support 2355701 1920

Sending Office: Honorable David B. McKinley
Sent By:

Co-Sponsor Bipartisan Legislation to Improve the Health Care Safety Net and Protect 340B

Supported by: 340B Health, America’s Essential Hospitals, National Association of Community Health Centers, National Rural Health Association, Ryan White Clinics for 340B Access

Dear Colleague,

Representatives David B. McKinley P.E. (R-WV) and Abigail Spanberger (D-VA) invite you to cosponsor H.R. 4390, the PROTECT 340B Act of 2021, which would prohibit pharmacy benefit managers (PBMs)  from hurting hospitals and other providers that participate in the 340B drug pricing program.

This legislation is in response to concerns from safety-net providers, especially those in rural areas, who have seen their benefits from the 340B Drug Discount program threatened by PBMs, insurers, and in recent years. The 340B Drug Pricing program offers a lifeline to the neediest and most underserved patients in this nation by requiring pharmaceutical companies to provide drugs at discounted prices to specified clinics and hospitals.

Unfortunately, PBMs and insurers have found creative ways to take 340B savings away from safety net providers. Through discriminatory and complex contracting procedures, PBMs/insurers can redirect 340B savings away from safety-net providers and towards their own bottom lines, transforming a program Congress intended to support vulnerable patients’ access to life-saving medications into a subsidy for these for-profit, third party middlemen.


  • Generally prohibits health insurers and Pharmacy Benefit Managers (PBMs) from discriminating against 340B providers or their contract pharmacies on the basis of their status as providers or pharmacies that dispense 340B drugs by imposing different rules or reimbursement terms than are imposed on other providers or pharmacies.
  • Specifically:
    • Treating 340B providers and their contract pharmacies differently from other similarly situated providers and pharmacies with regards to:
      • Reimbursement (1)
      • Fees (including professional dispensing fees), adjustments, etc. (2)(A) & (B)
      • Participation in standard or preferred networks – (2)(C)
      • Audits and inventory management systems – (2)(D)
    • Interfering in patients’ choice to receive drugs from a 340B pharmacy, whether in person or by mail (3)
    • Requiring 340B providers or pharmacies to identify 340B drugs, other than for Medicaid purposes (4)
    • Refusing to contract with a 340B provider or contract pharmacy (5)
    • Imposing “Any other restrictions, conditions, practices, or policies that, as specified by the Secretary through rulemaking, interfere with the ability of a covered entity to maximize the value of discounts provided under section 340B.” – – (2)(E)
  • For PBMs:  The HHS Secretary will impose civil monetary penalties.
  • For insurers:  Section XXVII of the Act already contains enforcement mechanisms
  • Instructs HHS to contract with a neutral third party to serve as a clearinghouse for data needed to prevent duplicate discounts under Medicaid.  The contractor will collect data on 340B drugs reimbursed by Medicaid and state rebate data and ensure that those drugs are not included in States’ Medicaid rebate requests.

A summary of the bill can be found here.

Bill text can be found here.

If you are interested in learning more about the PROTECT 340B Act or would like to cosponsor please contact Kirsten Wing in Rep. McKinley’s office ( or Nicholas Widmyer of Rep. Spanberger’s office (



David B. McKinley P.E.                          Abigail Spanberger

Member of Congress                            Member of Congress