Mike Parson pushed to pass drug discounts on to Missourians. Why hasn’t it happened? | Opinion

We are on the brink of a health care crisis in Missouri. One in 5 Missourians lacks health insurance, and those who do have health insurance face increasing costs of premiums, deductibles and co-pays that are outside of the reach for many of our neighbors. This is further exacerbated by half the state’s residents reporting they have or have had medical debt in the last five years. These elements create a storm that traps families into a cycle of economic insecurity that has generational implications.

It shouldn’t be this way. Frankly, we deserve better. The Missouri General Assembly and House Speaker Jon Patterson have the opportunity to change the tide for Missourians across the state with House Bill 781.

You see, there is a federal program designed to improve drug accessibility and affordability for underserved patient populations, enabling them to better manage their health conditions. It should be helping to bridge this gap. Unfortunately, this plan — the 340B drug pricing program — has strayed far from its intended course with third-party profiteering and rampant abuse, and in many cases, it is failing our neighbors in the state who need it most.

The 340B program requires drug manufacturers to give discounted prices on outpatient prescription drugs to health care organizations classified as covered entities, and for-profit contract pharmacies. Instead of passing those savings to patients, some covered entities and contract pharmacies are currently profiting at more than three times what they are spending on 340B medications. One report found that the average profit margin on 340B medicines dispensed through contract pharmacies is an estimated 72%, compared with just 22% for non-340B medicines dispensed through independent pharmacies.

H.B. 781 would ensure that proceeds from dispensed 340B medications are used to benefit Missouri’s vulnerable patients, and would require annual reporting of entities who are currently benefiting from those revenues without transparency and accountability.

Legislative efforts like those Missouri advanced in 2024 are expected to represent an additional $1.9 billion in cost to employer-sponsored plans, and $273 million to state and local government plans across the country. Fortunately, our state legislators in Jefferson City are considering reforms that would help to fix the lack of transparency and oversight plaguing 340B — answering a call from former Gov. Mike Parson to ensure the program works for patients.

For the 340B program to work as intended, patients need to benefit. Yet, under current federal law and regulation, covered entities are not mandated to disclose how funds from discount 340B prices are being used, nor is there transparent oversight of how covered entities use funds to support patients. Without these guardrails, there is no guarantee that 340B resources are being utilized by hospitals in a way that benefits patients here in Missouri.

Close to 0% prescription relief

There are the bad actors in this space, and as with all stories, there are the good guys. Federal Qualified Health Centers those who provide health care to the underserved, community oncology clinics that provide cancer treatment far from Kansas City and St. Louis, and the Ryan White AIDS Drug Assistance Program are all prime examples of entities using the 340B drug pricing program in line with its original intent: “To stretch limited federal resources to reach more eligible patients and provide more comprehensive services” — funds to provide more care and assistance to my neighbors for whom it would be out of reach.

The deeper you dive into the data in Missouri, the worse the situation looks. Only 12% of 340B contract pharmacies in Missouri are located in low-income areas. Meanwhile, 61% of 340B hospitals in the state are below the national average for levels of charity care, in which free or discounted health services are provided to patients who cannot otherwise afford them.

I share a mission with my organization, Community Access National Network, to improve access to health care services and support for people living with HIV/AIDS and viral hepatitis. How can a federal safety net program help these vulnerable patients if the pharmacies they contract with are not even located in their communities?

It’s not just patient advocates who are concerned about the lack of oversight of 340B in Missouri. Then-Gov. Parson raised concern about the state of the program last year, writing in a letter to the Missouri secretary of state that “the 340B Program at large lacks requirements for cost savings to be passed on to patients and further lacks transparency as to how cost savings are to be used.” Sadly, reforms that Missouri passed last year do nothing to ensure drug discounts reach patients. In fact, this comes as patients are receiving close to 0% in prescription relief even though their medication was purchased at the 340B discounted price.

H.B. 781 would go a long way toward providing guardrails for the 340B program here at home. The law would ensure that proceeds from dispensed 340B medications are used to benefit our most vulnerable neighbors, and would require annual reporting of how that goal is met.

We urge Speaker Patterson to refer H.B. 781 to committee for hearing and for members of the General Assembly to deliver on last session’s legislative debate promises, ensuring that Missourians can benefit from the 340B program.