Senate’s Second Hearing on 340B Drug Pricing Program

Last week, the Senate’s Health Education, Labor and Pensions (HELP) Committee held its second 2018 hearing on the utility of the 340B Drug Pricing Program, a Medicaid rebate program first adopted in 1992 to provide “to safety net providers the same kind of relief that Congress provided to the Medicaid Program.”

According to AIDS United, the testimony from federal entities centered around, “a desire to see increased transparency from both the safety net hospitals and pharmaceutical manufacturers and…wanting to ensure that the 340B program stays true to its original intended purpose,” of stretching federal resources and expanding services to eligible patients. AU add that “Ryan White clinics and community health centers already face stringent reporting requirements.”

The tone of the hearing was somewhat more supportive to 340B recipients than was the first one held last March 16. Senator Susan Collins (R-ME) said that limiting or eliminating the Program in her state would “decimate the state’s safety net hospitals.”

Even Senator Cassidy, who introduced the 340B PAUSE bill in the Senate last January to impose a moratorium on new 340B program participants, said of the safety net hospitals that, “some of their patients…they only got medicine because of this program”. He insisted, however, on the need for greater transparency because “there are issues with how it is currently being done.”

Last week’s hearing featured testimony from the Office of the Inspector General and the Government Accountability Office. A third hearing will be held by the committee later in the year and feature testimony from the Health Services and Resources Administration. A C-Span recording of the May 13 hearing is available here.

Medicaid Work Requirements Watch

Virginia’s General Assembly is still on the fence regarding Medicaid Expansion and work requirements. Its House of Delegates passed a state budget version in early April that included Medicaid expansion under terms that would, according to the Washington Post, make coverage available to 400,000 more of the Commonwealth’s poorest citizens.

Senate majority leader, Thomas Norment (R-James City), has been adamantly opposing any expansion and criticized the House’s work requirement as being too lenient, Politico reported, even after the House Appropriations Committee made them harsher by proposing “a state budget that models Medicaid work rules after Arkansas’ regs, which the Trump administration approved in early March.”

The Senate still hasn’t voted. Tension is mounting between Republican Senators and Governor Northam who ran last year on (among other things) a promise to get Medicaid expansion done. Northam opposes attaching work requirements, describing them, according to the Post as “just creating more bureaucracy”.

On May 22, Senate Republican leadership announced that they were delaying the budget vote for another week to give members more time to study the GOP’s latest revision of the plan, released last Monday. Senator Janet Howell (D-Fairfax) described this decision as a “last ditch obstructionist effort” to prevent Medicaid expansion.

Virginia’s budget has to be passed by July 1. The Republicans control both chambers of the Virginia legislature by a very small margin. Justin Fairfax, Virginia’s Lieutenant Governor, presides over its state Senate and is a Democrat. Politico pointed out that he may end up as the tie-breaker casting the deciding vote on Virginia’s Medicaid expansion.

View the latest HIV Policy Update here.