Hospitals and pharmacies debate 340B reporting amendments; committee delays HB1473

Stakeholders and lawmakers debated revisions to House Bill 1473, a measure tied to the federal 340B drug-pricing program and the use of contract pharmacies, but the House Committee on Industry, Business and Labor did not take final action and deferred further consideration.

Tim Blazell of the North Dakota Hospital Association and Andy Askew, vice president of public policy at Accenture Health, told the committee 340B is essential to keeping services open in rural communities. “This is a really important program for not just Accenture Health, but rural hospitals across North Dakota,” Askew said, noting Accenture Health operates 14 hospitals across Minnesota, North Dakota and Wisconsin and that critical access hospitals rely on contract pharmacies to dispense drugs the hospitals purchase through 340B discounts.

Askew presented an amendment that would require annual reporting to the Department of Health and Human Services describing how hospitals use savings from the 340B program to fund community programs and services, workforce, and to cover shortfalls in Medicare and Medicaid payments. He said the amendment aims to present a “holistic picture of how 340B is used” without imposing onerous data-sharing conditions.

Representative Schauer questioned the program’s original purpose, noting congressional language linking 340B to providers that serve low-income and underinsured patients. Askew replied that the statutory and committee history emphasize using 340B savings to “stretch federal resources to ensure access to comprehensive care,” and that federal audits already provide oversight. He challenged opponents to point to binding authority that restricts 340B savings to only charity care.

Representative Koppelman and others pressed for concrete data the committee can use: the share of prescriptions dispensed under 340B (excluding Medicare Part D), dollar savings per hospital, and how much of those savings are passed to contract pharmacies. Askew said his amendment did not include every specific data point lawmakers might request but that it was intended to provide meaningful transparency while protecting program functionality.

Mike Schwab of the North Dakota Pharmacists Association described how contract pharmacies and addenda can change pricing terms mid-contract and said the amendment’s opt-out provisions would give pharmacists a chance to exit unfavorable contract changes.

Tim Blazell said some hospital members viewed alternative amendments from drug manufacturers as effectively “gutting the bill” and that hospitals opposed reporting approaches that would require invasive data sharing with manufacturers. Committee members agreed to continue discussion and scheduled HB1473 for further consideration at the next meeting; Chairman Warray said parties would have additional time to share information.

The committee adjourned without taking a vote on HB1473 and planned to reconvene the following day to resume consideration of the bill and related items.