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. Madam Speaker, I rise today to speak about the 340B…
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.
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).
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).
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.
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).
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).
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.
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.
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
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.
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.
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.
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
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.