Committee weighs 340B reporting in H.202; hospitals warn some data requests are infeasible

At a March committee hearing, legislators reviewed proposed Section 3 of H.202 — language now being embedded in H.266 — that would require hospitals to file annual reports to the Green Mountain Care Board on participation in the federal 340B drug-pricing program.

The Vermont Association of Hospitals and Health Systems told the committee it supports reporting but urged a Maine-style approach that yields useful high-level data without imposing undue administrative burden. “We do support reporting requirements in H.266. We really appreciate the committee’s effort on this,” said Devin Green of the Vermont Association of Hospitals and Health Systems.

The proposed section would ask hospitals to report items including: aggregated acquisition cost for 340B drugs, aggregated payment amounts received for those drugs, aggregated payments hospitals make to pharmacies and vendors, administrative and staffing costs tied to operating 340B, the number of claims by payer type, the hospital’s estimated annual savings from 340B, examples of top drugs purchased through 340B, and a description of internal oversight of the program.

Hospitals warned several of those items are difficult to produce from existing systems. Jonathan Reynolds, vice president of clinical operations at Rutland Regional Medical Center, told the committee that payments for hospital encounters are typically bundled by insurers, so the hospital cannot reliably separate the portion of a payer’s payment that corresponds solely to a 340B drug. “In our revenue cycle ... we’re not able to come to that aggregated payment amount,” Reynolds said, adding that producing that number would require reworking billing systems, electronic medical records and likely adding staff.

Hospitals also raised a separate concern about how detailed data could be used by drug manufacturers. Devin Green said manufacturers have in some cases used detailed data to “reverse engineer” program activity and press for program changes; hospitals want predictable, limited reporting parameters to reduce such risk. Committee members asked whether state law could prohibit manufacturers from using the data in that way; hospital witnesses said a statutory prohibition could help but expressed doubt about enforceability against nationally acting manufacturers.

Several members and witnesses proposed alternative collection approaches to reduce hospital burden. Pharmacy representatives and a witness from the wholesalers recommended using wholesaler-distribution data: wholesalers track shipments and identify which units are 340B-eligible and could supply many requested data points centrally. “The wholesaler knows exactly what is 340B ... in the utilization in the state of Vermont and the entire country,” said Jeff Hochberg, a pharmacy representative, who argued wholesaler reporting would “eliminate the burden from the hospitals.”

Legislative counsel, Jen Harvey, said revised language (draft 1.1) is posted for the committee and described the main changes: removing insurer and PBM reimbursement provisions from the bill, embedding the Section 3 340B reporting requirement into H.266, and directing hospitals to submit reports annually to the Green Mountain Care Board for posting on the board’s website. Harvey also said the bill as drafted would make the first report due July 1, 2026.

Committee discussion focused on three implementation questions: which reporting methodology to adopt (Maine-style aggregate reporting versus Minnesota-style, more detailed reporting), how long the requirement should remain in place (a sunset), and which state office should be looped in on use of the data. Hospital witnesses recommended a Maine approach and suggested a shorter sunset; the Office of the Health Care Advocate and the Green Mountain Care Board representatives urged a longer transition to achieve consistent reporting. Committee members discussed sunsets ranging from two to five years; the Office of the Health Care Advocate recommended five years, and hospital witnesses suggested three.

The committee did not take a formal vote. Members directed sponsors and staff to refine proposed language: sponsors to compare Maine and Minnesota models and propose specific reporting elements; legislative counsel to update the draft (posted as 1.1) to reflect committee directions; and staff to consider a sunset period and an explicit statement of purpose describing how the data would be used. Members also requested that the committee consult the Office of Health Care Reform and the Green Mountain Care Board about capacity to analyze any collected data.

Next steps: sponsors agreed to meet and return revised language for the committee to review at its next convening, when members said they might consider a vote after reviewing the updated draft and the side-by-side methodology comparison.

Ending — procedural note: Jen Harvey indicated the revised language and deadlines are posted and that committee staff will bring updates at the next meeting; no formal action was taken at the hearing.