A clash between hospitals and pharmaceutical manufacturers has become as painfully complex as the actual policy they are fighting about, and House Speaker Lisa Demuth, R-Cold Spring, is right in the middle of it.
The bill concerns 340B, a federal program where qualifying nonprofit hospitals get prescription drug discounts. The Minnesota Hospital Association loves 340B. The Pharmaceutical Research and Manufacturers of America hates it.
Related: Health deserts, hospital windfalls, and a phalanx of pharma lobbyists: Inside the most controversial healthcare program you never heard of
But the skimpily written federal law creating the program says little on how hospitals would dispense these drugs.
Hospitals want to establish as many contracts as they please with pharmacies to distribute these drugs, in order to milk revenue collected under 340B. Drug manufacturers want to limit hospitals to just one contract with one pharmacy in order to sell drugs at higher prices.
Last month, the Minnesota Senate passed by a 42-24 vote a measure to force drugmakers to recognize all 340B contracts that hospitals have with pharmacies. The Minnesota Attorney General’s office would enforce the pharmaceutical industry’s compliance.
Bill sponsor Matt Klein, DFL-Mendota Heights, said the legislation would help hospitals in dire financial straits, an assertion that is kind of supported by a Minnesota Department of Health report released last year on hospital’s 340B revenues.
“Without these funds, Hennepin County Medical Center would close, rural hospitals across our state would close,” Klein told reporters after the bill passed.
But with five days left until the legislative session ends, the House companion bill is stuck in the Health Finance Committee. It stalled because Republicans, including bill sponsor Natalie Zeleznikar of Fredenberg, did not want an enforcement mechanism.
But on Tuesday, House Republicans changed their tune. At least some of them.
“Right now, my position is that this is too important to not get this passed,” Zeleznikar said at a press conference. “And so the original bill is what passed in the Senate and that would have to be the bill that we use, yes.”
Zeleznikar said that she arrived at this determination after looking at other enforcement mechanisms, including Minnesota Board of Pharmacy, and finding them unsatisfactory.
Also Tuesday, Rep. Jeff Backer, R-Browns Valley and co-chair of the House Health Finance Committee, said he supports the version of the bill that includes attorney general enforcement.
“We need to help our Greater Minnesota hospitals,” Backer said.
Since presumably every DFLer, including House DFL leader Zack Stephenson and Health Finance co-chair Robert Bierman support the 340B legislation, we’re off to the races, right?
Well …
Backer said it is too late for House Health Finance to meet and pass the bill.
This is sort of true.
Per the legislative agreement signed by Demuth and Stephenson, it is too late in the legislative session for House Health Finance to convene. However, if Demuth and Stephenson wanted to, they could ignore their self-imposed rules.
As House Speaker, Demuth also has sole power to report a bill that passed the Senate to the House floor. Demuth has not yet reported Klein’s 340B bill to the House floor.
DFLers say Demuth wants to kill the bill.
“The Republicans are functionally in control,” said Rep. Tina Liebling, DFL-Rochester in an interview. “Even though we’re split, they have the speaker’s gavel and the speaker actually has a lot of power.”
“There are a bunch of bills that have come over from the Senate and she’s put them in a figurative drawer, hidden them and is sitting on them because she doesn’t want a debate and a vote,” Liebling said, using a gun control package passed by the Senate as an example.
Related: Why a bill helping Minnesota hospitals may be doomed
Via a spokesperson, Demuth said that she has not taken a position on the 340B bill. The spokesperson also said that she is not sure if Demuth has met with pharmaceutical industry representatives.
The spokesperson pointed out that there are other ways to bring the 340B bill to the floor including a motion to suspend the rules. However, the bill would need ⅔ of House members (or 90 out of 134 people) to advance after a motion to suspend the rules.
If the House does not take up the legislation, it could be rolled into a larger health policy bill that passes in the waning moments of the session. Stay tuned if you can stomach it.
