340B bill aims to stop reimbursement discrimination for covered entities; hospitals seek inclusion

Representative Tara Peters told the committee House Bill 784 would limit discriminatory reimbursement practices that divert the savings from federally authorized 340B drug discounts away from the covered entities and their patients. She said last year's bill addressed contract‑pharmacy restrictions and this year's measure seeks to recover an additional component proponents described as "pickpocketing." "All we're doing this year is bringing back one component of those 340B pieces that were left out," Peters said, explaining the bill aims to ensure 340B discounts reach the covered entity that is intended to use those savings to expand services.

Supporters testified that 340B discounts are intended to stretch scarce federal resources and to allow covered entities — such as federally qualified health centers (FQHCs) and certain specialty clinics — to provide more services to underserved patients. Morgan Shalimar (Missouri Primary Care Association) and Katie Richard Eiken reiterated that the bill is intended to close loopholes by requiring third‑party payors and PBMs to treat 340B transactions in a way that the discount accrues to the covered entity rather than being captured by intermediaries. Proponents described a complex flow: a drug's list price can be high and manufacturers provide discounts that should be retained by covered entities to fund clinical services, dental care, or staffing. Proponents said audits have not shown misuse by covered entities in Missouri.

Opponents, including Rob Monsas of the Missouri Hospital Association, said the bill as drafted excludes hospitals and urged that hospitals be included because they are longstanding participants in the 340B program; Monsas said hospitals account for a large share of 340B drug volume and urged the committee to expand protections to hospitals as well as FQHCs. Shannon Cooper, representing America's Health Insurance Plans, said the program has expanded and cited data suggesting the share of drug‑sales revenue flowing to charity care has not grown proportionally as the program expanded; she warned changes could have unintended consequences and called for additional transparency. Several insurers and business groups also testified in opposition or with concerns about details and oversight.

Representative Peters and proponents emphasized the bill is limited in scope and does not seek to expand 340B eligibility beyond the federal list; rather, they said the goal is to make sure savings are not diverted by payors or PBMs. Witnesses urged enhanced reporting, audits and targeted protections. The committee asked the sponsor technical questions about which entities the bill covers and whether independent pharmacies benefited from last year's contract‑pharmacy change; Peters and witnesses confirmed that contract pharmacy relief from last year remains in law and this bill focuses on additional reimbursement protections for covered entities that are not hospitals.

No committee vote occurred during the hearing. Members signaled they would continue negotiations; industry groups asked for more transparency and for clarifications on audit authority and covered‑entity definitions.