault on several fronts. We have to stand 
up. And we must protect it.
  Community health centers are under tremendous pressure to keep their 
doors open while caring for the most impacted. The timing could not be 
worse for pharmaceutical manufacturers to undermine such a critical 
program. The 340B program provides lifesaving medication for nearly 1.5 
million patients of Illinois community health centers as well as 
housing, transportation, care management, and more.
  We must defend this crucial program. It is literally a lifeline for 
communities like mine.
  Ms. SPANBERGER. Madam Speaker, I thank my colleague from Illinois for 
providing such an important story, illustrating the value of the 340B 
program in Illinois, and those stories exist across the country.
  I now yield to the gentleman from Tennessee (Mr. Rose), as we 
continue our discussion about the value of this program.
  Mr. ROSE. Madam Speaker, I want to talk a little more about the 
importance of H.R. 4390, the PROTECT 340B Act of 2021, which was 
introduced by the gentleman from West Virginia (Mr. McKinley), my 
friend, and is co-led by the gentlewoman from Virginia (Ms. 
Spanberger), the lead organizer of this Special Order.
  Passage of the PROTECT 340B Act of 2021 is essential in order to push 
back against recent attacks on the 340B program.
  This bill would prohibit pharmacy benefit managers, otherwise known 
as PBMs, from discriminating against 340B providers or their contract 
pharmacies.
  The PROTECT 340B Act is supported by America's Essential Hospitals, 
340B Health, National Association of Community Health Centers, and Ryan 
White Clinics for 340B Access. To ensure PBMs are held accountable, it 
allows the HHS Secretary to impose civil monetary penalties.
  This is the definition of a good bill. It has broad, bipartisan 
support in the House as well as among outside groups, and it even has 
an enforcement mechanism that hits the bad actors where it hurts them 
most--their pocketbooks.
  Ms. SPANBERGER. Madam Speaker, I thank my colleague from Tennessee. I 
appreciate his talking about the PROTECT 340B program. I was so proud 
to lead this effort. And certainly, as we have heard today, Congress' 
intention for the 340B program is to support safety net providers and 
their ability to stretch their scarce resources and provide more 
comprehensive services to vulnerable patients.
  Congress certainly did not intend for the 340B program and those 
discounts to subsidize the profits of Fortune 100 pharmacy benefit 
managers, and I thank Mr. Rose for recognizing that.
  I was proud to work with my colleagues across the aisle to introduce 
PROTECT 340B to stop PBMs from, frankly, pickpocketing 340B discounts 
so that we can ensure the benefits of 340B reach the community health 
centers, the HIV/AIDS clinics, and the rural hospitals that Congress 
intended to support.
  I thank the gentleman from West Virginia (Mr. McKinley), who has been 
an absolute champion of this issue. I have been so grateful to work 
with him and his team every step along the way. His commitment to West 
Virginia, the safety net hospitals, the rural hospitals, and the 
communities that rely on 340B is apparent through his dedication to 
this.
  Our bill is in response to the stories that we have heard from 
pharmacists across our districts. PBMs have established two tiers of 
payment for pharmacy-dispersed drugs, one for chain and retail 
pharmacies unassociated with 340B providers, and another significantly 
lower rate for 340B pharmacies.
  Years of market consolidation have given the three leading PBMs 
incredible market power, and they can effectively dictate terms to 
smaller 340B pharmacies. What that means is PBMs are essentially 
pickpocketing 340B savings from safety net providers. Instead of 
helping the healthcare safety net reach more patients, the 340B savings 
are subsidizing the profits of some of the largest, most profitable 
companies in America, and that means that those safety net hospitals, 
those rural hospitals, those federally qualified health centers are not 
able to put those savings toward care to patients.
  Our PROTECT 340B Act would hold PBMs accountable and prevent them 
from applying these predatory business practices to the local health 
centers, the rural hospitals, and other Federal grantees. It would also 
create a national clearinghouse to track 340B discounts and make sure 
340B drugs are not included in States' Medicaid rebate requests. 
Together, these changes

[[Page H5329]]

would restore the integrity of the program and protect the healthcare 
safety net so many of our constituents rely on.
  I am proud that for over the past 2 years many States, including 
Virginia, have passed laws to protect the healthcare safety net from 
these predatory business practices, but it is not enough. A Federal 
standard is necessary to ensure consistent and broad protections for 
healthcare providers and, importantly, to actually ensure that we are 
enforcing the law, and we are seeing momentum toward that moment. 
Currently, our bill has more than 90 cosponsors, and I welcome the rest 
of our colleagues to join our effort. Certainly, from tonight, people 
should be able to see this is an issue that many people from across the 
country and across the aisle certainly can get behind, and I urge my 
colleagues to consider joining us in this legislation.

                              {time}  2015

  Madam Speaker, I am happy to yield time back to the gentleman from 
Tennessee (Mr. Rose) to continue this conversation and education about 
the value of the 340B program.
  Mr. ROSE. Madam Speaker, again, I thank the gentlewoman from Virginia 
for yielding, and I join her in calling on our colleagues to join us in 
this effort to preserve and protect the 340B program.
  I will share a success story that highlights how Members worked in a 
bipartisan way to solve a major issue within the 340B program.
  Because of the COVID-19 pandemic, some hospitals lost their 340B 
eligibility due to the influx of COVID-19 patients that overwhelmed 
some hospitals and diminished their ability to meet the requirements of 
the 340B program. Two of those hospitals were in my district in rural 
Tennessee. However, the gentlewoman from California, Representative 
Matsui, introduced H.R. 3203, which was designed to restore eligibility 
to hospitals that lost their 340B status due to the pandemic. I was 
proud to lend my name as a cosponsor to this bipartisan bill.
  I am happy to report that because of this bipartisan support and the 
leadership of Members like Representative Matsui, this issue was fixed 
in section 121 of the Consolidated Appropriations Act of 2022. Because 
of this bipartisan effort, I am pleased to report back that both 
hospitals in my district in Tennessee have since regained that 340B 
eligibility.
  Madam Speaker, I hope this story shows that Members are capable of 
protecting and strengthening the 340B program in a bipartisan way.
  Ms. SPANBERGER. Madam Speaker, I thank and appreciate the gentleman.
  Madam Speaker, we have been joining together to recognize the 
importance of this program, ensuring that it is there to serve our 
communities. And I will give an example.
  Virginia Commonwealth University, or VCU, is the largest safety net 
hospital in Virginia, and it serves the greatest number of uninsured 
and Medicaid patients in our Commonwealth.
  Nearly three-quarters of VCU's payor mix is public or uninsured. I am 
proud that VCU has been a good steward of the discounts it receives 
through the 340B program, consistent with Congressional intent that the 
340B program be used to ensure these discounts can stretch Federal 
resources.
  The 340B program supports VCU's health systems' commitment to serving 
all members of the community, regardless of their ability to pay. And 
in 2020 alone, the program's savings helped VCU Health provide nearly 
2,100 patients with $27,300 discounted or free medications and over $64 
million in uncompensated care in fiscal year 2021.
  I am going to repeat that. The program savings, the savings that VCU 
was able to get through the 340B program, allowed them to provide $64 
million in uncompensated care.
  VCU has used its 340B discounts to stretch its resources and expand 
patients' access to care. For example, in just one year, one patient 
visited VCU's Emergency Department nearly 50 times. He was homeless, 
and he had multiple chronic conditions; so the emergency department 
referred him to VCU's Health Complex Care Clinic. There, thanks to 340B 
discounts, the patient received significantly discounted medications 
from the hospital pharmacy. Meanwhile, the clinic staff helped the 
patient find transitional housing and apply for Medicaid coverage.
  Over the next 3 years, the patient only had four emergency department 
visits. In 1 year, this man visited the emergency room 50 times because 
it was how he was able to get the healthcare that he needed. But thanks 
to the 340B program and how well it is utilized by hospitals like VCU 
and hospitals across the country, this man was able to get the medicine 
he needed through this program at a discounted rate. And the hospital 
was able to invest its resources in providing care and ensuring that 
this gentleman could get the medication he needed for his chronic 
illness and also find his way into transitional housing, apply for 
Medicaid coverage, and over 3 years, he had four emergency department 
visits.
  That is investing in the community, in better health outcomes, and 
this is exactly why this program was created. The discounts available 
through 340B helped providers like VCU meet the needs of their patients 
and certainly uphold the intent of 340B and the program as it was 
created 30 years ago.
  Madam Speaker, I yield to the gentleman from Tennessee (Mr. Rose), my 
colleague.
  Mr. ROSE. Madam Speaker, again, I thank the gentlewoman from Virginia 
(Ms. Spanberger). She has done a commendable job putting tonight's 
Special Order together, gathering support from both sides of the aisle 
to come speak here tonight about the 340B program, and being one of the 
Members leading the fight to protect the lifesaving 340B program.
  Madam Speaker, by their presence on the House floor tonight and the 
persuasive and powerful words they have spoken, these Members have sent 
the unmistakable signal that we are all resolutely prepared to fight on 
behalf of our constituents who benefit from the 340B program, even if 
it ruffles some powerful feathers.
  If Big Pharma would just play by the rules and abide by the law, I am 
sure we wouldn't be in the position we are today. However, the big 
pharmaceutical companies aren't playing by the rules, and they are 
showing no signs that they have an interest in doing so.
  All we are asking is that they, too, are held accountable to the law. 
That is it. Nothing more, nothing less. In the meantime, we will 
continue to push back on their brazen attempts to undermine the law 
because I know we are on the right side of this fight.
  I encourage all Members to reach out to the Federally qualified 
health centers, the Ryan White Clinics, Medicare/Medicaid 
Disproportionate Share hospitals, rural hospitals, and children's 
hospitals in your districts that are 340B participants. You will find 
that the 340B program has an enormous impact on communities all across 
this country.
  Lastly, I reiterate my support for H.R. 4390, the Protect 340B Act, 
and I sincerely beseech House leadership to bring the bill to the floor 
for a vote.
  Ms. SPANBERGER. Madam Speaker, I thank Mr. Rose and his commitment to 
this issue, and I thank him for joining me in this Special Order hour. 
It has really been a wonderful experience to hear from our colleagues 
from across the country and across the aisle talk about the value of 
this program.
  Certainly, we heard Mr. Thompson of Pennsylvania talk about the 
impact that the 340B program has on hospitals; their ability to 
operate, their ability to provide their service, and their ability to 
be there for their patients, the importance that this program has to 
the operation of our healthcare system here in the United States.
  We heard from Mr. Pappas of New Hampshire, stories of particular 
people's experience, that thanks to the 340B program, patients with a 
need in communities wanting to serve their constituents have been able 
to ensure that people who need medication can get it through the 340B 
program.
  Mr. O'Halleran of Arizona highlighted the value of this program in 
rural communities across the United States. And Mr. Davis of Illinois 
talked about the creation of Federally qualified health centers and how 
vital the 340B program is to their ability to serve their patients, 
their communities, and our communities.
  Mr. Garcia of Illinois told a really specific story about the impact 
of 340B on a patient with diabetes and what he

[[Page H5330]]

is hearing directly from constituents. And certainly, Mr. Rose, in our 
comments back and forth, my colleague and I have talked about the value 
of this program, the intent of this program, and our efforts to ensure 
that pharmaceutical companies and pharmacy benefit managers are not 
breaking the law and are not raiding the coffers of the 340B discount 
program.
  Madam Speaker, I close out tonight by just thanking all of the 
Members who came to the floor, all of the Members who support 
legislation to support this vital program, and all of the Members who 
recognize the value of the 340B program within their district. Again, I 
give a very special thanks to my friend from Tennessee that helped 
manage the floor during this Special Order hour.
  Since it came into being nearly 30 years ago, 340B has enabled a 
strong healthcare safety net that has served thousands of communities 
and millions of patients. It has been a lifeline for hospitals, health 
centers, and clinics that serve patients with low incomes, especially 
those who are uninsured or on Medicaid and those in rural areas. It has 
done so with strong bipartisan support and without costing any taxpayer 
dollars. Again, these savings allow our communities' hospitals to 
stretch those Federal dollars, to save those Federal dollars. This 
program does not cost a single taxpayer dollar.
  The 340B Drug Pricing Program is a success story for patient access 
to care. We should celebrate it. We should protect it. We should defend 
340B.
  Madam Speaker, I yield back the remainder of my time.

                          ____________________