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Tribes urge HHS to exempt tribal health programs from 340B rebate model
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Summary
Tribal leaders warned that a proposed 340B rebate approach would raise upfront drug costs, create administrative burdens and risk closing tribal pharmacies. HHS said it is reviewing thousands of public comments and constrained by litigation but will consider exemption requests.
Tribal leaders at the HHS consultation urged immediate, explicit protections for tribal health programs in any revision to 340B drug-pricing policies, saying the proposed rebate model could undermine operations at tribal pharmacies.
Chief Brian Harris of the Catawba Indian Nation told HHS officials that a rebate model would ‘‘force tribal pharmacies to close’’ by creating cash‑flow and administrative burdens that many tribal programs cannot absorb. "Contract pharmacy arrangements are essential in many tribal communities — they are not optional," he said, asking HHS and HRSA to codify exemptions and reduce reporting requirements for tribal programs.
HRSA and CMS officials acknowledged the scale of public input and legal limits on regulatory action. HRSA said the agency had received thousands of comments during the public comment period and described court cases that have constrained prior regulatory approaches; HRSA officials said they are reviewing comments and exploring options within legal authorities.
Agency representatives cited rapid growth in 340B-covered sales as context for the review but said legal constraints and ongoing litigation limit immediate regulatory fixes. They committed to consider tribal exemption requests during rulemaking and to provide follow-up responses to questions submitted during the consultation.
Tribal speakers urged statutory or regulatory safeguards if possible, and asked HHS to explicitly protect tribal health providers — including IHS and tribal pharmacies — from downstream restrictions on access to 340B discounts. The agencies declined to promise a specific regulatory outcome at the meeting and said further work and consultation would continue.
