Committee backs bill protecting 340B participation for in-state hospitals and pharmacies; reporting amendment fails

The Industry, Business and Labor Committee voted to give House Bill 1473 a do-pass recommendation after several hours of debate over protections for hospitals and pharmacies participating in the federal 340B drug-pricing program and proposed reporting requirements.

Representative Ulmer moved adoption of an amendment submitted by hospital stakeholders; that motion was withdrawn and the committee instead considered a separate in-state pharmacy limitation offered by Representative Shower and seconded by Representative Koppelman. That in-state limitation'language, which would have made the bill apply only to physical contract-pharmacy locations in North Dakota, failed on a roll call (yes: 5; no: 7; absent: 2). The committee then considered the original bill.

The principal question in committee testimony and member remarks was whether the bill should pass without additional reporting requirements or be amended to demand more transparency about how 340B savings are used. Representative Johnson described the dynamic he sees between pharmacy benefit managers (PBMs) and pharmacies: "They're dwindling the pool" of pharmacies under contract and when drugs are dispensed outside contract pharmacies "the PBM gets to keep that discount," he said, arguing the bill is needed to preserve the program's benefits for hospitals and clinics.

Supporters, including Representative Casper and Representative Ulmer, said the bill protects rural hospitals, critical access hospitals and independent pharmacists from being squeezed out of the program by PBMs and manufacturers. Representative Casper told the committee: "This bill helps preserve and protect our North Dakota businesses."

Opponents and some members urged additional transparency. Representative Koppelman and Representative Ruby said they wanted reporting to show acquisition costs and where savings flow. Representative Koppelman described his objective as obtaining data to monitor whether health systems and pharmacies are sharing savings appropriately: "It would be nice to have...a breakdown" of where program savings are used, he said.

Representative Casper moved a do-pass on the original bill; Representative Johnson seconded. The committee adopted the do-pass recommendation on House Bill 1473 on a roll call of 10 to 2. The clerk recorded these votes for the do-pass motion: Vice Chairman Aussley: yes; Vice Chairman Johnson: yes; Representative Bail: yes; Representative Brown: yes; Representative Christie: yes; Representative Finley DeVille: yes; Representative Greenberg: yes; Representative Casper: yes; Representative Koppelman: no; Representative Ruby: no; Representative Shower: yes; Representative (Bulmer/ Ballmer in transcript): yes. The committee named Representative Ulmer as the bill carrier.

Why it matters: House Bill 1473 addresses state-level protections for participation in the federal 340B drug-pricing program, which stakeholders say provides revenue that hospitals and clinics use to support care for low-income and underserved patients. Passage from committee moves the bill to the floor; lawmakers debated whether to add reporting requirements to track program savings and their use.

Next steps: With a committee do-pass recommendation, House Bill 1473 advances toward floor consideration; members indicated the Senate could consider additional reporting or technical fixes if warranted.