The 340B drug discount program is a federal program that, for decades, has mandated pharmaceutical makers provide deep discounts to drugs for Federally Qualified Health Centers, which care for predominantly lower-income Medicaid and uninsured patients, and likewise for safety-net hospitals, with similar patient populations.
In recent years, drugmakers have pushed back on ballooning use of the drug discounts by health systems and contract pharmacies. Drugmakers have restricted 340B discounts on prescriptions filled by contract pharmacies. In response, state legislatures have intervened in the federal program by requiring pharmaceutical manufacturers to distribute the discounted drugs to pharmacies that contract with 340B-covered providers.
Illinois' bill would do the same, but opponents are pushing for amendments to the bill to mandate more transparency from those who are eligible for 340B discounts, to show whether discounts are passed along or are otherwise truly benefiting low-income patients.
And pharmaceutical manufacturers, for one, wouldn't be unhappy if nothing comes out of the General Assembly this session and the program remains untouched.
"Rushing 340B legislation through Springfield without careful consideration ignores the program's lack of transparency and guardrails," said Stami Turk, a spokesperson for pharmaceutical trade group PhRMA. "This ultimately allows large, tax-exempt hospitals, pharmacy benefit managers, third-party administrators and for-profit pharmacies to continue profiting from markups at the expense of patients, employers and taxpayers. Lawmakers should take the time to understand how unchecked expansion of this program harms the communities it was meant to help."
Dr. Gary Kay, a medical oncologist with Northwest Oncology & Hematology in the northwest suburbs, said expansion and abuse of the 340B program has "accelerated health care consolidation as it provides an incentive for physicians groups to be purchased by hospitals that can access 340B," he said.
Private practices like his do not get the drug discounts, he said.
Kay said uncontrolled growth of the program has "completely subverted it," with suburban hospitals in affluent areas claiming eligibility for the discount program.
Kay said he doesn't want a state-by-state protection of contracting pharmacies, but, instead, federal government reform of the program to have the discounts "follow the patient" paying for discounts for the poor, not for entire health systems.
However, for Illinois health centers, state-level "inaction is not an option," Cyrus Winnett, chief public affairs officer at the Illinois Primary Health Care Association, said in a statement.
"The General Assembly must act this session to protect the 340B program and preserve access to care for the people who need it most," the IPHCA statement said. "We are encouraged by the progress we have made in Springfield this session to show the very real pain facing our health centers and our patients from 340B restrictions, and we are hopeful the Legislature will recognize that progress and approve these protections by May 31.
"With looming Medicaid cuts from Congress and ongoing inflationary pressures, the financial stability of our health centers is more fragile than ever. Every day without action allows pharmaceutical manufacturers to continue undermining the 340B program, compounding the harm to patients and providers alike."
Hospitals, too, note that Medicaid cuts make it important that the 340B legislation passes next week.
"The 340B program is a critical lifeline that helps hospitals stretch limited resources to serve vulnerable patients and communities throughout Illinois," Paris Ervin, senior director of media and public affairs at the Illinois Health & Hospital Association, said in a statement.
"Big Pharma has a massive financial interest in blocking this legislation," Ervin's statement said. "Defeating this bill means protecting their shareholders and hundreds of billions of dollars in annual revenue. These drug companies have brought their D.C. style disinformation smear campaign to Springfield, and are spending hundreds of thousands of dollars to mislead lawmakers in an all-out effort to dismantle this program."
With just over a week left in the 104th General Assembly session, health care bills are moving along, with some already headed to Gov. JB Pritzker's desk for signature.
House Bill 2517 has passed out of both houses and, upon signature, would add new anti-bias education requirements for providers of maternal health services. Providers would need to receive one hour of anti-bias training to renew their state license, starting July 26. The bill is aimed at improving maternal mortality for marginalized groups by educating providers on historic racial discrepancies in maternal care.
"As a country, the United States is the most dangerous place to give birth in the developed world, and it's three times as dangerous for Black people," Kelly Hubbard, director of policy and advocacy at EverThrive Illinois, said to Capitol News Illinois. That statistic comes from the Illinois Department of Public Health's 2023 Maternal Morbidity & Mortality Report.
Senate Bill 1560 will make Illinois one of the first states to guarantee universal mental health screenings for students in grades three through 12, if signed by Pritzker, according to a statement from state Rep. Lindsey LaPointe, D-Chicago, and Sen. Sara Feigenholtz, D-Chicago, who sponsored the bill.
The bill requires Illinois public schools to offer age-appropriate, confidential mental health screenings to proactively identify mental health concerns and link students with necessary support.
"No child should have to struggle in silence. This bill is a proactive way we can integrate early detection, because too often warning signs are missed or dismissed, and kids fall through the cracks," LaPointe said in a statement. "I'm thrilled to work alongside Sen. Feigenholtz and the state's Children's Behavioral Health Officer to ensure public schools have the tools to connect students and families with real help, and intervene before it becomes too late."
SB 291 is also on the governor's desk. The bill would create an interdisciplinary commission to study the interplay between animals, the environment and infectious disease within the Illinois Department of Public Health, Capitol News Illinois reports.
The One Health Commission would bring physicians, veterinarians, scientific professionals and state agencies together on the topics of public health and safety, particularly when it comes to diseases that originate or mutate in animals.
"I think it gives us an advantage so that we have a little bit to be prepared," bill sponsor Sen. Julie Morrison, D-Lake Forest, told Capitol News Illinois after the bill passed. "Hopefully there will never be another COVID or another avian flu, but it does give us kind of a leg up in how to plan and how to prepare for that."
The bill's passage comes after federal action in 2021 and 2023 instructed the Centers for Disease Control & Prevention to create a One Health framework in collaboration with other federal agencies. In February, the CDC launched the National One Health Framework in an effort to protect people, animals and the environment across America from zoonotic diseases, which are viruses or bacteria passed from animals to humans.
SB 0126, which would expand coverage of Alzheimer's disease care, is also heading to Pritzker's desk from the General Assembly.
The amendment to the Illinois Insurance Code builds on legislation signed last year ensuring coverage of Alzheimer's disease testing and treatment state employees insurance programs, by mandating private health insurance and managed care plans to cover the same. The bill calls for coverage of all medically necessary diagnostic testing and U.S. Food & Drug Administration-approved treatments or medications to slow the progression of Alzheimer's disease or other related dementia, and that they not be subject to step therapy.
The private insurance mandate would go into effect after Jan. 1, 2027.
SB 1288, also going to Pritzker, would educate food handlers on handling issues of food allergies, Capitol News Illinois reports.
The bill requires additional training in the hope that food handlers with a better understanding of such conditions will take allergies and cross-contamination more seriously.
It would cover celiac disease as well as training on allergies to milk, eggs, fish, crustaceans, tree nuts, wheat, peanuts, soybeans, sesame and food ingredients that contain protein derived from those allergens.
"It was really an easy bill to pass, because so many people now have some friends, neighbors and relatives that have celiac and are recognizing that and they just want to make sure that everybody is going to be healthy when they go out to eat," Sen. Sally Turner, R-Beason, said following the bill's passage. "It just might encourage more people to recognize that."
Meanwhile, HB 3489 is working its way through the Legislature. It would allow pharmacists to dispense contraceptives, including emergency contraception, without a doctor's prescription and provides that the state's medical assistance program shall cover patient care services provided by a pharmacist for contraceptives, including emergency contraception, rather than just hormonal contraceptives.
The bill expands the types of contraceptives pharmacists may dispense to include non-hormonal and emergency contraceptives such as Phexxi (non-hormonal), Plan B (levonorgestrel pill) and Ella (ulipristal acetate pill).
The bill passed out of the House Health Care Availability & Access Committee on March 18.