--- title: House Health Committee, March 5, 2026 collection: meetings id: 2026-03-05/house-health cite_as: House Health Committee, March 5, 2026, video https://vimeo.com/1170834056 (machine transcript by Georgia Commons) canonical_url: https://georgiacommons.org/meetings/2026-03-05/house-health md_url: https://georgiacommons.org/meetings/2026-03-05/house-health.md text_url: https://georgiacommons.org/meetings/2026-03-05/house-health/text source_url: https://vimeo.com/1170834056 date: 2026-03-05 status: machine transcript corpus_version: meetings-2026-10-23-8c15ead0f18d license: Machine transcript and summaries by Georgia Commons from the General Assembly's public video; the video stays on the General Assembly's Vimeo channel; see about.md publisher: Georgia Commons, an independent project of Georgia Civic Data. Not the State of Georgia. Not legal advice. up: https://georgiacommons.org/meetings/2026-03-05.md previous: https://georgiacommons.org/meetings/2026-03-05/house-regulated-industries-2.md next: https://georgiacommons.org/meetings/2026-03-06/house-higher-education.md index: https://georgiacommons.org/meetings/index.md chamber: House body: House Health Committee body_url: https://georgiacommons.org/meetings/house-health.md meeting_kind: committee session: 2025-2026 Regular Session start_time: 2026-03-05T14:30:00-05:00 location: 403 CAP duration_seconds: 7904.0 video_id: 1170834056 video_title: 3.5.26 Health agenda_url: https://www.legis.ga.gov/api/document/agendas/house/Health%2FHealth.Agenda.03.05.26.pdf bills_discussed: - HB 1089 - HB 810 - HB 139 summaries_model: gpt-6.1-sol transcript_turns: 575 transcript_chars: 148444 parts: - https://georgiacommons.org/meetings/2026-03-05/house-health.md?start=0 - https://georgiacommons.org/meetings/2026-03-05/house-health.md?start=59901 - https://georgiacommons.org/meetings/2026-03-05/house-health.md?start=119511 --- # House Health Committee, March 5, 2026 House Health Committee; March 5, 2026; 2025-2026 Regular Session. Video, on the General Assembly's Vimeo channel: https://vimeo.com/1170834056. Agenda: https://www.legis.ga.gov/api/document/agendas/house/Health%2FHealth.Agenda.03.05.26.pdf. > This is a machine transcript of the General Assembly's video, made by a speech-recognition model. It is not an official record and can mishear words, names, and numbers. Speakers are not identified. The video is the record: every timestamp links to the moment it plays. ## Summary written by Georgia Commons Written by gpt-6.1-sol from the transcript below. It is not part of the record. Quote the transcript or the video, not the summary. The committee approved [HB 1089](https://georgiacommons.org/bills/2025-2026/hb1089), which the sponsor described as allowing ivermectin purchases without a prescription through a pharmacist, and approved [HB 810](https://georgiacommons.org/bills/2025-2026/hb810) with an amendment changing its rural-area population threshold. Most of the meeting concerned [HB 139](https://georgiacommons.org/bills/2025-2026/hb139), addressing restrictions on pharmacies participating in the federal 340B drug discount program. Supporters said it would protect medication access and funding for safety-net services. Opponents raised concerns about transparency, healthcare costs, hospital consolidation and legal challenges. Members questioned conflicting testimony about reporting requirements and effects on the State Health Benefit Plan. The committee voted to table [HB 139](https://georgiacommons.org/bills/2025-2026/hb139) for further study. Complete vote counts were not stated. ## Bills discussed (3) Each account was written by gpt-6.1-sol from the stretch of the transcript it names. The bill's number is said in that stretch, unless it was the only bill on a committee's agenda. ### HB 1089. Controlled substances; ivermectin as an over-the-counter medication; provide [HB 1089](https://georgiacommons.org/bills/2025-2026/hb1089) (2025-2026 Regular Session). From [0:00:20](https://vimeo.com/1170834056#t=20s), turns 2 to 108. The sponsor said [HB 1089](https://georgiacommons.org/bills/2025-2026/hb1089) would allow people to buy ivermectin without a prescription, while keeping it behind the pharmacy counter. The sponsor described it as an antiparasitic medicine, called it safe, and identified pregnancy, breastfeeding, Coumadin use and solid-organ transplants as contraindications. One committee member questioned whether removing the prescription requirement would conflict with FDA rules and asked what problem the bill would solve. The sponsor cited Tennessee, Idaho, Utah and Arkansas as states allowing purchases without prescriptions, acknowledged that much of the information received was anecdotal, and expressed interest in more research. Another member asked about safeguards. The sponsor said patients would speak with a pharmacist and sign a register, giving pharmacists an opportunity to counsel them. The committee approved a do-pass recommendation after voice and hand votes. Opposition was recorded, but a complete vote count was not stated. Members briefly clarified the substitute's document number afterward. ### HB 810. Insurance; require that final reimbursements to pharmacies for prescription drugs are based on certain formulas [HB 810](https://georgiacommons.org/bills/2025-2026/hb810) (2025-2026 Regular Session). From [0:07:06](https://vimeo.com/1170834056#t=426s), turns 111 to 157. The sponsor presented a revised version of [HB 810](https://georgiacommons.org/bills/2025-2026/hb810), describing it as a compromise focused on smaller, independent pharmacies. In response to a member asking what had changed since the committee previously passed the bill, the sponsor said the earlier version covered large and small pharmacies, while the revision limited eligibility to ownership interests involving up to 10 pharmacies. The sponsor also proposed changing the rural-area population threshold from 35,000 to 50,000, saying 50,000 matched definitions used in recent legislation. The committee approved that amendment and then approved the bill as amended by voice vote. No opposing votes were heard in the transcript, and no numerical tally was announced. ### HB 139. Pharmacies; prohibit drug manufacturer and wholesalers from preventing a licensed pharmacy from acquiring drugs from entities that participate in a particular federal drug discount program [HB 139](https://georgiacommons.org/bills/2025-2026/hb139) (2025-2026 Regular Session). From [0:10:42](https://vimeo.com/1170834056#t=642s), turns 159 to 574. The sponsor said [HB 139](https://georgiacommons.org/bills/2025-2026/hb139) would prevent manufacturers and wholesalers from restricting 340B drug deliveries, interfering with covered entities' pharmacy contracts, or conditioning access on data beyond legal requirements. The sponsor said restrictions had reduced participating pharmacies and threatened funding for services such as dialysis and cancer care. Supporting legislators, pharmacists, and hospital and health-center witnesses said local pharmacy contracts supported affordable medicines, delivery and safety-net services. A Georgia Hospital Association witness said voluntary data sharing would remain allowed. Members questioned reporting, fraud safeguards, state-plan costs, legal authority and results elsewhere. The sponsor said existing oversight was sufficient but had no quantitative results from other states. An independent rural oncologist opposed the bill, saying it would strengthen hospitals' financial advantage and accelerate consolidation. Manufacturer witnesses and PhRMA disputed supporters' reporting claims and said lost rebates increased employer and government-plan costs. A Johnson & Johnson witness estimated additional annual costs of more than $22 million for businesses and workers and $3 million for government plans, and warned of constitutional challenges. The chair relayed a State Health Benefit Plan statement that 340B claims were excluded from rebate guarantees. A Healthcare Distribution Alliance witness requested removing wholesalers. A witness for Mended Hearts and Georgia First urged stronger transparency and patient protections. The committee voted to table the bill for further study; no complete tally was announced. > The transcript runs 148,444 characters. A reader that cannot take it at once can read it in 3 parts: part 1 https://georgiacommons.org/meetings/2026-03-05/house-health.md?start=0; part 2 https://georgiacommons.org/meetings/2026-03-05/house-health.md?start=59901; part 3 https://georgiacommons.org/meetings/2026-03-05/house-health.md?start=119511. ## Transcript (575 turns) [0:00:02](https://vimeo.com/1170834056#t=2s) Okay, it is 2:30 and, uh ... Oh, thank you. [0:00:07](https://vimeo.com/1170834056#t=7s) Yeah. [0:00:07](https://vimeo.com/1170834056#t=7s) We have a quorum, so we're gonna go ahead and begin our meeting now. Um, appreciate all y'all coming today. Um, and, uh, we've got some important bills. We're gonna first take up HB1089. Uh, Representative Mathiak, you can do, go from there. [0:00:24](https://vimeo.com/1170834056#t=24s) Thank you. Thank you, Mr. Chairman. I sure appreciate that. Oh, thank you everybody for being here today. This is a very simple bill, and I know you hear this all the time, but all it, all this bill is doing is allowing people to buy ivermectin over the counter. They're ... It will be behind the counter. The pharmacists have, um, agreed to that, and that's basically the bill, Mr. Chairman. [0:00:54](https://vimeo.com/1170834056#t=54s) Okay. [0:00:54](https://vimeo.com/1170834056#t=54s) Um, I would like to t- tell you a little bit about it if, if you care to hear that. [0:00:58](https://vimeo.com/1170834056#t=58s) Sure. [0:00:59](https://vimeo.com/1170834056#t=59s) Okay. Um, this is a anti- antiparasitic drug. It was developed in 1980 and approved by the FDA in '87. It paralyzes or kills, um, certain parasite organisms, and it is a safe drug. It won the N- Nobel Peace Prize. Um, it's FDA approved for intestinal parasites and worms. Um, it does treat external, um, parasites such as hes- head lice. [0:01:32](https://vimeo.com/1170834056#t=92s) Um, and it's usually used with animals. And, um, I don't know how much I can say about my patients. I'm not using any names, but I have patients that use this frequently. Some of them, I think, are over taking it, but, um, they tell me all kinds of, um, symptoms that are eliminated. Um, something got brought to me yesterday about some of our mission- missionaries that go to other countries, and they use it when they come back from another country, and it's, it's helping some intestinal problems with them too. [0:02:10](https://vimeo.com/1170834056#t=130s) All right. [0:02:11](https://vimeo.com/1170834056#t=131s) I hadn't even, hadn't even thought about that until yesterday. [0:02:14](https://vimeo.com/1170834056#t=134s) Right. [0:02:15](https://vimeo.com/1170834056#t=135s) Contraindications are pregnancy, breastfeeding, Coumadin, and if you have any kind of solid, um, organ transplant. [0:02:23](https://vimeo.com/1170834056#t=143s) Right. [0:02:23](https://vimeo.com/1170834056#t=143s) Those medicines are not compatible with ivermectin. [0:02:27](https://vimeo.com/1170834056#t=147s) Right. Okay. Are there any questions? Representative Gisler, is that you? [0:02:33](https://vimeo.com/1170834056#t=153s) Yes. [0:02:34](https://vimeo.com/1170834056#t=154s) Yeah, go ahead. [0:02:35](https://vimeo.com/1170834056#t=155s) Thank you, Mr. Chairman. Um, I, I have a lot of concerns with the bill, honestly, but probably the biggest one is doesn't this set up a conflict between the State of Georgia and the US Federal Drug Administration? Uh- [0:02:48](https://vimeo.com/1170834056#t=168s) Not that I'm aware of [0:02:49](https://vimeo.com/1170834056#t=169s) ... I mean, human consumable ivermectin is approved for use, you know, in humans by the FDA- [0:02:55](https://vimeo.com/1170834056#t=175s) Right [0:02:55](https://vimeo.com/1170834056#t=175s) ... but with a prescription, and this would say in the State of Georgia a prescription is not required. [0:03:00](https://vimeo.com/1170834056#t=180s) Right. That's right. [0:03:03](https://vimeo.com/1170834056#t=183s) Would they- [0:03:03](https://vimeo.com/1170834056#t=183s) There's four, um- [0:03:04](https://vimeo.com/1170834056#t=184s) How does that work? [0:03:05](https://vimeo.com/1170834056#t=185s) ... states that do not have prescriptions, um, Tennessee, Idaho, Utah, and Arkansas. So it is, there is precedence. [0:03:15](https://vimeo.com/1170834056#t=195s) Okay. [0:03:16](https://vimeo.com/1170834056#t=196s) With- [0:03:16](https://vimeo.com/1170834056#t=196s) And a, and a follow-up question. [0:03:17](https://vimeo.com/1170834056#t=197s) Sure. [0:03:17](https://vimeo.com/1170834056#t=197s) What, what problem is this solving? Like, why do we need to make ivermectin available? [0:03:20](https://vimeo.com/1170834056#t=200s) Well, that's the million-dollar question, and that's really why I would like this to, so that we can do some more research. The, a lot of what I hear is anecdotal. Um, I live in a rural area, so a lot of my families that have farms use it for various reasons. [0:03:40](https://vimeo.com/1170834056#t=220s) Okay. I mean- [0:03:42](https://vimeo.com/1170834056#t=222s) And w- [0:03:42](https://vimeo.com/1170834056#t=222s) To be clear to everyone, I mean this was obviously highly politicized during COVID. [0:03:47](https://vimeo.com/1170834056#t=227s) Yes, it was. [0:03:48](https://vimeo.com/1170834056#t=228s) Is that a reason for the bill? [0:03:51](https://vimeo.com/1170834056#t=231s) It could be. I'm sure it, I'm sure that it was used, yes. [0:03:55](https://vimeo.com/1170834056#t=235s) Okay. That, I don't think I have anything else. Thank you. [0:03:57](https://vimeo.com/1170834056#t=237s) Thank you. [0:03:59](https://vimeo.com/1170834056#t=239s) All right. Representative Schofield, is that you? [0:04:01](https://vimeo.com/1170834056#t=241s) No, go ahead. No. I'm trying to turn it off. [0:04:02](https://vimeo.com/1170834056#t=242s) Davis, is that you? [0:04:06](https://vimeo.com/1170834056#t=246s) Yeah. Thank you, Chairman. Can you hear me? [0:04:08](https://vimeo.com/1170834056#t=248s) Uh, s- number two. [0:04:10](https://vimeo.com/1170834056#t=250s) Number two. [0:04:10](https://vimeo.com/1170834056#t=250s) Yeah. Oh, hold on. It's not gonna... Put, press your button, see if it'll... Yeah. [0:04:17](https://vimeo.com/1170834056#t=257s) Can you hear me okay? [0:04:18](https://vimeo.com/1170834056#t=258s) Now, now we got it. [0:04:20](https://vimeo.com/1170834056#t=260s) Thank you, Chairman. You said that it would be behind the counter? [0:04:23](https://vimeo.com/1170834056#t=263s) Yes, ma'am. [0:04:24](https://vimeo.com/1170834056#t=264s) And that, would that be classified as a safeguard, uh, so that the pharmacist can tell them what the side effects or what you need to be, you know- [0:04:35](https://vimeo.com/1170834056#t=275s) Yes, ma'am. That, anything... It's like Sudafed being behind the counter. [0:04:39](https://vimeo.com/1170834056#t=279s) Mm-hmm. [0:04:39](https://vimeo.com/1170834056#t=279s) Then the pharmacy has, um, opportunity to counsel with the patient. [0:04:47](https://vimeo.com/1170834056#t=287s) So when you say that it's... Uh, follow-up, please. [0:04:49](https://vimeo.com/1170834056#t=289s) Yeah. [0:04:50](https://vimeo.com/1170834056#t=290s) So when you say that it is over the counter, it's not like it's gonna be just placed out there? [0:04:55](https://vimeo.com/1170834056#t=295s) Right. That's correct. [0:04:56](https://vimeo.com/1170834056#t=296s) They would need to speak to the pharmacist before- [0:04:58](https://vimeo.com/1170834056#t=298s) That's correct [0:04:59](https://vimeo.com/1170834056#t=299s) ... they can access. [0:05:01](https://vimeo.com/1170834056#t=301s) Inside. [0:05:02](https://vimeo.com/1170834056#t=302s) Inside. [0:05:02](https://vimeo.com/1170834056#t=302s) Inside. [0:05:02](https://vimeo.com/1170834056#t=302s) They have to sign in. [0:05:04](https://vimeo.com/1170834056#t=304s) Okay. [0:05:04](https://vimeo.com/1170834056#t=304s) To keep a register. [0:05:05](https://vimeo.com/1170834056#t=305s) Okay, that's the main thing I wanted to hear. [0:05:07](https://vimeo.com/1170834056#t=307s) Yes. [0:05:07](https://vimeo.com/1170834056#t=307s) Thank you. [0:05:08](https://vimeo.com/1170834056#t=308s) Yeah. Representative Silcox. [0:05:10](https://vimeo.com/1170834056#t=310s) Thank you, Mr. Chairman. I was just curious, um, Representative Mathiak, how many other, um, states have it this way? [0:05:16](https://vimeo.com/1170834056#t=316s) Okay. There are four. Tennessee, Idaho, Utah, and Arkansas. [0:05:21](https://vimeo.com/1170834056#t=321s) Thank you. [0:05:23](https://vimeo.com/1170834056#t=323s) Okay. I see no other questions. Do I hear a motion? [0:05:28](https://vimeo.com/1170834056#t=328s) Make a motion to be passed. [0:05:30](https://vimeo.com/1170834056#t=330s) Second. [0:05:30](https://vimeo.com/1170834056#t=330s) All those in favor, say aye. [0:05:32](https://vimeo.com/1170834056#t=332s) Aye. [0:05:32](https://vimeo.com/1170834056#t=332s) Aye. [0:05:33](https://vimeo.com/1170834056#t=333s) All those against, say nay. [0:05:34](https://vimeo.com/1170834056#t=334s) Nay. Nay. [0:05:36](https://vimeo.com/1170834056#t=336s) Show of hands. All those in favor, raise your hand. All those... Okay. All those against, raise your hand. [0:05:44](https://vimeo.com/1170834056#t=344s) I'm going too quick. [0:05:46](https://vimeo.com/1170834056#t=346s) Oh, I'm sorry. All those in favor, raise your hands again. And, uh, and I apologize. [0:05:57](https://vimeo.com/1170834056#t=357s) Okay. All those against. How's that? Is that better? [0:06:05](https://vimeo.com/1170834056#t=365s) Just, just two? [0:06:06](https://vimeo.com/1170834056#t=366s) No. [0:06:06](https://vimeo.com/1170834056#t=366s) It, it, got three. Okay. All right. Thank you. Uh, let me finish that up though. Congratulations, you have due pass on HB1089, that's LC461504S. Okay, thank you. [0:06:24](https://vimeo.com/1170834056#t=384s) Mr. Chairman. [0:06:26](https://vimeo.com/1170834056#t=386s) Yes. [0:06:29](https://vimeo.com/1170834056#t=389s) Is that the bill number? [0:06:31](https://vimeo.com/1170834056#t=391s) Is [0:06:34](https://vimeo.com/1170834056#t=394s) that it? Is that the LC we have the bill? [0:06:36](https://vimeo.com/1170834056#t=396s) I'm confused. I think it's LC461500S. [0:06:42](https://vimeo.com/1170834056#t=402s) Substitute. [0:06:44](https://vimeo.com/1170834056#t=404s) We have a substitute. You, you brought a substitute? [0:06:46](https://vimeo.com/1170834056#t=406s) We have 04. Okay, okay. That's a whole thing. [0:06:49](https://vimeo.com/1170834056#t=409s) Yeah, 04S. [0:06:49](https://vimeo.com/1170834056#t=409s) Sorry. [0:06:49](https://vimeo.com/1170834056#t=409s) That's a different bill. That's, that's 82. [0:06:53](https://vimeo.com/1170834056#t=413s) I'm sorry. Thank you. [0:06:54](https://vimeo.com/1170834056#t=414s) You're testing me again. [0:06:55](https://vimeo.com/1170834056#t=415s) Never mind. Yes, I am, sir. I apologize. Thank you. [0:06:57](https://vimeo.com/1170834056#t=417s) That's okay. That's okay. Okay. [0:07:00](https://vimeo.com/1170834056#t=420s) Well, I knew that number. It's good there. [0:07:03](https://vimeo.com/1170834056#t=423s) Up next- [0:07:03](https://vimeo.com/1170834056#t=423s) Did you know it, Lisa? [0:07:04](https://vimeo.com/1170834056#t=424s) Uh, okay. Up next, HB810, uh, Representative or Chairman Jaspers. [0:07:15](https://vimeo.com/1170834056#t=435s) Thank you, Mr. Chairman. Yeah, members, this, uh, House Bill 108 is the bill we've been working on for the past month or so on the, about pharmacies. The bill set back, uh, to, as a compromise to have this bill move on, the bill really only, there's only a couple of changes. One, if you look on lines 22 through 23, we now reduce the number, we reduce the focus of the bill now to eligible pharmacies, and that's up to 10. [0:07:47](https://vimeo.com/1170834056#t=467s) You know, this is gonna be, is for really going back to looking at our independent pharmacies only. [0:07:52](https://vimeo.com/1170834056#t=472s) Ownership interest, yeah. Okay. [0:07:54](https://vimeo.com/1170834056#t=474s) Yes, sir. And then, uh- [0:07:57](https://vimeo.com/1170834056#t=477s) Yeah [0:07:57](https://vimeo.com/1170834056#t=477s) ... also, I want to ask the chairman's permission to make an amendment on line 24 to change that 35,000 to 50. 50 is b- what we normally have in any, uh, the bills of recent time for the description of a rural area. [0:08:14](https://vimeo.com/1170834056#t=494s) That's a good amendment. That's it? [0:08:17](https://vimeo.com/1170834056#t=497s) That's it. That's what the bill does. [0:08:19](https://vimeo.com/1170834056#t=499s) Any questions? Okay, do I have a motion on the bill? [0:08:24](https://vimeo.com/1170834056#t=504s) Second. [0:08:25](https://vimeo.com/1170834056#t=505s) Second? Oh. Oh. Sorry. Representative Gisler. [0:08:30](https://vimeo.com/1170834056#t=510s) Just had one quick question. Thank you, Mr. Chairman. Um, and, and I think it's probably a friendly question, but we passed this before and it came back again. Can you speak to what changed? [0:08:39](https://vimeo.com/1170834056#t=519s) Yes, that's it. I thought I did. Sorry, I didn't. [0:08:42](https://vimeo.com/1170834056#t=522s) You did. [0:08:42](https://vimeo.com/1170834056#t=522s) Okay, that's the- [0:08:43](https://vimeo.com/1170834056#t=523s) Sorry. [0:08:44](https://vimeo.com/1170834056#t=524s) Thought I did, but no, the, the original- [0:08:46](https://vimeo.com/1170834056#t=526s) Good [0:08:46](https://vimeo.com/1170834056#t=526s) ... bill covered all pharmacies, big and small- [0:08:49](https://vimeo.com/1170834056#t=529s) Mm-hmm [0:08:50](https://vimeo.com/1170834056#t=530s) ... from, you know, Walmart, Publix, to down to the Jasper Drugs. This now will b- focus, it takes out all the larger pharmacies, and you look on line 23, that's a group that has an interest of up to 10 pharmacies. So that's really now the bill focuses on independent, smaller pharmacies within our state. [0:09:13](https://vimeo.com/1170834056#t=553s) Okay. Thank you. [0:09:14](https://vimeo.com/1170834056#t=554s) Yes, sir. [0:09:14](https://vimeo.com/1170834056#t=554s) Sorry for making you repeat yourself. [0:09:16](https://vimeo.com/1170834056#t=556s) That's fine. That's fine. Okay, uh, on the amendment, do I hear a motion? [0:09:23](https://vimeo.com/1170834056#t=563s) So moved. [0:09:24](https://vimeo.com/1170834056#t=564s) I don't know if we did the amendment because I thought we got, you know, interrupted. We already did the bill. [0:09:29](https://vimeo.com/1170834056#t=569s) I think so, the bill. [0:09:33](https://vimeo.com/1170834056#t=573s) Again, then. Let's do it again on the bill. Third time. Do I hear a motion on the bill? [0:09:39](https://vimeo.com/1170834056#t=579s) So moved. [0:09:40](https://vimeo.com/1170834056#t=580s) Second? [0:09:41](https://vimeo.com/1170834056#t=581s) Second. [0:09:41](https://vimeo.com/1170834056#t=581s) Okay. Now the amendment. Do I hear a motion on the amendment? And please, one more time, read your amendment. [0:09:47](https://vimeo.com/1170834056#t=587s) The amendment is on line 24, change that 35,000 to 50,000. [0:09:54](https://vimeo.com/1170834056#t=594s) How about the, uh, 10 pharmacies? [0:09:56](https://vimeo.com/1170834056#t=596s) Oh, we're leaving that 10. [0:09:57](https://vimeo.com/1170834056#t=597s) Well, that's fine. I'm s- [0:09:58](https://vimeo.com/1170834056#t=598s) Yeah, we're leaving the 10 where it is. [0:09:59](https://vimeo.com/1170834056#t=599s) That's all right. Correct, correct. Okay. All those in favor of the amendment, say aye. [0:10:04](https://vimeo.com/1170834056#t=604s) Aye. [0:10:05](https://vimeo.com/1170834056#t=605s) All those against, say nay. Okay, the amendment passes. Now to the main bill. All those in fa- favor of the bill as amended, say aye. [0:10:13](https://vimeo.com/1170834056#t=613s) Aye. [0:10:14](https://vimeo.com/1170834056#t=614s) Aye. [0:10:14](https://vimeo.com/1170834056#t=614s) All those against, say nay. All right, congratulations. [0:10:18](https://vimeo.com/1170834056#t=618s) Thank you. [0:10:19](https://vimeo.com/1170834056#t=619s) You have HB810D Pass LC461500S. Okay. All right. Do, do we have another bill? I think we got one more, don't we? [0:10:35](https://vimeo.com/1170834056#t=635s) Yeah, we do. [0:10:37](https://vimeo.com/1170834056#t=637s) All right. Uh, now, uh, ha ha, HB139, Chairman Jones. [0:10:46](https://vimeo.com/1170834056#t=646s) There it is. [0:10:48](https://vimeo.com/1170834056#t=648s) Very well. [0:10:55](https://vimeo.com/1170834056#t=655s) Mr. Chairman Jones, can I see the stamps? [0:10:58](https://vimeo.com/1170834056#t=658s) Pardon. [0:11:00](https://vimeo.com/1170834056#t=660s) It's not moving. [0:11:05](https://vimeo.com/1170834056#t=665s) Or are you just, you know... [0:11:07](https://vimeo.com/1170834056#t=667s) Just making sure. [0:11:13](https://vimeo.com/1170834056#t=673s) Yeah. [0:11:14](https://vimeo.com/1170834056#t=674s) Sorry. [0:11:27](https://vimeo.com/1170834056#t=687s) Okay. [0:11:29](https://vimeo.com/1170834056#t=689s) Okay. Chairman Jones, you're ready to go. [0:11:32](https://vimeo.com/1170834056#t=692s) Thank you, Mr. Chairman. I'm just doing IT support right now. [0:11:35](https://vimeo.com/1170834056#t=695s) Oh, okay. [0:11:38](https://vimeo.com/1170834056#t=698s) No Wi- Not, no Wi-Fi network in here, right? [0:11:41](https://vimeo.com/1170834056#t=701s) Because you're not helping me. I just need that Georgia Bulldog help. Yeah. [0:11:47](https://vimeo.com/1170834056#t=707s) He went to Oregon. [0:11:48](https://vimeo.com/1170834056#t=708s) You're here. Yeah, I was like, I'm gonna have to be something soon. [0:11:57](https://vimeo.com/1170834056#t=717s) We have an attorney, we don't have a tech guy. [0:12:00](https://vimeo.com/1170834056#t=720s) What? [0:12:00](https://vimeo.com/1170834056#t=720s) We weren't, we weren't ready for Zoom. Yeah, we weren't, weren't ready for this. [0:12:03](https://vimeo.com/1170834056#t=723s) The Zoom flashing. [0:12:05](https://vimeo.com/1170834056#t=725s) Which we got [0:12:07](https://vimeo.com/1170834056#t=727s) We have some virtual, but we're getting there. Okay, we, we good? [0:12:13](https://vimeo.com/1170834056#t=733s) Um, one moment, sir. Right there, sorry. [0:12:27](https://vimeo.com/1170834056#t=747s) Chairman, are you ready or do you need me to wait? Oh, okay. [0:12:29](https://vimeo.com/1170834056#t=749s) Waiting on you. [0:12:30](https://vimeo.com/1170834056#t=750s) Just wanna make sure, sir. All right. [0:12:32](https://vimeo.com/1170834056#t=752s) Go ahead. [0:12:33](https://vimeo.com/1170834056#t=753s) All right. First of all, thank you very much, Mr. Chairman, members of the committee. Um, let me first say my hunch is your phones have been blowing up for about the last 15, 18 hours. My understanding is that dogs and cats will be living together, it'll be total anarchy. Um, but at the end of the day, in all seriousness, what this bill is about is very straightforward. Follow the law. It truly is that simple. This is just about following 340B within the federal statute, and then the regs that the department has made since the passage of 340B. [0:13:12](https://vimeo.com/1170834056#t=792s) I will be the first to say that if I could go back three decades and speak to DC, I would, because I think what we've seen has not been probably optimal and not what the intention of the bill authors and, you know, wanted to see through this program. The intent of the program was absolutely what it should be. The exercise of that program has, as usual, not been what was expected. But that doesn't change the fact that it still is law. It is still regs, ones that we shall follow. [0:13:45](https://vimeo.com/1170834056#t=825s) And not to get into what we do at the beginning of every term, but that little funky oath that we make regarding federal and state constitution and statutes. So what this is about, and I'm-- I'll take it through you quick, because obviously the committee saw some of this last year, but I just wanted to remind you of a couple of things before we go. So here we go. First-- Well, hold on. [0:14:13](https://vimeo.com/1170834056#t=853s) While I give you a few use cases in terms of what this is used for, let me be crystal clear. Money that is used that comes out of 340B funds, in some instances, one hundred percent of oncology programs, funds one hundred percent of dialysis programs. The payer mix that we're talking about at these particular institutions literally are sometimes of the effect that if without 340B, these programs would not be funded. [0:14:47](https://vimeo.com/1170834056#t=887s) This is one example with Chris Regional in terms of what they are doing with it, but in terms of the savings that are occurring. [0:14:56](https://vimeo.com/1170834056#t=896s) This is an example with WellStar in terms of the savings that have occurred because of 340B, and in addition to a little over one billion dollars of charity and uncompensated care, the community benefits being a myriad of things. I'm gonna go ahead and not read to you 'cause I'm not a fan of people reading PowerPoints to me, but I think what you can see is a myriad of different programs, both everything from pre and post, chronic, wellness, you name it. That's exactly what we're trying to do here with the 340B proceeds. [0:15:29](https://vimeo.com/1170834056#t=929s) And go quick, and I know I just said that wrong according to Cash-- to Chas Cannon, but at the end of the day, this is a pretty impressive amount of money that is moved through the program in order to ensure that literally oncology programs and dialysis programs stay in, in effect. I'll be frank with you, until I ran this bill, I was not aware that it even had an impact on those individuals who are incarcerated, and that was something that was pretty eye-opening to me. But again, this directly impacts their ability to take care of individuals that are, are, are incarcerated, and also relieves, in this case, the county taxpayers from that burden. [0:16:05](https://vimeo.com/1170834056#t=965s) This is St. Mary's, and again, I won't read through everything for you. I feel as if you guys can do that, but hopefully we wanted to give you a sense of not just one geographic area, but several. Sickle cell, um, I've spoken with a summer in between last year and this year, got a much better understanding of what this applies to regarding sickle cell, what it applies to regarding hemophilia, and we'll get that-- we'll get there in a moment. But at the end of the day, these are programs that are, again, one hundred percent funded. [0:16:37](https://vimeo.com/1170834056#t=997s) And I can't stress that enough, guys. This is not ninety-nine or ninety-five or ninety or eighty. In many instances, it's one hundred. Not all instances. I don't wanna be, you know, disrespectful to the committee and say it's always that. But I think at the end of the day, I think we need to be saying to ourselves, "This is the process that the feds have put in at the time." Look, I'd like to tell the five thirty-six, that of course is including one extra for the president, "We need to fix this." And I'm sure you're going to hear that from the people coming in to talk about the bill. [0:17:09](https://vimeo.com/1170834056#t=1029s) And I will say to you, you're right. It should be fixed. But until it is fixed, this is the program that we have. [0:17:18](https://vimeo.com/1170834056#t=1038s) There was comments made that this isn't affecting the contract pharmacist, and let me take a step back really quick. I'm sure you guys have read through this very short bill. And you'll see that basically there's a contract pharmacy arrangement, there's a covered entity, and then there's effectively that agreement between them allows them to basically distribute vis-a-vis the program. One of the things that was stated was that there has not been a reduction of contract pharmacists due to the 340B and the actions of some players within the ecosystem. [0:17:52](https://vimeo.com/1170834056#t=1072s) That has just been patently not true. I thought what I would provide to you are basically five instances or six instances where in fact we have seen a significant reduction, and that reduction from literally, you'll see on the upper left in Appling, we had four, now we have zero. And Dodge, you know, we went all the way down again to zero. Effingham, zero. Jefferson, six to two. The dollar figures that we're talking about that are lost are well, well into the millions of dollars by reducing the contract pharmacists. [0:18:25](https://vimeo.com/1170834056#t=1105s) Think about this for a second. I'm fortunate. I live in Forsyth County. I fall out of bed and I see six hospitals and 100 doctor's offices. That is just not the case in the southern end of our state, nor in, frankly, certain parts of the coast and up north. Imagine a time where the only way you could get your phar- pharmaceuticals is through, per se, a hospital. Imagine if you're sitting there maybe in Albany, or maybe you're sitting down in Clinch, or maybe you're sitting, you know, I guess maybe heading over to Lanier. [0:18:57](https://vimeo.com/1170834056#t=1137s) The fact is, is if there isn't a contract pharmacist close to you, there's a very good chance you will not take your preventative medicines. And now something that wasn't chronic is now chronic. We need to be able to provide access and provide that access appropriately. There again, I don't want to-- This is getting super technical, but I wanted to make sure that you knew, again, this is a federal law, and that's what this bill is saying. It's a federal law, and we'll go into the three things that this bill does momentarily. [0:19:28](https://vimeo.com/1170834056#t=1168s) But again, the idea here is to stretch the resources in such a way that we handle those that need it most. You will hear from folks that people are abusing this program. Guess what? I don't know if they are. But if they are, I highly encourage them to report them to the federal government, have the auditor investigate them, and have them stand in front of that department to determine, did you or did you not apply 340B correctly? [0:19:58](https://vimeo.com/1170834056#t=1198s) But it's not for anybody in this room or anybody else in this state to say that the law should not be followed. If you feel as if the law is not being followed, just like if you thought it was a criminal issue, go to your sheriff or go to your police department, go to the GBI, go to the FBI. In this case, go to the federal department and say, "This is what's happening," and have that conversation. In terms of who qualifies, I know there's always that question. I wanted to make sure that you guys understood who was qualifying for this and who was not qualifying. [0:20:29](https://vimeo.com/1170834056#t=1229s) A question was made regarding, for instance, for-profit. You don't see that on that list, and I wanna make sure that you guys have that. Benefits are a myriad of ones, and I think we've hit those, so I don't wanna belabor the point. In terms of how the savings work, this is where, frankly, if I could go back to the '90s, I would tell them this was an inefficient structure, just because of the fact that we're expecting such a transfer of cash and a transfer and an expectation of private companies like pharmaceutical companies to move at a certain dollar amount, and then that margin to be applied in a certain way. [0:21:05](https://vimeo.com/1170834056#t=1265s) It's just, I think there probably was a more elegant and simple solution. I don't know if Staples had created the Easy Button yet, but if they had, it needed to be hit. And right now, frankly, if I was redoing the bill, I would say we need to hit the Staples Easy Button because it is complex. There is no doubt that there is a spaghetti-like litany of regulations that cause this program to be challenging. But again, I'll come back to it is the program that we have to live with. So you're gonna hear from the opponents. You guys saw a bunch of this last year. [0:21:37](https://vimeo.com/1170834056#t=1297s) We updated it just a little bit. And by the way, I'm gonna s- show you a proponent slide here momentarily. But I think at the end of the day, the fact is I still wanna come back to everyone's entitled to their opinion, but what they're not entitled to is to unilaterally break the law. That's not part of anyone's power, no matter what private entity you are or publicly traded entity making billions of dollars with a market cap in the hundreds of billions, if not trillion. [0:22:07](https://vimeo.com/1170834056#t=1327s) The proponents, of course, will go ahead and move you through this. [0:22:11](https://vimeo.com/1170834056#t=1331s) I was surprised that even, you know, a few states have had to do this because of the fact that it just doesn't seem to be something that the state should have to do. We don't typically have to run a bill to tell everyone, "Follow the law." But that's in case what, in fact, what we're having to do here. So there's the conclusion, and if I could very quickly, Mr. Chairman, I'd like to just point out the three sections to the committee to be respectful. Everybody, if you could pass to-- if you could go to lines eighteen to twenty-two. [0:22:44](https://vimeo.com/1170834056#t=1364s) What this is essentially saying is that the flow of, I'm just gonna call them pharmaceuticals generally, but here it talks about drugs, but the flow of meds or the flow of pharmaceuticals will in fact occur underneath how the program lays it out. Lines twenty-three through twenty-seven effectively says you cannot, meaning you, a private entity, you cannot step in the middle of a valid contract, and we talk about that on the front of the bill. [0:23:15](https://vimeo.com/1170834056#t=1395s) That valid contract is between, in, in this instance, the covered entity and the f- and the contract pharmacist. The third is lines twenty-eight through thirty-four, and this basically says you can't require, meaning you, a participant in this program, typically a pharmaceutical company, can't require additional reporting or additional data on top of what the feds are already requiring. And again, I wanna make clear of the importance of the audits that already occur on 340B. [0:23:45](https://vimeo.com/1170834056#t=1425s) And again, that's for the feds to do, and if the feds find issues, then let that be the case. Last but not least, you saw the slide around our contract pharmacists. Others call them, and, and, and some are chains, but many of them are independent pharmacists, independent pharmacists that are a key to the health and the wellness of several communities in our state. They play a, such a critical role of being not just the hearts, but the lungs and the livers and literally the kidneys of what's occurring within those communities and being able to give those communities the ability To distribute not just the drugs, but also the programs and have those programs be successful, I think is absolutely a stalwart part of what makes up the community and the culture of rural Georgia, mountain Georgia, coastal Georgia, et cetera. [0:24:34](https://vimeo.com/1170834056#t=1474s) With that stated, sir, I'll stand for questions. [0:24:38](https://vimeo.com/1170834056#t=1478s) I see no questions right now. I think everybody's thinking. Well, now they, they've lit up. Okay, number 10 is, uh, Representative Clark, or who is... Oh, yeah. [0:24:50](https://vimeo.com/1170834056#t=1490s) Thank you, Mr. Chair, and thank you for your presentation. So I feel like, um, very often, um, in this chamber and just in general, we hear the, the phrase fraud, waste, and abuse. Like, it is... We hear it ad nauseam at this point. And so, um, for lines 28 through 34, um, is there any concern that by blocking, um, you know, requirements for, as you said, additional data, we keep the door open for possible fraud, waste, and abuse should it be happening? [0:25:30](https://vimeo.com/1170834056#t=1530s) And specifically, when we're thinking about the cost to the state, are you saying that, um, the state would not have an interest in having more information about how this, uh, program is being implemented and how much it's costing the state as well? [0:25:47](https://vimeo.com/1170834056#t=1547s) Representative, thank you very much for the question. I'd like to point you to the end of 33 and the beginning of 34, required to be furnished under applicable federal or state law. Clearly, we are o- at least I hope all of us do not wanna see fraud, abuse, and waste. However, I can assure you that the federal requirements on this, I'll say, reporting are very high. State requirements are high. I would join you not in amending this bill, but introducing another bill if we wanted to enhance what the state law was on reporting here to basically do that. [0:26:18](https://vimeo.com/1170834056#t=1578s) What I w- I'm saying or what the bill is saying in 28 to 34 is that an entity cannot just come in, a private entity, and just say, "Oh, and by the way, can you also give me these 14 pieces of data?" Well, hold on, I'm already giving literally a ream of data to the feds, a partial ream of data to the state. They are going through an audit every year through the feds. So the feeling is, is do I believe fraud and abuse and waste is occurring? I hope not, but if it is, the federal government has the authority and the ability to audit and bring, I'll say, penalties. [0:26:52](https://vimeo.com/1170834056#t=1612s) Now, you'll see in 35 through 40, we effectively put in there what would occur if you do break that. Now, that's for the people trying to break it in terms of requiring that type of in- in- information. But again, I'm with you. We don't wanna do it. I feel as if the fed and state law has it, and I would join you in a bill if you'd like to even enhance the state law. [0:27:10](https://vimeo.com/1170834056#t=1630s) All right. Um, can, can I just do a quick follow-up? Um, I hear what you're saying, and I love that. Honestly, um, this is my first time seeing this version of the bill, so I was actually going in and, um, comparing the notes from the last one, and the first version did not have it written that way. So, um, I, uh, appreciate that. I guess, um, looking at it from the, um, other perspective, if you are a business owner and you would like to, um, know that the thing that you're doing, the, uh, the intended purpose is actually happening, are you saying that they should not have access to the same data that the feds and the state have so that they can know that what they're doing... [0:28:00](https://vimeo.com/1170834056#t=1680s) Because this is costing them money, too. Like, as a business owner, wouldn't you wanna know how things are being implemented? [0:28:06](https://vimeo.com/1170834056#t=1686s) Sure. And every bit of that submittal is public record. So, like, so if... What, what, what's moving, just go ahead and take the information that they're, they are supplying to the feds and to the state. We're talking about incremental. [0:28:19](https://vimeo.com/1170834056#t=1699s) Thank you. [0:28:20](https://vimeo.com/1170834056#t=1700s) You're welcome. [0:28:21](https://vimeo.com/1170834056#t=1701s) Chairman Jasper. [0:28:22](https://vimeo.com/1170834056#t=1702s) Oh, thank you, Chairman. Okay, so yes, we got this sprung on us, so I had to lock my door a little while ago to keep the hordes out, uh, to so I could just look at this myself and just, um, try to figure out exactly what we're doing. I remember it from last year, but, you know, um, and I, and I think I will recognize, I mean, um, we're gonna have all these people talk in a minute, but what this does for rural hospitals. I mean, there's no, no question about that. But from what you said, Chairman Jones, this bill, this program is already, uh, working. [0:29:00](https://vimeo.com/1170834056#t=1740s) Is it not true? [0:29:01](https://vimeo.com/1170834056#t=1741s) Oh, yes, sir. Yes, sir. [0:29:03](https://vimeo.com/1170834056#t=1743s) Then why do we need this bill? [0:29:05](https://vimeo.com/1170834056#t=1745s) Because you have actors who are effectively usurping the, I'll say, the operation of 340B, and I'll give you an example. We have operators within the ecosystem that are claiming that a covered entity can't have the number of contract pharmacists or independent pharmacists that they would like to have underneath there. So that's why we had to put Chairman Jasper's lines 23 through 27. [0:29:30](https://vimeo.com/1170834056#t=1770s) Sure. It just seems like that it's, I guess from what I'm just, you know... Of course, you know more about it than we do on this, but it seems like it's working, and it seems like it's, the abuse in it is rampant, just by your own testimony within this program. I mean, it seems to me, but maybe I'm reading into what I looked online. [0:29:51](https://vimeo.com/1170834056#t=1791s) Mm-hmm. [0:29:52](https://vimeo.com/1170834056#t=1792s) You know, that's what you see in the program. It's, um, doing what it's supposed to in some cases, but not in others. [0:30:01](https://vimeo.com/1170834056#t=1801s) I would say- [0:30:02](https://vimeo.com/1170834056#t=1802s) And- [0:30:02](https://vimeo.com/1170834056#t=1802s) Oh, I'm sorry. Sorry [0:30:03](https://vimeo.com/1170834056#t=1803s) ... and, and I mean, you're challenging the committee to, or somebody to, um, bring suit, r- r- report, whatever. It seems like that would already be done if people who are supposed to be auditors are looking after this to straighten this out. I guess, is there, and I guess in, on the lines 28 through 30 when I looked at it. I wrote in my original notes- [0:30:24](https://vimeo.com/1170834056#t=1824s) Mm-hmm [0:30:24](https://vimeo.com/1170834056#t=1824s) ... this, this bill seems to just ban or do away with transparency as far as I can tell in that lines 28 through 34. Does it not do that? [0:30:35](https://vimeo.com/1170834056#t=1835s) No, sir. Not, not slightly, sir. As a matter of fact, it is saying they are absolutely required to provide to the federal and the state governments all of the information. So that is as much transparency as we can possibly ask for, 'cause even our state laws, we don't have federal requirements. In this case, there's federal and state requirements. [0:30:57](https://vimeo.com/1170834056#t=1857s) Yeah, so I just wanted to make sure the State Health Benefit Plan, th- those who operate it, have access to all this information. I d- just felt that there's something about it, you know, I'm not a lawyer either, that it just kind of limited their access to information. [0:31:12](https://vimeo.com/1170834056#t=1872s) Sir, if you look at lines 28, it says, "A drug manufacturer, a wholesale distribut- distributor, agent, or affiliate," the State Health Benefits Plan as an example is none of those. [0:31:25](https://vimeo.com/1170834056#t=1885s) Sir. [0:31:26](https://vimeo.com/1170834056#t=1886s) Yeah. [0:31:26](https://vimeo.com/1170834056#t=1886s) You know, you can see that we're all scrambling- [0:31:29](https://vimeo.com/1170834056#t=1889s) No, no. Yes, sir [0:31:30](https://vimeo.com/1170834056#t=1890s) ... because we don't- [0:31:30](https://vimeo.com/1170834056#t=1890s) No, no, no, no [0:31:30](https://vimeo.com/1170834056#t=1890s) ... completely understand it [0:31:31](https://vimeo.com/1170834056#t=1891s) I, I didn't mean to be pedantic. I, I, I just wanna make sure that, that, that, that, that you're seeing it yourself, sir. [0:31:35](https://vimeo.com/1170834056#t=1895s) And is there... I mean, I guess my other question, Mr. Chairman, if I can continue. [0:31:40](https://vimeo.com/1170834056#t=1900s) Go ahead. [0:31:40](https://vimeo.com/1170834056#t=1900s) Is there... You know, I thought, "Well, okay, since this will affect all the State Health Benefit Plan, all the different things that we do, is there not a physical note that will have this would increase, decrease, change?" [0:31:54](https://vimeo.com/1170834056#t=1914s) So because what we're asking for, but for, you saw in slide about five, you saw the number of contract pharmacists that, that have been reduced against what the desire of the covered entity was. But in terms of the physical note to the state, the state continues to do what the state needs to do with the State Health Benefits Plan, how it's working with the CMOs, with Medicaid, et cetera. And that, again, if any of those see any type of fraud, then I would, I would encourage them to report it. If they're not reporting it, I'm going to assume it's business as usual to your point. [0:32:27](https://vimeo.com/1170834056#t=1947s) What we don't wanna have happen is a breaking of the agreement, we don't wanna have any restriction of the meds moving, and we don't wanna have over-reporting burdens being placed on them by private entities. [0:32:37](https://vimeo.com/1170834056#t=1957s) Well, I certainly would love to hear the state, if someone from, if they're here from the State Health Benefit Plan, to comment on have, are they seeing fraud. And, and I guess, 'cause it's, by your testimony and what we'll hear from others, it's there, then why we're not looking into it. [0:32:52](https://vimeo.com/1170834056#t=1972s) Well, again, I don't wanna say, I didn't say fraud was there. What I said was if there is fraud- [0:32:57](https://vimeo.com/1170834056#t=1977s) Yeah [0:32:57](https://vimeo.com/1170834056#t=1977s) ... then by all means, I welcome you to report it and do what you need to do. If you're gonna make the accusation that there is fraud, and I wanna be clear to the committee, if you're gonna make the accusation that there's fraud in this program and you haven't gone to the feds and asked the feds to audit and enforce, then I'm gonna ask you, do you really think there's fraud, or is it just a talking point and a bullet point? [0:33:23](https://vimeo.com/1170834056#t=2003s) To, to answer your question, I've spoken- [0:33:26](https://vimeo.com/1170834056#t=2006s) Yes, sir. Thank you [0:33:26](https://vimeo.com/1170834056#t=2006s) ... with the State Health Benefit. They do not participate in 340B. They do the rebates. By federal law, you can't do both. [0:33:34](https://vimeo.com/1170834056#t=2014s) Okay. [0:33:35](https://vimeo.com/1170834056#t=2015s) It's not... There's no duplicate. [0:33:37](https://vimeo.com/1170834056#t=2017s) Okay. Thank you, Chairman. [0:33:38](https://vimeo.com/1170834056#t=2018s) Does that answer your question? [0:33:39](https://vimeo.com/1170834056#t=2019s) I don't need, Chairman. [0:33:40](https://vimeo.com/1170834056#t=2020s) Thank you. Uh, let me see who do we have. Representative Davis. [0:33:45](https://vimeo.com/1170834056#t=2025s) I'm fine. [0:33:46](https://vimeo.com/1170834056#t=2026s) Okay. Uh, Representative Clark. [0:33:49](https://vimeo.com/1170834056#t=2029s) Oh, it's actually Representative Me. [0:33:51](https://vimeo.com/1170834056#t=2031s) Oh. Okay. I'm sorry. [0:33:53](https://vimeo.com/1170834056#t=2033s) Um, Representative Jones, I appreciate what you're trying to do. Um, with respect to the states that have engaged in similar reform, do you have any data on the results that they've seen with respect to the goal that you're trying to accomplish, which I think we all agree with the goal. And so could you provide, if there is any data from those other states, what the results have been? [0:34:13](https://vimeo.com/1170834056#t=2053s) I don't have any quantitative data, but I know people who are gonna be testifying have that quantitative data. If you wouldn't mind, if we could, I'll say, I hate to say park it, but, you know, if we could table that question, let the people who frankly have the quantitative... Qualitatively, I can tell you I called Arkansas, and Arkansas really feels as if they have seen, you know, effectively what they were expecting to see out of that. But other than that, I did not speak to anyone, so I can't give you anything quantitative. I'd rather, I'll say, folks testify to that. And if you don't mind, you know, please hold them to task. [0:34:44](https://vimeo.com/1170834056#t=2084s) Representative Silcox. [0:34:46](https://vimeo.com/1170834056#t=2086s) Thank you, Mr. Chairman. You know, this is the m- most amazing thing because, you know, we, we get emails, you know, as state representatives, and I have never, ever received emails about a federal program to the degree that I have on this bill. And these are people in my community that have no connection to healthcare whatsoever. So I guess I have to believe on some level that if there's, if it's working now and we're following the law, as you say we are, and it's helping the rural hospitals, as you say we are, that wouldn't the court system and the, and our legal system work to fix this without this bill? [0:35:30](https://vimeo.com/1170834056#t=2130s) Because this is so divisive. I mean, we have all these organizations that have sent letters saying this is terrible, and we don't have any quantitative data, as you just said, to see whether it's good or it's not. And I'm not really opposed to your bill, I just- I've never had emails from so many people in my district concerned about a federal program that we as a state do not govern, and that's just... it's really disconcerting to me. [0:35:59](https://vimeo.com/1170834056#t=2159s) Yeah. [0:35:59](https://vimeo.com/1170834056#t=2159s) I just don't know that the state should step into this because to me, we could possibly be exposing ourself to some legal liability that we're not responsible for. I really am serious. And- [0:36:11](https://vimeo.com/1170834056#t=2171s) Can I comment? [0:36:11](https://vimeo.com/1170834056#t=2171s) Yes, of course. [0:36:12](https://vimeo.com/1170834056#t=2172s) Yeah. So we've, we, we've-- And again, I'll let some folks speak to this who are coming behind me who know it better than I do. Uh, but in terms of, you know, the challenges that have been made to Arkansas, also known as Arkansas- [0:36:24](https://vimeo.com/1170834056#t=2184s) Yes [0:36:24](https://vimeo.com/1170834056#t=2184s) ... uh, those challenges, you know, they did not hold up Arkansas, and this is basically based on what Arkansas was able to do. In terms of I can't speak to all the letters. Uh, you gotta remember, I carried House Bill 1013. Um, you know, I got basically accused- [0:36:40](https://vimeo.com/1170834056#t=2200s) But it wasn't then or now felt- [0:36:41](https://vimeo.com/1170834056#t=2201s) Yeah. No [0:36:41](https://vimeo.com/1170834056#t=2201s) ... than whole neither by the ball act. [0:36:43](https://vimeo.com/1170834056#t=2203s) No, but well, if you would allow me to answer the question, what I'm trying to say is I had a pile of 500 things telling me that what we were doing was wrong, and I had a pile of what was going right. So my point being is- [0:36:55](https://vimeo.com/1170834056#t=2215s) Is this expanding the 340B program? [0:36:58](https://vimeo.com/1170834056#t=2218s) No, it's not expanding it. What it's doing is, I wanna be clear to the committee, it's not expanding anything. It's basically saying, "Stop doing the actions that you're doing in terms of restricting, especially the contract pharmacist." That we, to not be concerned about that, and respectfully, Chairman Silcox, coming out of your district, we don't have, I'll say, an access issue when it comes to healthcare and when it comes to pharmaceutical studies. [0:37:24](https://vimeo.com/1170834056#t=2244s) We do not. That's what was so shocking- [0:37:25](https://vimeo.com/1170834056#t=2245s) Right [0:37:25](https://vimeo.com/1170834056#t=2245s) ... to receive these emails. And so- [0:37:27](https://vimeo.com/1170834056#t=2247s) No, exactly. But for the communities where this is paramount to them, this is paramount in terms of program funding, this is paramount in terms of access to, to basically pharmaceuticals. If you have to drive an hour and a half instead of driving just 10 minutes or 15 minutes to get your pharma, then that's a pretty big deterrent in terms of getting the meds that we know hopefully doesn't force you, in, not force you, pardon me, cause you into a chronic issue. And we don't want that to occur 'cause that's bad for everybody, 'cause we want you to basically stay there. So I think at the end of the day, I think what has to take weight here, the most weight in my opinion that has to be taken here, respectfully to the letters, and I received them too, is the areas that are receiving this funding are fundamentally telling us, and you got Grady in your hands, so that's an inner-city hospital, then you got literally folks from rural, you got folks from the coast and the north telling us these funds are literally lifesaving and imperative, that but for these funds, we have no replacement, we have no backup, and all these programs go away. [0:38:31](https://vimeo.com/1170834056#t=2311s) So I can say this, this is one of those times where I don't think there's a perfect solution, but all I'm saying in this bill is to just maintain exactly what the fed is until they change it. Stop trying to reduce the contract pharmacist and let it run. To stop, for instance, a mail-order pharmacist when someone has to drive two hours, I think that is... [0:38:54](https://vimeo.com/1170834056#t=2334s) I don't know. I'm gonna say, man, it borders on consciously knowing that you're affecting the health of a Georgian to not allow a mail-order pharmacy. So just keep that in mind as you ponder and you hear all the different testimony. [0:39:11](https://vimeo.com/1170834056#t=2351s) Okay. Thank you. [0:39:14](https://vimeo.com/1170834056#t=2354s) Representative Clark. [0:39:17](https://vimeo.com/1170834056#t=2357s) Um, um, Mr. Chairman, I yield. [0:39:20](https://vimeo.com/1170834056#t=2360s) Oh, okay. Uh, Representative Gun- or Chairman Gunter. [0:39:27](https://vimeo.com/1170834056#t=2367s) Thank you, Mr. Chairman. I don't know who I'm directing this question to, but, um, I'm just trying to get a... I'm the lawyer here, not the physician, so I don't really understand a lot of the mechanisms here. But I was a patient, and, uh, the medication that they gave me monthly came through the pharmacy at the hospital, and it was $5,000 of bottles, what they told me, and I didn't pay anything for it. So is, is that an example of what's going on here or? [0:40:00](https://vimeo.com/1170834056#t=2400s) I'm not gonna say yes or no to that because I don't know the specifics, and I am definitely not an expert. And so I would... Can, can we ask someone who comes up who maybe is part of Pharma Georgia that can maybe answer that question? Because I feel I don't wanna give an incorrect answer to the chairman. [0:40:16](https://vimeo.com/1170834056#t=2416s) Are you a state health benefit? [0:40:18](https://vimeo.com/1170834056#t=2418s) Yes. [0:40:18](https://vimeo.com/1170834056#t=2418s) They do not participate in 340B. [0:40:20](https://vimeo.com/1170834056#t=2420s) Okay, yeah, that's good. [0:40:21](https://vimeo.com/1170834056#t=2421s) Okay. All right. So- [0:40:22](https://vimeo.com/1170834056#t=2422s) So- [0:40:22](https://vimeo.com/1170834056#t=2422s) That- [0:40:23](https://vimeo.com/1170834056#t=2423s) You're, you're rebate. [0:40:24](https://vimeo.com/1170834056#t=2424s) Okay, good. I'm glad. [0:40:26](https://vimeo.com/1170834056#t=2426s) Yeah. [0:40:26](https://vimeo.com/1170834056#t=2426s) If I could, Chairman Gunter. Chairman Gunter, you do bring up a good point. The theory around this, in some instances, is that a 340B covered entity is going to be able to get, and let's just... We'll, we'll just call it X, drug X. If drug X is supposed to be this much, the pharma company has to sell it for this much, then basically that entity is supposed to basically delve that out. Now, if it's someone who's indigent or someone who basically qualifies, then it's at either a low cost or no cost. [0:40:58](https://vimeo.com/1170834056#t=2458s) However, if it's someone who has, you know, I'll say benefits or is paying cash, they're supposed to take that, that margin and basically apply it to these programs. That's where they're getting the funding to pay for the oncology, to pay for the dialysis, et cetera. So hopefully, I wanna be clear to the committee, this isn't just can the drug be moved, as you said, at no cost, but at no cost or low cost, but also can the drug be moved to someone who is paying, call it retail rack rate, and then taking that margin and moving it into programs for folks that need it. [0:41:33](https://vimeo.com/1170834056#t=2493s) And like I said, we have some places where literally the payer mix requires it to be 100%. [0:41:37](https://vimeo.com/1170834056#t=2497s) Okay. Thank you. [0:41:41](https://vimeo.com/1170834056#t=2501s) Okay. Representative Gisler. [0:41:44](https://vimeo.com/1170834056#t=2504s) Thank you, Mr. Chairman. Um, so 24 hours ago, I didn't know anything about 340B, so I, I'm coming up to speed. I like to think I'm a quick learner. The gist of it, as I understand it, is, is providers who are in a 340B program are able to acquire drugs from manufacturers, contract, through contract pharmacies at a reduced rate, and then they sell them at normal rates and put that difference towards... [0:42:14](https://vimeo.com/1170834056#t=2534s) Okay, well, that's not really my point. But it- [0:42:18](https://vimeo.com/1170834056#t=2538s) Okay [0:42:18](https://vimeo.com/1170834056#t=2538s) ... the big fight here is who gets to keep that, that discount, right? Um, this section toward lines 28 through 34 i- is denying access to data to those manufacturers, and if I was the one giving up, you know, selling my product at a discounted rate, I might be interested in that data. But to your point- [0:42:39](https://vimeo.com/1170834056#t=2559s) This is available at the federal government. Mm-hmm. Okay. Okay, so go- god, god bless. If I wanna know about a charitable organization, I go out to their 990s. If I wanna know really about anything- Yeah ... that's moving to the government, I can get it. Okay. I just need to... It just takes a little effort. Okay. And I imagine that we're gonna hear from- I'm sure ... speakers today that there's at least circumstantial evidence that larger systems may not be applying this correctly. Well, again, let- let's take that up. You know, I intentionally showed WellStar in there. [0:43:10](https://vimeo.com/1170834056#t=2590s) Right. Right? Okay. And, and I did that with, with, with intention. $1.3 billion of, of, of indigent care. That's our constituents. $1.3 ba- billion dollars of indigent care. That margin that you're referring to, sir- Mm-hmm ... literally funded that. Now, we can have all kinds of arguments about the fungibility of money, and I, and I agree with you, uh, 100%. But at the end of the day, if that moved into that, I think that's, that is the law being applied. In my opinion, and respectfully to those that are even contemplating going, not supporting this, gotta ask yourself then it truly is not a bas- basically bringing back 340 to the form that we expected it to be, which was the covered entity could literally have the number of contract pharmacists they need in order to do the job. [0:43:58](https://vimeo.com/1170834056#t=2638s) That's it. I mean, that's it. That is, that is why it's only 40 lines long. Stable coin was 40 pages long, so- ... but thank you for the question Rep- Rep- Yeah, thank you ... Representative. I see no other questions. We do have some people who wanna speak to the bill, and first up is Chairman Ron Stephens. [0:44:30](https://vimeo.com/1170834056#t=2670s) Mr. Chairman, members of the committee, I appreciate the time today on a very complicated issue. Um, and first of all, let me be- because it's kinda related to this, as you might have remembered, a couple of years ago we had your independent pharmacies falling like flies, um, going out of business for, um, not being able to support, uh, with reimbursement rates. Um, that aside, this bill here will help your independent pharmacies stay in place. Uh, it'll help them to stay in business. [0:45:01](https://vimeo.com/1170834056#t=2701s) It's even more important, the thing that nobody's talking about is patient access. You have the opportunity with this particular bill today to go back to what it was intended for, for these folks that cannot get to the facility which is contracted federally, to be able to have a contracted pharmacy that's maybe 100 miles away to provide these prescription drugs and life-saving medication with a 340B plan that they'll share, um, with the covered entity. [0:45:34](https://vimeo.com/1170834056#t=2734s) That'll be the hospital, the FQHC, and so on. It's an opportunity to, um, to expand the coverage to these people that need it, uh, where they may not get it as you continue to reduce these pharmacies and, uh, participate. Let me tell you how a pharmacist works. Whenever they sign up as a contracted pharmacist with a 340B plan, let's just say they're a rural hospital, they've got a pharmacy that they like to use in, I don't know, Colquitt, Georgia, somewhere down in, um, in, in southwest Georgia. [0:46:08](https://vimeo.com/1170834056#t=2768s) Uh, they would contract with a pharmacy. The, uh, they'll, they'll use the difference in the wholesale acquisition cost and what the, um, what comes through the wholesaler and the actual, uh, 340B cost. And the, uh, covered facility will take, uh, the majority of the, of the savings. The pharmacy will also use part of that, and that can be used for delivery service or even stocking the drug. The way that it happens once we get a prescription in for 340B, uh, let's just say that you've got a bottle of 100 tablets of something. [0:46:43](https://vimeo.com/1170834056#t=2803s) Uh, the prescription comes in from that facility. The pharmacy, from its stock, at its cost, dispenses that medication. It might take three prescriptions to get that bottle empty before that bottle may be replaced from the wholesaler. Let me say that again. They're using the inventory of your local independent pharmacy to help with this program until that can be replenished with a 340B plan. [0:47:14](https://vimeo.com/1170834056#t=2834s) That is the way this plan works. It's about as plain and as simple as I can make it, and the more these pharmacies that can get involved with this direct 340B plan will help the healthcare of the patients that's needed. I'll give you an example of how the FQHC works in my area. They, um, they would close without 340B, the Federally Qualified Healthcare Centers. They're the safety net, if you are, down in, in, uh, most parts of the, of the state. What they've done in my part of the state because of the profits they use from 340B is they've gone out, believe it or not, and bought vans to go out into the community for the service and, and the healthcare of these patients. [0:47:56](https://vimeo.com/1170834056#t=2876s) That's the kind of thing that goes away without 340B. So Mr. Chairman, as short as and, and concise as I can make it, this will help your independent pharmacies to stay in the business, those that can find a contract, especially those that are out in the rural area, and I would ask you to consider some favorable consideration. Did you have a question? Representative Parrish. Thank you, Chairman. Chairman, I just wanted to ask you to cla- clarify something for me. You're just talking about s- some entity down there that would go away without 340B, but this doesn't, this bill, uh, I mean, it's not gonna go away. [0:48:34](https://vimeo.com/1170834056#t=2914s) If this bill doesn't pass, it's not gonna go away. No. No. But the, but the pharmacies that are contracted that are limited, a- as you just heard, they are limiting the number of pharmacies that are there. They need to be expanding those instead of limiting them. Thank you [0:48:48](https://vimeo.com/1170834056#t=2928s) To get the service. Representative Clark. Um, Mr. Chairman, um, I... Thank you, Mr. Chairman. Now to you, Chairman Stephens. Um, when we talk about, um, the expansion part, I understand what you're saying. Uh, w- what is your stance on the idea of not collecting data? I'm just trying to get a good understanding of why we are writing into code that we do not want these manufacturers to know who is getting access to this medicine. [0:49:24](https://vimeo.com/1170834056#t=2964s) You know, the, the, the federal, uh, data is collected from what I understand, so that's... As far as the state, I, I don't have a, a comment or any knowledge on that, but the federal is required to collect this data. So I guess the federal is allowed, the state is allowed. Why are we just like, "No, manufacturers, you cannot see this data"? I'm just trying to get... I think that's the big question that I have today. There may be somebody else to speak to that. Okay. Thank you. All right. I see no other questions. [0:49:56](https://vimeo.com/1170834056#t=2996s) Thank you, Mr. Chairman. Mr. Chairman and members of the committee. We have another house member who wants to speak. Uh, Sam Park. [0:50:06](https://vimeo.com/1170834056#t=3006s) Yes. Uh, thank you, uh, Mr. Chairman and members of the committee. Um, I'm here to speak in favor of, uh, House Bill 139, as amended by the, uh, bill rep- uh, that Representative Jones, uh, provided. Um, and I'll do my best given my, uh, familiarity with this issue, uh, to help answer and, and clarify some questions. Uh, first and foremost, I'd, I'd like to begin just by stating the federal intent of the 340B program. The primary purpose of the 340B program is to stretch scarce federal resources, allowing covered entities to provide more comprehensive services and reach more eligible low income and uninsured patients. [0:50:50](https://vimeo.com/1170834056#t=3050s) One of the great benefits of the 340B program is that it's a, it's a, it allows us to provide more services without a single additional taxpayer dollar, which is why a fiscal note is not needed, because there's no state dollars being impacted by this. There's no additional federal dollars that is allowing safety net providers to provide additional services. With respect to who are 340B covered entities, we're talking Grady Hospital, right? Every single safety net hospital in Georgia is impacted by the 340B program. [0:51:23](https://vimeo.com/1170834056#t=3083s) Every single FQHC from Mercy Care to N- what have you, every single nonprofit HIV AIDS service organization, Ryan White Clinic, is a 340B covered entity in which the 340B program is absolutely critical to ensure that they are able to provide the services they, that they need for the most indigent, the most vulnerable here in the state of Georgia. And so to Representative Clark's very good question as to why are we trying to restrict access to data per lines 28 to 34, and, and the purpose of the bill per Representative Deborah Silcox's, uh, Chair Lady Silcox's, uh, question, big pharma hates 340B, right? [0:52:09](https://vimeo.com/1170834056#t=3129s) That, that, that is very clear and abundant, certainly given the outreach that y'all have received. Um, you know, big pharma, th- there is an industry-wide campaign to try and attack the 340B program. Why? Because it is profits from big pharma that are being required under federal law to be returned to safety net providers in order for them to provide additional services. All right? So again, that, that is, whatever arguments, you know, big pharma may say, this bill is to protect the three, to, to protect 340B covered entities that are currently under assault by big pharma. [0:52:51](https://vimeo.com/1170834056#t=3171s) What big pharma has been doing, and, and just, uh, uh, as some background, um, outside of the legislature, I serve as general counsel for a large HIV nonprofit organization in which we are a 340B covered entity, right? What we have seen in practice, and I've heard this from so many other safety net providers and other FQHCs, is pharma collects this data to go to create workarounds, to cut, cut, cut, cut, cut the 340B program and undermine the federal intent to expand limited res- uh, to, to stretch scarce federal resources. [0:53:28](https://vimeo.com/1170834056#t=3208s) So what this bill is trying to do, it's not to expand the 340B program, it is to protect the 340B program from ongoing attacks by big pharma, in which ultimately this is their profit that they want to keep, as opposed to ensuring it is being reinvested back into the community, being reinvested especially, um, to ensure that the most vulnerable among us are receiving the services and the life-saving medications, uh, that they need. [0:53:59](https://vimeo.com/1170834056#t=3239s) Um, so, uh, with that, I, I'm happy to answer any questions that folks may have. Um, I will otherwise urge, uh, my committee members and, and, uh, to, to vote yes to this bill. But happy to yield. I see no questions. I see one question. Go ahead. Um, thank you, Mr. Chairman. To my friend, um, can you describe some of these workarounds? 'Cause I, I guess I'm just a big transparency person. So it would, it's a very big burden for me to say no to transparency. [0:54:32](https://vimeo.com/1170834056#t=3272s) So, like, what are some of the workarounds that are happening that you feel the lines 28 through 34 are trying to- Yeah ... stop from happening? S- so one, you know, there's two things I'll say about, uh, subsection C, lines 23 to 27. Uh, or I'm sorry, t- lines- Three ... 27 to 34. Uh, first, this is only applicable to big pharma and PBMs, right? We're saying big pharma and PBMs aren't, cannot require or demand- [0:55:05](https://vimeo.com/1170834056#t=3305s) You know, uh, this data from 340B covered entities, right? Uh, as Representative Jones mentioned, uh, you know, this also requires, um, compliance with federal and state law. So federal and state entities should have access to all of this information, certainly HRSA and, you know, all the other entities that do heavily, heavily reg- regulate 340B covered entities, in which the organization where I work at, you know, we're looking at five to 10 audits yearly. Um, so for example, when we are saying, um, let's see, um, claims or utilization data, um, purchasing, uh, data, uh, you know, just, just the- What we have seen through my experience is what, you know, you enter into a contract with the pharmaceutical company, right? [0:55:52](https://vimeo.com/1170834056#t=3352s) They will then provide an amendment that you have to essentially meet that requires additional collection of data, right? So that they understand how many patients or how many prescriptions are, you know, 340B eligible. Uh, what they have then done is, with the collection of that information, undermine the program, right? By bypassing existing protections, uh, that exist. And so based on what we're seeing across the country, uh, this bill is drafted in a manner to prohibit big pharma and PBMs from r- forcing safety net providers and independent pharmacists to provide data that they are using in a myriad number of ways, uh, to, to undermine, uh, the 340B program so that they can retain more of their profit. [0:56:44](https://vimeo.com/1170834056#t=3404s) Okay, counselor. [0:56:45](https://vimeo.com/1170834056#t=3405s) Yes, sir. [0:56:45](https://vimeo.com/1170834056#t=3405s) I hate to interrupt you, but we're getting a little repetitive, and- [0:56:47](https://vimeo.com/1170834056#t=3407s) Yes, sir [0:56:48](https://vimeo.com/1170834056#t=3408s) ... I've got an oncologist still online waiting, and I need to get to him. He's actually seeing patients today. That's fine. Thank you. So let me put you on hold. Let's go ahead and, and hear from- Yes ... Harsha Vis, uh, Vis, right? That's right. Uh, down at the cancer center, uh, of Georgia, Dublin, Georgia. Can we bring him up? [0:57:10](https://vimeo.com/1170834056#t=3430s) Thank, thank you, Representative Hawkins. [0:57:12](https://vimeo.com/1170834056#t=3432s) And I apologize. I know you've been waiting, and I know you have patients, so thank you for being patient. [0:57:16](https://vimeo.com/1170834056#t=3436s) Thank you. Thank you so much, sir. Thank you so much for putting me on. Um, you're absolutely right. I wanna get back to my patients. But, uh, I wanted to speak, uh, the reason why I s- took an hour off seeing my dear patients and wanted to talk about House Bill 139, is what it will do to independent community practices like me in a rural area. Several of the, um, uh, speakers supporting this, uh, program spoke about what it, you know, does to strengthening, um, the current 340B program. [0:57:48](https://vimeo.com/1170834056#t=3468s) But I'll tell you what it's done to community oncology, which is basically a physician-owned community practice in the state of Georgia. It's pretty much devastatingly killed independent practices like mine, and I'll tell you why. The 340B hospitals have a significant financial advantage over independent practices like mine. I provide the same cancer care at significantly cheaper costs and with absolutely no benefit from this program, because the program does not follow the patient, but follows an actual entity. [0:58:22](https://vimeo.com/1170834056#t=3502s) So don't matter. I could see a Medicaid patient, I could see a cancer patient, I figure out how to somehow get care to this patient as a board-certified oncologist hematologist, but the benefit goes to the entity which has this 340B stuck on its, you know, uh, tax status. And just because I'm a private practice small business, I don't get the benefit. This bill will further accelerate hospital consolidation of oncology care. Over a period of 15 years, we've had a devastating wipeout of independent practices like mine, and there's a reason why these large hospital systems are acquiring oncologists, because more 340B dollars will flow to them. [0:59:02](https://vimeo.com/1170834056#t=3542s) And there's a significant margin associated when you get co- drug at that cost and you have the leverage to negotiate excellent payment from, uh, from insurers, and it's supposed to translate into indigent care. I could tell you the average, national average for, um, operating, uh, for, for, um, um, charity care is about 2%, and I could tell you this program is far more, um, profitable than that. It is not... Again, this program's original intent is very, uh, completely agreed upon by everyone. [0:59:36](https://vimeo.com/1170834056#t=3576s) Um, rural hospitals in my area, several of them are needed, HIV programs, absolutely. But the distortion it's caused in the oncology market, this particular bill will significantly worsen it. Um, it will, and the anchor- the growth of contract pharmacies and middlemen will further worsen this. We have, we have clear-cut data, this contract pharmacy, several of them are out of state. Um, many of them, I think, I believe up to 40% are on actually affluent areas, uh, not in the poor areas like mine, where the average income is about $35,000 a year. [1:00:10](https://vimeo.com/1170834056#t=3610s) And I'm sorry, I have really not seen any of these benefits being told in my area. I practice in a rural area. Nobody's helping me. I could tell you that I've been trying to recruit another doctor, and every single doctor I talk to ends up in one of these hospital systems, and I'm basically burning the midnight oil before, you know, simply burning out. Also, this is going to harm, harm state taxpayers. The healthcar- healthcare costs are gonna go up simply because there's gonna be a further shift of cancer care into these higher cost hospital system models and employers. [1:00:43](https://vimeo.com/1170834056#t=3643s) And there is, yeah, ample data I'll be glad to share on how much my cost is to treat cancer patients and how much more it costs in the hospital outpatient department, um, to, to treat the same, uh, cancer patients. And like I mentioned, the, uh, benefits which would actually follow the patient ends up following these, uh, hospitals, and then the contract pharmacies are simply going to worsen this Expanding a federal program like this without fixing its structural problems is a huge deal. [1:01:13](https://vimeo.com/1170834056#t=3673s) You should be very careful when you're saying, "Oh, yeah, there are problems. We don't know. We can't point it, point out where it, where the problems are." Well, I'm telling you, there's a problem. A lot of people know this. And yes, it's federal law, but I think we should seriously consider taking a pause on expanding the program without examining, you know, what, what did we do f- because this essentially expands the reach of these hospitals and 340B entities, and there'll be more dollars flowing through this program. There's graph after graph which shows that from simply the program was in the early '90s, from 2000 to 2024, the growth of this program just simply dollar-wise cannot keep up. [1:01:53](https://vimeo.com/1170834056#t=3713s) If it, if it truly went into indigent care, it would be a different story. And there are more than enough exposés, there are more than enough, uh, uh, articles out there to tell you, it is not going into indigent care. And I can tell you, as the probably the last remaining rural doctor-owned private practice, it is just simply, uh, unsustainable to fight with these healthcare systems simply because of the 340B dollars. So I'd strongly urge the committee to reject this bill ba- based on what I have seen personally. Thank you. [1:02:25](https://vimeo.com/1170834056#t=3745s) Thank you, Doc. I, I know that you've been waiting, and I appreciate it. I don't see any questions for you, so get back to your patients and save some lives. Thank you, sir. Thanks. I appreciate it. Great physician. He has spoke to us many times on our cancer, uh, care, um, meetings this summer. Okay, I'm sorry, now back. Hmm? She just handed it to someone. I can't hear you. [1:02:54](https://vimeo.com/1170834056#t=3774s) Well, he's in the middle, so just- Yeah, I cut him off. I'm sorry. No, no worries. I, I don't know where I was, so- Mr. Park. Not at all, sir. I'm, I'm happy to defer to, uh, Chair Lady Silcox if she had a question. Oh, okay. Good, good. Go ahead. So I was gonna ask you, um, what part, isn't it true that ultimately this is an expense of the federal government? It is a federal program. No. Actually, I just Googled this, and it says, "The 340B Drug Pricing Program operates primarily as a discount mechanism between pharmaceutical manufacturers and hospitals rather than a direct federal appropriation. [1:03:30](https://vimeo.com/1170834056#t=3810s) However, it cost federal and state taxpayers $6.5 billion per year in lost Medicaid rebates. While not a direct outlay, the program, which grew to over $66 billion in discounted purchases in 2023, drives up costs for private insurance and states through higher drug spending." And it goes on and on. I won't read it all, but it says, um, "While the program provides billions in benefits to communities, analysts note that the rapid expansion, as referenced by the oncologist, often utilized by large for-profit contract pharmacies, creates significant financial burdens on the health system." So it's really a cost of how we wanna spend the money, is, is kind of the bottom line. [1:04:17](https://vimeo.com/1170834056#t=3857s) Do we w- continue this model, or do we not? I, I, I appreciate the question and the comment. If I may reply, you know, what I would say is we are not debating the 340 Pro- Program in and of itself, right? We are trying to ensure that we are complying with federal law that has this program that ultimately determines its structures. Do I support reform of the 340B program at the federal level? Absolutely. All right? If this bill passes, will the 340B program still be in place? The 340 progra- the 340B program will continue to be whittled down by pharmaceutical companies that are trying to undermine this program. [1:04:52](https://vimeo.com/1170834056#t=3892s) Again, this- This shows, this, this data shows that it grew, um, in 2010 it was $6.6 billion, and it's grown to over $43.9 billion in 2021. What I, my understanding would be that that's $43 billion of big pharma profit that is not being reinvested in the community. And again, it's how you wanna spend your money. A- again, my hope is- But the re- regardless whether this bill passes, this federal program will still be in place, correct? We- we'll see. Again, big pharma is doing everything possible to undermine the existing program as it is. All this bill does is not expand the 340B program. [1:05:25](https://vimeo.com/1170834056#t=3925s) It protects what currently exists. The reason why this bill is needed is because we've seen big pharma through contract arrangements, through contract pharmacies, through s- a multitude of especially safety net providers using terms, trying to collect as much information and data, especially from 340B entities, in order to discriminate against them, which is why this body, as a part of PBM reform a few years ago, passed legislation prohibiting PBMs and other drug manufacturers from discriminating against 340B providers, which is legislation that red states and blue states have adopted, again, to ensure that we are protecting a critically important, uh, revenue stream for safety net providers across the state. [1:06:07](https://vimeo.com/1170834056#t=3967s) Thank you very much. I appreciate it. Thank you for your testimony. Yes, sir. Okay, up next, uh, Corbin Santo, Johnson & Johnson. All right. Good afternoon, Chairman Hawkins and members of the committee. My name is Corbin Santo, and I am a senior counsel at Johnson & Johnson Innovative Medicine. Uh, just to start, as you may know, J&J's history and commitment to Georgia goes back more than 100 years, and it continues today. We currently operate two manufacturing sites in Athens and one in Cornelia, with a total of 1,500 employees and over 750 retirees who, uh, reside in Georgia, and we are a proud part of the robust life sciences ecosystem there in the state. [1:06:50](https://vimeo.com/1170834056#t=4010s) Just to start out on the 340B program, I will note emphatically that J&J supports the original intent of the 340B program, which is to help vulnerable patients access more affordable medicines. However, we respectfully oppose House Bill 139, and I urge you to vote no on this legislation. [1:07:08](https://vimeo.com/1170834056#t=4028s) And I'll touch on four key points. First, this bill would further increase 340B costs for employers and state and local government plans in Georgia. 340B discounts displace commercial discounts manufacturers give to employer and state government plans. In other words, if a drug dispensed is 340B eligible, employer and state plans generally don't get a rebate on the same drug dispensed to one of their plan participants. So, as 340B grows, states and employers miss out on rebates. [1:07:43](https://vimeo.com/1170834056#t=4063s) This dynamic is costing Georgia employers and workers $187 million annually right now, and the government health plans over $27 million annually. Expanding contract pharmacies under this legislation would add more than $22 million in annual costs for Georgia businesses and workers, and more than $3 million in annual costs for government health plans in the state. Second, the 340B program of today is not working for patients it was originally intended to benefit. [1:08:15](https://vimeo.com/1170834056#t=4095s) What started out as a buy low, sell low program operating in core public safety net hospitals and clinics, has morphed into a buy low, sell high arbitrage scheme for more than half of hospitals in the country, with outsize abuse occurring among many of the country's largest and best performing corporate health systems. In North Carolina, just across the border, uh, and a couple states up, um, the state treasurer found that 340B hospitals marked up oncology drugs an average of 5.4 times their discounted acquisition cost when billing state employees. [1:08:50](https://vimeo.com/1170834056#t=4130s) This was 85% higher than the markups from non-340B hospitals, and those costs affected patients at their out-of-pocket obligation at the pharmacy counter. The program's expansion via contract pharmacy has not translated into meaningful gains in access or affordability for vulnerable Georgians. Indeed, patients almost never benefit, and this is a critical point, patients almost never benefit, and this is borne out in research, from 340B discounts through lower out-of-pocket costs at contract pharmacies. [1:09:22](https://vimeo.com/1170834056#t=4162s) If enacted, this bill would run, this is number three, if enacted, this bill would run headlong into complex and rapidly evolving litigation that would impose unnecessary costs on the state of Georgia. Federal courts have confirmed manufacturers may set reasonable conditions on contract pharmacies and claims data. This is a settled question of law. And just to emphasize, um, the requirements around use of unlimited contract pharmacies appear in un- a non-binding HRSA guidance issued in 2010 that two federal courts of appeals have since said cannot be enforced against manufacturers because guidance itself is not binding and does not have the force of law. [1:10:07](https://vimeo.com/1170834056#t=4207s) The federal 340B statute does not speak to the use of contract pharmacies, and HRSA does not have regulatory authority on this issue to issue binding requirements on manufacturers regarding use of contract pharmacies. Additionally, just last week, the federal government for the first time stated unequivocally that these types of state laws are unconstitutional. The federal government's involvement in this litigation is an important development that occurred after courts ruled on laws enacted by Arkansas and Louisiana. [1:10:39](https://vimeo.com/1170834056#t=4239s) So this is a late-breaking, important development, um, given the federal government's position on this issue. Number four, enacting this bill would empower large hospitals to continue resisting bipartisan 340B reforms under consideration at the federal level in Congress. There is recognition in Congress that federal legislation needs to reign in abuse of contract pharmacies and create an efficient way for covered entities to exchange limited commercially standard claims data identifying which drug dispenses are 340B eligible. [1:11:14](https://vimeo.com/1170834056#t=4274s) This bill moves in the wrong direction on these critical policy issues. I wanna emphasize, there are currently zero 340B reporting requirements that apply to hospitals participating in this program. Absolutely no claims data is shared with the federal government under this program. Only 200 audits are conducted annually out of a total of 14,000 covered entities participating in this program. And the agency that enforces this program, HRSA, receives an annual budget of $16 million. [1:11:49](https://vimeo.com/1170834056#t=4309s) That budget does not ascend adequately support the level of oversight needed for this program, and the other complicating factor is that HRSA does not have regulatory authority to compel covered entities to provide the information that manufacturers, as confirmed by federal courts, are permitted to include as a term of their federal pricing offer. In closing, please note that this, that rejecting this bill will not impact patients' ability to access their medicines. And 340B drugs are available in unlimited quantities at any 340B covered entity location. [1:12:25](https://vimeo.com/1170834056#t=4345s) However, rejecting this bill, as the committee did last year, will send a clear message that the road to addressing the problems in 340B runs through Congress and not the Georgia legislature. We respectfully urge your no vote on this bill, and I would be more than happy to answer any questions that you may have. [1:12:43](https://vimeo.com/1170834056#t=4363s) Thank you. We have a long list of people signed up, and our agreement, some of y'all might have not known about the agreement, but the agreement I have with many of you, that we have three-minute testimonies. We're starting a shot clock because we're gonna get out of here before breakfast. In fact, we're gonna get out of here by 4:30. Go ahead, Representative Gisler. [1:13:08](https://vimeo.com/1170834056#t=4388s) Yeah. Thank you, Mr. Chairman. Um, point number one from Mr. Sentos, Sentos, is that his name? He's still up there [1:13:18](https://vimeo.com/1170834056#t=4398s) I thought I heard he mentioned that the state benefit, state health plan is, is paying for 340B today. No. But we've been told that we are not. They do not participate. Can I ask him to repeat point number one? Could, could- Is he gone? Yeah, he's still on. I'm here if you guys, if you'd like me to speak to that. Yeah, go ahead. Yeah, so, so it's a, it's a cost to the state government, it, um, and local government plans in that the rebates that they would otherwise receive from manufacturers that are, that are provided by contract would not be paid if those drug dispenses also qualify for 340B pricing. [1:13:57](https://vimeo.com/1170834056#t=4437s) So it's a one or the other situation. So if you have state or local government plan participants that are going to a 340B covered entity and receiving 340B drugs, um, the provision of a 340B discount means that a rebate would not be paid to the state plan or the local government plan. So those would be foregone rebates to those plans, and that does come at a cost that would be made up presumably by higher premiums and higher, uh, taxpayer contributions to cover those plan expenses. [1:14:28](https://vimeo.com/1170834056#t=4468s) Okay, but to be clear, since the state plan is not 340B and does use the rebate program, that's not really a factor, right? See if we can get him over here to speak about that. Sure, thank you. Speak about the rebate. We'll, we'll ask you when you get up here. Okay. The federal law does not allow you to duplicate- Right ... the re- you know, the rebate or, or, uh, or the 340B plan. You can't do both. Sure, I was just concerned about any conflict. [1:15:00](https://vimeo.com/1170834056#t=4500s) No, that's all. But, yeah. Uh, Chair Lady, we've got Silcox. I'm sorry. I, I, I've-- I'm sorry. [1:15:12](https://vimeo.com/1170834056#t=4512s) Yes, sir. Can you hear me? [1:15:16](https://vimeo.com/1170834056#t=4516s) Yes. Is that, is that for Corbin? Yeah, that's for you. Hey, just to- Yes, I can hear you. Um, I'm not a litigator or an appellate lawyer, but my understanding was that the Arkansas Act was upheld by the Eighth Circuit and SCOTUS denied review. Is that accurate? That is correct. Uh- Okay ... and, and I will submit to you that it's also true for the State of Louisiana in the Fifth Circuit. But since those decisions have been issued, the federal government has made its position clear. That was just last week, so this is late-breaking news. [1:15:48](https://vimeo.com/1170834056#t=4548s) The federal government has been very clear, unequivocal, that these laws are unconstitutional because they violate the Supremacy Clause. They conflict with the dispute resolution process that Congress laid out in the statute, and they violate the intragovernmental immunity doctrine by targeting for additional regulation manufacturers based on their participation in a federal program. Thank you. Okay. We have a lot of people. Can you make it quick? Thank you. Could you possibly send to the committee or to Representative Jones the cites for the Supremacy Clause decision? [1:16:25](https://vimeo.com/1170834056#t=4585s) Could you s- that recent decision, could you send that to us? Yes, I can do that. Thank you so much. Sure. Okay. Thank you very much. I appreciate that. Uh, Will Dain. Is, is he on? I am. Okay. Go ahead. Can you hear me? All right. Thank you. Good afternoon, Chairman Hawkins and members of the committee, and thank you very much for the opportunity to speak today, especially for setting this up virtually. My name is Will Dain, and I represent the Healthcare Distribution Alliance, or HDA. [1:16:59](https://vimeo.com/1170834056#t=4619s) Uh, we're the National Trade Association for Pharmaceutical Wholesale Distributors. It's a bit out of the norm for me, uh, on behalf of wholesale distributors to testify in opposition to a measure such as House Bill one three nine. Our members work very closely with others in the healthcare supply chain. Uh, obviously manufacturers with whom opt to contract with wholesale distributors and, um, covered entities such as hospitals and pharmacies, and those hospitals and pharmacies are customers of my member companies. [1:17:33](https://vimeo.com/1170834056#t=4653s) So my goal here is not to point fingers at our sup- supply chain partners or any entity, um, rather to clarify wholesale distributors' role when it comes to 340B, which in short is not financial, uh, but logistical, as we are ensuring delivery of product and subsequent access to care for patients served by our member company customers, and as such, respectfully just stating wholesale distributors don't belong in this legislation. [1:18:04](https://vimeo.com/1170834056#t=4684s) Distributors handle the movement of product in the pharmaceutical supply chain. That's our role. We safely s- store medications, we main- maintain inventory, and we deliver them to pharmacies and hospitals. What we don't do is make decisions about pricing, reimbursement, claims, or eligibility under programs like 340B. Those decisions happen elsewhere in the system. You might call it the payment side, if you will. Um, and importantly, wholesalers have no interest in being in a position where we are denying access to our customers. [1:18:39](https://vimeo.com/1170834056#t=4719s) If that were an ongoing issue, wholesalers would likely lose those customers very quickly. Um, what we've seen over the last couple of years is a significant amount of 340B legislation across the country. In many cases, wholesalers were initially included in language such as this or similar to this measure. Generally, after conversations with sponsors, hospital associations, uh, and other stakeholders, those bills were adjusted or amended to remove wholesalers once our role was better understood. [1:19:14](https://vimeo.com/1170834056#t=4754s) Off the top of my head, that's happened in states, going back into '25, Oklahoma, Hawaii, New Mexico, Utah [1:19:23](https://vimeo.com/1170834056#t=4763s) Mm, 24 in Missouri, uh, and Kansas, just to, to throw out a few. Um, big picture as far as the complete state team goes for HDA, we either tracked or engaged on more than 40 340B related measures last year and creeping into 2024 a bit. Um, not all included wholesale distributors. So I would really welcome that same opportunity for discussion here. Ideally, one that includes everyone this measure impacts as well as the sponsor and co-sponsors. [1:19:56](https://vimeo.com/1170834056#t=4796s) Because the reality is wholesalers are not here to referee the broader 340B debate between manufacturers and covered entities. Our role is simply to move medications safely and efficiently through the supply chain. The reason this matters is because wholesalers do have very real legal obligations, particularly when it comes to controlled substances. If an order is flagged as suspicious under DEA requirements, a distributor cannot ship that product until the order is resolved. [1:20:28](https://vimeo.com/1170834056#t=4828s) Sometimes that clears up very quickly, a day. Sometimes it takes longer. In those situations, distributors are going to get caught between Georgia law, if this were to pass as is, federal DEA regulations, and the requirements of the national opioid settlement. So, you know, at the end of the day, wholesalers move product. They don't make policy decisions about that product. We just want to make sure wholesale distributors are not regulated for decisions that are made elsewhere in the system. [1:21:00](https://vimeo.com/1170834056#t=4860s) So respectfully, what we're asking is that wholesale distributors be removed from the bill, or that we have the opportunity to work with the sponsor and stakeholders to ensure the legislation reflects the actual role distributors play in the supply chain and ultimately results in sound policy. Thank you for your time, Chairman Hawkins and members of the committee. I'm happy to answer any questions. [1:21:24](https://vimeo.com/1170834056#t=4884s) Thank you. I see no questions. Re- appreciate it. Thank, thank you for joining us. [1:21:29](https://vimeo.com/1170834056#t=4889s) Thank you. [1:21:29](https://vimeo.com/1170834056#t=4889s) Okay. Amanda, is it Gaddy? [1:21:33](https://vimeo.com/1170834056#t=4893s) Gaddy. [1:21:33](https://vimeo.com/1170834056#t=4893s) Yep. [1:21:38](https://vimeo.com/1170834056#t=4898s) Same thing. Oh, I can do it. [1:21:41](https://vimeo.com/1170834056#t=4901s) Can you hear me okay? [1:21:42](https://vimeo.com/1170834056#t=4902s) Yeah. [1:21:43](https://vimeo.com/1170834056#t=4903s) I'm Amanda Gaddy. I am a pharmacist in Georgia, and I work with a pharmacy association. I also work with over 400 pharmacies across the United States in the 340B, um, contract pharmacy arena. So I have a lot of experience when it comes to everything that's happened at the state level. And I have-- Um, this is the first time I've ever done this. I'm a little bit nervous. I'm a rookie about, like, notes. Um, I just wanna tell y'all what's going on here. So prior to 2020, pharmac- a covered entity could have multiple contract pharmacies. [1:22:14](https://vimeo.com/1170834056#t=4934s) When you think about a hospital that's in, like, a major area, they may have satellite clinics in s- the rural part of Georgia. Could be twenty minutes away, could be thirty minutes away. Well, in 2020, we started seeing manufacturer restrictions, and what that meant is, uh, well, over, what, thirty-nine manufacturer restrictions. And what they are, it, it's a multiple of things. Some of them are all, you know, every hospital, every clinic. Some are just hospitals. [1:22:44](https://vimeo.com/1170834056#t=4964s) Um, and what it has caused is access to medications for patients. Okay, what I mean by that is now if they can only get the prescription filled at the hospital, the main hospital, the main area, but they live twenty miles away, how do they get their medicine? Whereas before, they were getting it at their local pharmacy. Um, a lot of hospitals have clinics that are twenty minutes away, so they would go into their clinic. And not only that, but these independent pharmacies, they deliver their medication. [1:23:15](https://vimeo.com/1170834056#t=4995s) They package their medication. They do adherence packaging. And when somebody said that, um, something about increasing cost, I wanna tell you something. If a patient can't get their medication and they go end up at the emergency room, guess who's paying for that? Georgia tax dollars is paying for that, and it happens. So I mean, there's w- there-- I've heard all this stuff about 340B, and a lot of this is, um, at the federal level. But what this bill, my understanding, is to stop these restrictions that are happening with these manufacturers at the state level. [1:23:50](https://vimeo.com/1170834056#t=5030s) That's what we're talking about here. Yes, 340B needs a rehaul, but that is a federal thing. So I would ask you to really think about that. Patients are impacted. And since 2020, in Georgia, there are patients who are not getting their medications because of these restrictions. And I'll answer any questions that you may have. [1:24:14](https://vimeo.com/1170834056#t=5054s) Uh, I see no questions. Thank you. Okay. Next, uh, Yvonne Barton. I think she's on the Zoom. [1:24:25](https://vimeo.com/1170834056#t=5065s) Yes. Hello. [1:24:27](https://vimeo.com/1170834056#t=5067s) Go for it. [1:24:28](https://vimeo.com/1170834056#t=5068s) Great. Thank you. Good afternoon, Chairman Hawkins and committee members. My name is Yvonne Barton, and I serve as the Director of State Government Affairs at AbbVie, covering the southern region. I'm based in Texas, so I'm so sorry I was unable to be there in person today. Um, AbbVie is an American-based company headquartered in Illinois with over fifty-five thousand employees worldwide, including more than three hundred employees in Georgia, which also includes our Allergan Medical Institute there in, in Atlanta. Our mission is to discover and deliver innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. [1:25:06](https://vimeo.com/1170834056#t=5106s) More than sixty million patients are treated with our medicines every year. Thank you today for the, for the opportunity to testify in opposition of House Bill 139, which would expand the 340B program beyond the federal statute to contract pharmacies, including the nation's largest PBMs. From the manufacturer's perspective, the 340B discount can be upfront, but it can also be applied in the back end, uh, referred to as a charge-back Where the manufacturer receives a bill from the wholesaler after the drug is dispensed to the patient. [1:25:39](https://vimeo.com/1170834056#t=5139s) This process occurs when the covered entity uses arbitrary care criteria that can change at their discretion to identify previously filled prescriptions to claim that 340B discount, even for prescriptions that were dispensed many years ago. After this, the pharmacy will place an order to refill or replenish their regularly priced drug inventory at the 340B price, or even change the pricing on a previous drug order without even getting the shipping and the physical inventory. [1:26:13](https://vimeo.com/1170834056#t=5173s) We as manufacturers offer these discounts, but we do not get to see the data. AbbVie just receives an invoice that says, "You owe this much." We don't even get an itemized receipt. We don't even get the same information that a hospital provides to a commercial insurer, Medicare, or Medicaid for reimbursement for a service. Unlike other healthcare reimbursements, the 340B program requires manufacturers to provide discounts on an honor system. Last year alone, AbbVie provided more than $205 million in 340B d- drug discounts to Georgia covered entities. [1:26:52](https://vimeo.com/1170834056#t=5212s) In '22, in, in 2022, our 340B discounts in Georgia totaled $121 million. This represents a 70% increase in 340B discounts in just three years. This represents just one manufacturer, just us in one year. This number continues to grow year after year. This unprecedented 340B growth directly impacts the loss of rebates, as mentioned pr- previously by other, other folks testifying, that, that can impact employers and even state budgets. [1:27:29](https://vimeo.com/1170834056#t=5249s) This program is a financial windfall for large hospital systems and not-for and for-profit middlemen like the PBNs, who own large pharmacy chains with no requirement that those savings are passed through to the most vulnerable patients. AbbVie currently pays the bulk of our discounts, $188 million, or 92%, to hospitals in the Georgia, in, in the state of Georgia. Within those covered entities, two large hospitals alone made up 49% of our discounts. [1:27:59](https://vimeo.com/1170834056#t=5279s) All Georgia grantees, including the small grantees like FQHCs, only make up a fraction of the discounts paid last year with about $17 million, or 8% of that. It is important for the committee to note that 340B hospitals also prescribe in a very different fashion. They're, they're prescribing 23% fewer biosimilars to non-340B hospitals. Let's take AbbVie's drug Humira for an example. [1:28:27](https://vimeo.com/1170834056#t=5307s) I hate to interrupt you, but- Yes ... the three minutes are up, and I apologize, but we have a lot, lot more folks, a number of folks that still need to speak. Thank you for- Okay. So- Thank you. Okay. Up next, uh, Michael Azalin. Azolo? [1:28:47](https://vimeo.com/1170834056#t=5327s) Azlin. [1:28:48](https://vimeo.com/1170834056#t=5328s) Azal. Okay. Azlin. Excuse me. [1:28:52](https://vimeo.com/1170834056#t=5332s) Oh, my hobbling around doesn't count. It's part of my three minutes. Yes. [1:28:57](https://vimeo.com/1170834056#t=5337s) So thank you. Appreciate your time speaking to us. [1:29:00](https://vimeo.com/1170834056#t=5340s) Yeah. Thank you for the time. Hear me okay? [1:29:03](https://vimeo.com/1170834056#t=5343s) Yeah, go ahead. [1:29:04](https://vimeo.com/1170834056#t=5344s) Um, [1:29:08](https://vimeo.com/1170834056#t=5348s) so I'm Michael Azlin. Our company, PharmD On Demand, manages 340B programs on behalf of covered entities here in Georgia and across multiple other states. So we work in 25 rural hospitals here in Georgia. We don't provide that service right now to any large hospital systems. They just don't need it. They've got internal resources that can do it. In our company, we have what's called Apexis certified experts, people who are certified in understanding the knowledge of the regulatory requirements of 340B. So our job is to make sure that hospitals are being compliant to the program while maximizing the utilization of the 340B program. [1:29:41](https://vimeo.com/1170834056#t=5381s) Um, we actually work a lot with Ms. Gaddy because we don't work on the pharmacy side, we work on the hospital side in coordinating the relationship between the contract pharmacies. And I'll just start with a question for you to ponder. When you need a prescription, where do you get it from? [1:29:59](https://vimeo.com/1170834056#t=5399s) A pharmacy. So the covered entity has the right to access 340B drugs because they've met the federal requirements, and I'll speak to those in just a minute. Then in order for them to utilize the program, and for a patient that they see to get a drug, they need to get it from a pharmacy. The only way they can get it is to contract with that pharmacy, and then the 340B drug be accessed through that pharmacy to the patient. If you don't contract with the pharmacies, or if the drug manufacturers don't allow the 340B drugs to get to the pharmacies that the hospital is contracted with, then the patients can't get the drug. [1:30:38](https://vimeo.com/1170834056#t=5438s) Let me give you a real-life example of that. If you are a patient that has no insurance and cannot afford your insulin or your Xarelto for your anticoagulation of your, um, atrial fibrillation, by the way, I am a pharmacist as well, and you need to go to a pharmacy to get that drug, and the drug manufacturer has said, "We're not going to allow a contracted pharmacy to access a 340B drug," when that patient goes to get it, they can't get that 340B drug. Now all of a sudden, a Xarelto, which may only cost them $10, is gonna cost them $300. [1:31:10](https://vimeo.com/1170834056#t=5470s) So they choose not to get it, and it hurts them. They get sicker. These are real-life scenarios. I can show you multiple instances because we're the ones that monitor when it happens for, on behalf of the covered entities. And don't let anybody tell you it can't. I keep hearing from multiple people that this bill expands 340B. Prior to 2020, hospitals and other covered entities such as FQHCs, also called community health centers, could contract with as many pharmacies as they wanted to, and there's a reason for that. [1:31:40](https://vimeo.com/1170834056#t=5500s) There's a reason why they contract with pharmacies in Nevada that are mail-order pharmacies. You wanna know why? Because patients have a choice, number one, of where they can get their drugs from. And if they wanna get their drugs from a mail-order pharmacy in Nevada, then they can. So in order for that covered entity to be able to utilize its 340B drug, which it has the right to do because it saw that patient, they have to contract with that pharmacy in Nevada. They're not telling the patient to go there. They're not trying to get extra. Just, they're just trying to get what they have the rights to get to. Furthermore, we've heard they're in affluent areas. [1:32:10](https://vimeo.com/1170834056#t=5530s) Well, of course they are. If they're seeing patients that live in affluent areas and they see the ho- the, the provider at the hospital, that prescription is then eligible. Wherever that patient lives or wherever they get their prescription from, they're gonna get that filled in that pharmacy. So in order for the hospital or the other covered entity to utilize the access to 340B that it has a right to, it has to contract with that pharmacy. That's not a special or unique thing. I also hear people, including attorneys, saying that the purpose of the program is to get low-cost medications to people who need it. [1:32:42](https://vimeo.com/1170834056#t=5562s) That is explicitly not the purpose of 340B. I've been screaming this for 15 years. The purpose of the program is to offset the cost of indigent care for covered entities, including hospitals, that are forced to see indigent patients due to the laws of such as EMTALA. And I can read to you what EMTALA means in just a minute. But if a patient walks through a hospital door and they use Medicare or they participate in Medicare, they have to see that patient no matter their ability to pay. As a result, they have less reimbursement, and as a result, they have to, or they have the option through the 340B program to offset some of those costs. [1:33:17](https://vimeo.com/1170834056#t=5597s) That's the purpose of it. Now, that said, like I said a minute ago, when a patient can't afford it, the hospital, through typically a drug purchasing card, will allow that patient to get that drug and the hospital will pay for it or pay most of it and only have the patient pay a small co-pay, if not nothing, so that they can get that medication as opposed to having that patient pay full price for it. But if the drug manufacturers don't allow the contract pharmacies to get the drugs, then the patient can't get the drug from the pharmacy at that discounted price. It's as simple as that. [1:33:47](https://vimeo.com/1170834056#t=5627s) Um, I could talk for hours. I'd love to share more, but what I can tell you is all this program does, as Representative Jones said earlier, is protects the original intent of the program. It's always-- I also heard that, that the, uh, federal legislation doesn't contemplate contract pharmacies. No, it doesn't. Why would it? Where do drugs come from? Pharmacies. It has to come from pharmacies, so you have to contract with them to get it. There's no other way. Also, I heard the, the, uh, oncologist a few minutes ago mention that this is an expansion of the program and it's gonna hurt his practice. [1:34:21](https://vimeo.com/1170834056#t=5661s) His drugs don't come from retail pharmacies. Those drugs come from hospital pharmacies. That's not gonna impact his practice. This bill won't impact his practice at all, and that's truth. I'll yield the rest of my time, but I've got a lot more I'd love to share. A lot more I'd love to share. [1:34:38](https://vimeo.com/1170834056#t=5678s) Sure appreciate it. Thank you for coming, popping in here to speak to us. [1:34:42](https://vimeo.com/1170834056#t=5682s) You're welcome. [1:34:43](https://vimeo.com/1170834056#t=5683s) Have a good day. Okay. Yeah. Anna Adams. [1:34:53](https://vimeo.com/1170834056#t=5693s) Is Anna... Yeah. Okay. [1:34:56](https://vimeo.com/1170834056#t=5696s) I didn't wanna knock him down and make it worse. [1:34:58](https://vimeo.com/1170834056#t=5698s) Right. Right. [1:35:00](https://vimeo.com/1170834056#t=5700s) Thank you, Mr. Chairman, members of the committee. For those of you who do not know me, I am Anna Adams with the Georgia Hospital Association. We represent 150 hospitals across the state, small rural, large urban, for-profit, nonprofit, you name it. GHA does have the, um, distinct honor of representing several 340B hospitals across our state, and we stay in close contact with them about what it is that they're doing with their 340B savings, and the stories really differ from community to community. You see things like, um, dialysis clinics, cancer care, um, mercy care clinics for people who don't have access to insurance, and all of that is possible through the savings of the 340B program. [1:35:43](https://vimeo.com/1170834056#t=5743s) There have been a lot of words thrown out there today that make you think this is some kind of a cash cow program, and I'm not here to debate the original intent of 340B, but this is akin to using a coupon at the grocery store. If you have the opportunity to purchase something for less and you can use that savings towards something good, wouldn't you wanna do that? Not every hospital in the state qualifies for 340B. You have to treat a really large number of disproportionate patients, uninsured patients. [1:36:15](https://vimeo.com/1170834056#t=5775s) These dollars are meant to go toward community care. Our hospitals are doing exactly that through 340B. You heard from many people earlier about access to medications and what it means when you live, especially in a rural area, and you have to drive thirty, forty minutes to get access to your drugs. Medication compliance is so important to have a healthy Georgia, and as you all have been discussing access to care for Georgians, access to care in rural areas, access to medications for patients, this is a really key important part of that. [1:36:49](https://vimeo.com/1170834056#t=5809s) Hospitals contracting with other pharmacies allows patients, uh, the ability to go in and get their medications where maybe they wouldn't have gotten it at all before. There have been some assertations here today that I think are incredibly interesting, where they're, where they're living, um, where they're coming from, but this is really about Georgians taking care of Georgians and the ability to continue to do what the federal government has always allowed us to do and has said we are able to do. These restrictions or rollbacks that started happening in 2020 are a, um, the program really being diminished by big pharma. [1:37:27](https://vimeo.com/1170834056#t=5847s) It is not an expansion of the program. So we're just saying stop the bleeding. We recognize what the federal government allows us to do. Let us keep doing that. Stop telling us that we can't have these contract pharmacies. Stop telling us that we can't provide drugs to our patients and access to those services. This is a really simple bill, and I know you all have a lot of experience with really simple bills. They're often short, but they have a meaningful impact. This bill Just lets us continue to do what we've always done to provide access for care, to care. [1:37:58](https://vimeo.com/1170834056#t=5878s) Without it, I fear we will continue to lose those contract pharmacies and our patients will have fewer and fewer options. So Mr. Chairman, I am happy to answer any questions that you may have. Okay. Very well. [1:38:13](https://vimeo.com/1170834056#t=5893s) So I first wanna say I personally appreciate the 340B program. I have an FQHC, um, that, that has one. I wanna exempt them from, from this question because as we know through HRSA they have their own regulatory regimes that, you know, well, they can have multiple purposes. One of them is definitely to serve indigent cares. So it occurs to me through this debate that two things can be true at once. [1:38:33](https://vimeo.com/1170834056#t=5913s) Mm-hmm. [1:38:33](https://vimeo.com/1170834056#t=5913s) Uh, big pharma may be abusing it, hospitals may be abusing it to do profits. I understand that that is not your opinion. My question is, the way I see this bill, it's addressing one part of that. It's big pharma and their, what I read, as non-competitive behavior. My question is, would, I don't wanna put you on the spot, but why does this bill not also include any protections, which to my understanding would also, if this is not federally preempted, what I'm about to say would not be federally preempted, would have data collection, not by the drug manufacturers, but by the state to ensure that in fact if the original intent of 340B is in fact to recoup costs by serving indigent care, that we are actually doing that through this program, and that's something that I know is part of a larger debate on Schedule H, community benefits, et cetera. [1:39:31](https://vimeo.com/1170834056#t=5971s) But considering that this is a specific program and the stated intent is clear, why does this bill not include that part of it so that we can cover kind of both sides of the debate? [1:39:42](https://vimeo.com/1170834056#t=5982s) You know, I think other states have passed this legislation, and we talked about that, um, earlier. Some states do have some requirements for additional data. I did wanna point one thing out in this bill, because there has been so much discussion about data, that that provi- or that provision in the bill, section D, only applies so much so that if the pharmaceutical company is requiring this additional data while they are holding hostage the drug, it does not require that we don't participate with them voluntarily in order to give them the data that they need to do their jobs. [1:40:20](https://vimeo.com/1170834056#t=6020s) It just says, "Don't hold up the drug movement because you wanna employ, or some brand-new requirements that we just keep adding on to year over year over year," which we all know is kind of a delay tactic. Um, I am not against having conversations about transparency. We've been having those at the federal level for years, and I think many of the hospitals, as you saw in Representative Jones', um, PowerPoint, are very happy and proud to talk about what they're able to do with their 340B drug discounts, and they want their communities to know how they were able to save those dollars and how they were able to reinvest them. [1:40:55](https://vimeo.com/1170834056#t=6055s) So I would encourage you to even talk with your own hospital about what their 340B program means to them and how it's contributing to your constituents. [1:41:03](https://vimeo.com/1170834056#t=6063s) Uh, just a quick follow-up question. In what form, if any, are they already required to report that kind of data? And again, uh, to be clear, this is not to the drug manufacturer. [1:41:13](https://vimeo.com/1170834056#t=6073s) Mm-hmm. [1:41:13](https://vimeo.com/1170834056#t=6073s) It would be either to, I'm assuming, the federal government at this point. Uh, in what form are they currently required to report that? [1:41:21](https://vimeo.com/1170834056#t=6081s) Let me get you some information on what is required from them, because I can't speak to that off the top of my head. [1:41:26](https://vimeo.com/1170834056#t=6086s) Okay. [1:41:26](https://vimeo.com/1170834056#t=6086s) But they are required to report, and this is a program that has a lot of scrutiny, and so I think our hospitals take it very seriously, making sure they're staying within the lines. [1:41:35](https://vimeo.com/1170834056#t=6095s) Thank you. [1:41:35](https://vimeo.com/1170834056#t=6095s) Mm-hmm. Okay. Well, thank you very much. Thank you, Mr. Chairman. Up next, Sarah Balogh, Balogh? Balogh? [1:41:43](https://vimeo.com/1170834056#t=6103s) Ba- Balogh, yes. [1:41:44](https://vimeo.com/1170834056#t=6104s) Okay. [1:41:49](https://vimeo.com/1170834056#t=6109s) Hello, good afternoon. Uh, my name is Sarah Balogh with, uh, the Pharmaceutical, uh, Research and Manufacturers of America, AKA Big Pharma. Um, I'm also a proud Georgian, so glad to be here today. And Mr. Chairman, I agree with you on we wanna get outta here because I'm trying to get back to my son's JV match at 5:30. So I am right there with you. Um, just wanted to quickly just, um, speak to a couple of the things that we've heard. I know this has been a really, um, passionate debate. There's a lot of passionate views, um, on, on, you know, about how care is delivered to, to the residents of our state. [1:42:20](https://vimeo.com/1170834056#t=6140s) Um, I just want to say upfront that this is not an access issue. Um, 340, whether a 340B patient seen at a 340B covered entity fills their prescrip- takes, takes a prescription and fills it at their neighborhood pharmacy or at a contract pharmacy, there's no difference in that, that patient's ability to access that drug, to pay for that drug. The only difference is if it's not a 340B contract pharmacy, the covered entity doesn't have the opportunity if they choose, they don't always mark up the drugs, but if they choose to mark up the drugs, they then lose that opportunity. [1:43:01](https://vimeo.com/1170834056#t=6181s) So certainly if a FQHC, if a, you know, a, a hospital that is following the original intent of the program and is passing that discount on to the patient, then they're not m- they're not marking up the drug. But both of those things cannot be true at the same time. It cannot be a source of f- of revenue that stretches scarce federal resources and be passing along a discount, because they're either passing the discount they've received to the patient and that patient is paying that low cost, or they're marking up the drug and pocketing the difference. [1:43:37](https://vimeo.com/1170834056#t=6217s) So- And this, which leads me to just another, I think, critical point. The revenue that is generated by the 340B program is not paid by the manufacturers. It does not come out of the manufacturer's pocket. The revenue that is generated by the 340B program is paid by patients at the pharmacy counter and the employers that provide them their insurance coverage. Because as we've heard a lot about how 340B claims are adjudicated behind the scenes, once a patient has been tagged, get- gets an invisible sign that says, "I'm a 340B patient," that status comes in front of, and during the claims adjudication process, steps in front of any rebate that has been negotiated. [1:44:19](https://vimeo.com/1170834056#t=6259s) So that's where you see, um, and, and we'll get some more information to this, on this to you. So the state employee plan does in fact have costs, increased costs. The only way for the state employee plan to exempt itself from, uh, from the 340B program would be to deny its employees the ability to get care at 340B entities. So interestingly, what, what the state has done in the Medicaid program, the, the medic- the state Medicaid program does not allow contract pharmacy. So I think that may be where some of that confusion is. [1:44:52](https://vimeo.com/1170834056#t=6292s) Um, but the, um, there was a study that was released in January by IQVIA that, um, the cost to Georgia, um, sorry let me just find the right page here. Find, know we're trying to be fast. Um, as an employer with, um, SHBP, the, the total 340B annual spread price paid by SHBP was 40.5 million. So that's, that's the markup. These 340B entities are getting a discounted price and they're marking it up to the tune of 40.5 million in one year for the state plan. [1:45:28](https://vimeo.com/1170834056#t=6328s) Thank you very much. [1:45:29](https://vimeo.com/1170834056#t=6329s) Okay. [1:45:30](https://vimeo.com/1170834056#t=6330s) You know, we talked to, uh, some of the folks in State Hill Benefit this morning in my office, and obviously this is a very confusing point here because as they said, they u- they do not utilize the f- 340B. You cannot do both. [1:45:45](https://vimeo.com/1170834056#t=6345s) Right. [1:45:45](https://vimeo.com/1170834056#t=6345s) You know, they're doing rebates. I'm not sure, maybe if it's, uh, isn't somewhere in the m- middle of where they're negotiating the rebate and the 340, uh, B price is being mentioned, used, or whatever. I don't know that for sure. Uh, this is, um, this is a very confusing subject, that's for sure. I've got questions on the board. Representative Gisler. [1:46:09](https://vimeo.com/1170834056#t=6369s) Thank you, Mr. Chairman. Um, I've got a couple of questions for you real quick. [1:46:12](https://vimeo.com/1170834056#t=6372s) Okay. [1:46:12](https://vimeo.com/1170834056#t=6372s) Um, so you just said that the purpose of the 340B program was to, to get these discounted drugs to indigent patients. [1:46:22](https://vimeo.com/1170834056#t=6382s) Yes, that's the original intent of the program. [1:46:24](https://vimeo.com/1170834056#t=6384s) The gentleman, two speakers before you said that was explicitly not the intent of the program. The intent of the program is to have that profit margin that can be invested into indigent care. [1:46:35](https://vimeo.com/1170834056#t=6395s) It- [1:46:36](https://vimeo.com/1170834056#t=6396s) Right. [1:46:37](https://vimeo.com/1170834056#t=6397s) Right. I mean, I, I guess it's just good people of faith disagree. I mean, it's the, the- [1:46:42](https://vimeo.com/1170834056#t=6402s) I mean, it's law. It's there is an answer, right? [1:46:47](https://vimeo.com/1170834056#t=6407s) And it's, it's our position that the, the original intent of the program is to ensure access to discounted medicines for communities that are at risk. [1:46:55](https://vimeo.com/1170834056#t=6415s) Okay. Um, my second question goes back to the, the data-sharing requirement or, or, um, I guess prevention here. [1:47:02](https://vimeo.com/1170834056#t=6422s) Uh-huh. [1:47:03](https://vimeo.com/1170834056#t=6423s) Um, you know, there, there is, I guess, you know, from what I've learned, circumstantial evidence that maybe larger systems are profiting from this. Um, but I've also heard that there are federal requirements as far as audits and data collection on 340B programs that is publicly available. Is that data not sufficient enough to know whether there is something in- uh, incorrect, or some kind of fraud going on there? [1:47:30](https://vimeo.com/1170834056#t=6450s) Right. It's, um, it's a very opaque program and, you know, that's why we've heard, you know, some discussion that, um, you know, some, uh, of what other states have done. You know, um, states like, uh, Minnesota, like Indiana, have passed laws that are requiring very robust, um, data transparency and, you know, insight and reporting out on what the, what the program's costs are. Um, you know, that you have to pass a state law in order to get that data because it's not, it's not sent to the federal government. [1:48:03](https://vimeo.com/1170834056#t=6483s) It's, and with, under this bill, it would be proactively prohibited from being shared with manufacturers. So it is a, it is a very opaque program that definitely needs more transparency. [1:48:14](https://vimeo.com/1170834056#t=6494s) So you're saying at the federal, that, that it's incorrect, that data is reported back to the federal government? [1:48:19](https://vimeo.com/1170834056#t=6499s) There's a, there's a, there's a federal database that's publicly searchable by anyone- [1:48:23](https://vimeo.com/1170834056#t=6503s) Okay [1:48:23](https://vimeo.com/1170834056#t=6503s) ... but the, the t- the terms of the contract pharmacy agreements are opaque. Um, you know, the- [1:48:30](https://vimeo.com/1170834056#t=6510s) Sure, but- [1:48:31](https://vimeo.com/1170834056#t=6511s) ... duplicate, you know, concerns about duplicate discounts, it's just there's... So I'm sorry, I'm cutting you off. [1:48:36](https://vimeo.com/1170834056#t=6516s) No, I, I'm sorry, I was cutting you off. Um, uh, no, I can leave it at that. Thank you. [1:48:41](https://vimeo.com/1170834056#t=6521s) Okay. [1:48:41](https://vimeo.com/1170834056#t=6521s) Thank you. Uh, is that Representative Jasper? [1:48:46](https://vimeo.com/1170834056#t=6526s) Oh, yeah. Thank you. [1:48:47](https://vimeo.com/1170834056#t=6527s) Chairman Jasper. [1:48:48](https://vimeo.com/1170834056#t=6528s) Just, just real quick, ma'am. So did I understand you correctly a moment ago when you said that, uh, the way you're interpreting it, the manufacturer distributors cannot prohibit, uh, a retail pharmacy from taking part in this program? 'Cause that, I've heard that they can. [1:49:09](https://vimeo.com/1170834056#t=6549s) Sure. So, so again, so the original statute doesn't speak to contract pharmacy at all. In 1996, the federal government said you can have one contract pharmacy. In 2010, they said you can have un- unlimited contract pharmacy, and HRSA said that through what's called subregulatory guidance. It doesn't have the effect of law. So that's just another... Th- there are no laws being broken right now. If this bill didn't pass, the program stays exactly the way it is. Um, but what I was saying is that if I am wearing an in- an invisible 340B tag, having gotten care at a 340B covered entity, I can take my prescription wherever I like and fill it wherever I like. [1:49:45](https://vimeo.com/1170834056#t=6585s) There are no restrictions on where a patient can fill a prescription that they've received. Absolutely none. [1:49:51](https://vimeo.com/1170834056#t=6591s) Okay. [1:49:51](https://vimeo.com/1170834056#t=6591s) Okay. Thank you, Chairman. [1:49:53](https://vimeo.com/1170834056#t=6593s) Yeah. Representative, do we have Davis? [1:49:57](https://vimeo.com/1170834056#t=6597s) Thank you, Chairman. I think the last time I spoke on this issue, I made note of a patient that I was listening to who went to three different pharmacies looking for a name brand drug and could not find one right here in Metro Atlanta, and I asked him to keep me on the phone so I could hear what is going on, and I didn't understand how that could be possible. Um, I wanna make it known that that patient did file several complaints, even with the pharmacy board, with the federal, uh, a number of others, and I wrote my own letter stating that I was on the phone and what I experienced listening to him on the phone. [1:50:51](https://vimeo.com/1170834056#t=6651s) So a lot of what's going on here, I said, "I wanna s- make sure that the independent pharmacy do not, you know, go out of business." But then again, when a patient is supposed to have-- be able to get his medication and can't, I'm trying to figure out where is the conflict here and why is it that the patient can't get his medication. So my question to you, 'cause I'm still waiting, where can we get the data that says that somebody is tracking this? [1:51:27](https://vimeo.com/1170834056#t=6687s) If the federal government is supposed to have this data and it's supposed to be publicly available, to this date, me nor that patient or any of his people can access that information. So if you can answer that, do you know? [1:51:44](https://vimeo.com/1170834056#t=6704s) Uh, no, I-- You know, the, the pharmaceutical supply chain is very complex with, you know, wholesalers and, and retail and manufacturers. It's, it's all a very, very complex process, and a lot of it happens behind the scenes that isn't visible to patients. Um, it's-- there's really no way to know whether that situation was-- whether that was even a III, IV, V drug. Um, so the, the bill that's before you today doesn't necessarily speak to that problem, but I hear you. It's a very, it's a very frustrating problem. [1:52:16](https://vimeo.com/1170834056#t=6736s) Um, you know, and, and that, you know, that is an access barrier, but it's, it's not necessarily as a result of, of the III, IV, V program. [1:52:25](https://vimeo.com/1170834056#t=6745s) Well, apparently it was a III, IV, V drug, and the, the patient, uh, apparently has problems trying to get to the bottom of it. So I wanted to put it on record that, uh, there was someone who did file a complaint. Thank you. [1:52:42](https://vimeo.com/1170834056#t=6762s) Thank you. Uh, before our next speaker, I did get an answer from State Health Benefit, and this is gonna clear it up greatly for you. [1:52:54](https://vimeo.com/1170834056#t=6774s) Also, III, IV, V are excluded from rebate guarantees, and therefore they do not affect them. That's her statement. [1:53:02](https://vimeo.com/1170834056#t=6782s) You can still take advantage of the system if you don't need a rebate. Is that what you're saying? [1:53:07](https://vimeo.com/1170834056#t=6787s) I just read you what she said. [1:53:11](https://vimeo.com/1170834056#t=6791s) Thank you. [1:53:11](https://vimeo.com/1170834056#t=6791s) Okay, uh, up next, Ashley Groom. [1:53:16](https://vimeo.com/1170834056#t=6796s) The... [1:53:23](https://vimeo.com/1170834056#t=6803s) Thank you, Mr. Chairman and members of the committee. My name is Ashley Groom, and I'm Director of Government Affairs for Bristol Myers Squibb, an American company dedicating to transforming patients' lives through science. On behalf of BMS, I would like to voice our strong opposition to HB 139. It should be noted, and you've heard this already, this is a federal program that requires ultimately a federal fix. HB 139 does not help the vulnerable patients that it is promoted to help. Instead, it incentivizes the dramatic expansion of the III, IV, V program in Georgia. The s- same program that has been referred to as diminishing has actually exploded in size through program abuse to become an eighty-one billion dollar program, second only in size to Medicare Part D. [1:54:04](https://vimeo.com/1170834056#t=6844s) To put it a different way, since twenty ten, the increase in contract pharmacy arrangements has increased twelve thousand percent. Twelve thousand percent. And sixty-nine percent of those are tied to PBMs, reflecting the use of these arrangements for profit, not to serve the vulnerable patients in Georgia who need it. This number is continuing to rise without legislation such as this proposal. In other words, if you do nothing today, this program will continue to grow. [1:54:35](https://vimeo.com/1170834056#t=6875s) Just to give you an example with our own numbers, since this bill was introduced last year, in twenty twenty-five, BMS paid more than two hundred and twenty million dollars in III, IV, V discounts in Georgia alone, an increase of more than twenty percent compared to the previous year, without the commiserate growth in the III, IV, V covered entities or within the patient population. Ninety-seven percent of those discounts were extended to hospitals. Ninety-nine percent went to large disproportionate share hospitals, while only three percent of those discounts were extended to grantees such as federally qualified health centers. [1:55:12](https://vimeo.com/1170834056#t=6912s) This is a stark reminder of how today's III, IV, V program has evolved into a money-making scheme for major health systems and PBMs rather than a program with transparency, accountability, and with direct benefit for vulnerable patients. Most notably, there is nothing in this legislation that would require hospitals or contract pharmacies to pass III, IV, V savings onto patients. And we, we've talked a lot about audits. We've heard some comments about audits. Thirty-four of fifty-one audits from the federal government on this issue have returned adverse findings, including violations involving illegal distribution of III, IV, V purchased drugs. [1:55:50](https://vimeo.com/1170834056#t=6950s) The cost of that failure is passed on to Georgia families and taxpayers. It's estimated that employers in Georgia already pay a hundred and eighty-seven dot- a hundred and eighty-seven million more each year in healthcare costs due to lost rebates, resulting in a reduction of more than fourteen million dollars in state and local tax revenue. Passing this bill would increase the cost to taxpayers without any benefit to patients. All of this data is provided in the letter in your folders or in your in- inbox. [1:56:21](https://vimeo.com/1170834056#t=6981s) Instead of passing this bill, let's join the states who are enacting transparency laws to shed light on what's happening with this program. So far, seven states have enacted transparency laws, and we expect that number to grow. Where we have seen under the hood, the findings are eye-opening. In North Carolina, even their Republican state treasurer did their own report and found one hospital system, we'll just say they overbilled a lot, and it cost the state a lot of money. So with that, I encourage you to oppose this bill. Thank you. [1:56:51](https://vimeo.com/1170834056#t=7011s) Thank you, ma'am. Up next, Becky Rouse. [1:56:56](https://vimeo.com/1170834056#t=7016s) FQHCs. [1:57:07](https://vimeo.com/1170834056#t=7027s) Good afternoon, Mr. Chairman, members of the committee. Thank you for the opportunity to present to you today. Um, what I'd like to do is speak to some of the questions that I've heard, and also shed light on what the 340B program means for your community health centers in Georgia, and most importantly, the patients in Georgia who are patients at the health center. And let me be clear that a patient must be a patient at a community health center, at an FQHC, in order to take advantage of the 340B drug program. [1:57:44](https://vimeo.com/1170834056#t=7064s) And that's not a one-time, "Oh, I'm gonna go get a vaccine and now I'm a patient." These are patients where the community health center, the FQHC, is their medical home. Um, and just a little bit of history, and in fact, just to bring a little levity, um, to this, uh, discussion today, let me first say that I agree with big pharma 100%. The purpose of the 340B program was to provide discounted medications to patients who are underserved, who otherwise would not get access to those medications. [1:58:23](https://vimeo.com/1170834056#t=7103s) It was tied specifically to the creation of the FQHC program when the feds decided that if individuals were able to get healthcare close to home, they would be more likely to receive primary and preventative care. So the FQHC system was put in place so that patients in underserved communities would have a medical home, access to primary and preventive care. [1:58:55](https://vimeo.com/1170834056#t=7135s) The 340B program evolved about 10 years later, because policymakers realized if individuals received a diagnosis, what good is that if they can't get access to the medication? Um, and Representative Davis, I look forward to working with you, and we'll get to the bottom of your situation. Um, in Georgia, there are 330 clinical sites of health centers. Um, health centers see over, um, 700,000 Medicaid patients. [1:59:28](https://vimeo.com/1170834056#t=7168s) They also see, um, Medicare patients, third party, uh, other third-party payers. Um, in many places in Georgia, the health center is the only point of access to care, um, particularly in rural Georgia. And the, as far as reporting, very rigorous reporting requirements in order to take advantage of the 340B program as a health center, and in order to keep your status as an FQHC, you must meet those requirements year after year. [2:00:03](https://vimeo.com/1170834056#t=7203s) Um, the reporting is clear as to what can be, uh, what the savings can be used for, but I'll just give you some numbers, um, that you can hold on to. For a patient at a health center, they receive their medication at about a third of the cost if they were to go to a pharmacy that was not a 340B entity. There are additional savings, as has been mentioned by Chairman Stephens. They are turned into services for patients, or expansion of how to help patients become compliant with their medications, such as the vans that go to the neighborhoods to s- provide the access to the care, and then partner with a contract pharmacy, um, to sometimes deliver the, the meds, um, or make sure that they are available to the patient when they come in for their medical visit. [2:00:56](https://vimeo.com/1170834056#t=7256s) Um- [2:00:56](https://vimeo.com/1170834056#t=7256s) Thank you, Becky. [2:00:56](https://vimeo.com/1170834056#t=7256s) And you are very welcome- [2:00:57](https://vimeo.com/1170834056#t=7257s) Very good [2:00:58](https://vimeo.com/1170834056#t=7258s) ... Mr. Chairman. Um- [2:00:59](https://vimeo.com/1170834056#t=7259s) Thank you. Okay. Up next, Natalie Crawford. [2:01:04](https://vimeo.com/1170834056#t=7264s) Thank you, Mr. Chairman and committee. Um, my name's Natalie Crawford. I'm here today in my capacity as executive director for both the Mended Hearts, Inc. and Georgia First. Uh, our organizations, both organizations work closely with patients, healthcare providers, and policymakers across the state. We strongly support the mission of the 340B program and the critical role that it plays in communities across Georgia, in helping to serve the vulnerable, those vulnerable communities you've heard so much about today, ensuring that patients can access affordable medications, particularly rural and underserved areas, and that's a goal that I think we all share. [2:01:48](https://vimeo.com/1170834056#t=7308s) Um, but protecting the status quo is not the same necessarily as protecting patients. We have concerns, uh, about House Bill 139, uh, in that it does not address several structural issues within the program that have raised legitimate conc- questions and concerns nationwide, really. The 340B program was originally designed to help safety net providers stretch limited federal resources to serve more low-income and uninsured patients, as you've heard many times today. [2:02:19](https://vimeo.com/1170834056#t=7339s) But the law itself is relatively short and ambiguous about how those savings must be used, and that's why we're here having this conversation. Over time, the program has expanded significantly, and policymakers across the political spectrum have increasingly raised questions about transparency, accountability, and whether the program's financial benefits consistently reach patients. HB 139 focuses primarily on protecting contract pharmacy arrangements by prohibiting manufacturers from restricting them. While that may preserve the program in the short term, uh, it does not address the broader questions that many patients, policymakers, and healthcare stakeholders are asking. [2:02:58](https://vimeo.com/1170834056#t=7378s) How are the 340B savings being used? Are those savings consistently reaching the vulnerable patients the program was designed to help? And how do we ensure the program remains- sustainable and credible for the long term. Importantly, 139 does not require transparency into how 340B margins are spent, nor does it establish clear expectations that savings be directed towards reducing drug costs for patients. A more balanced approach would protect patient access while also strengthening transparency and accountability. [2:03:31](https://vimeo.com/1170834056#t=7411s) One example, uh, of this type of framework can be found in the 340B Access Act that was introduced by our own Congressman, Buddy Carter. Um, the proposal seeks to ensure the program remains focused on its original safety-net purpose by improving reporting requirements, strengthening eligibility standards, and helping ensure discounts reach patients directly. We believe that Georgia should pursue reforms for both protecting access and reinforcing public trust in the program. And I wanna be clear, both my organizations firmly stand with Georgia's hospitals and the essential work that they do every single day. [2:04:09](https://vimeo.com/1170834056#t=7449s) But maintaining the long-term integrity of 340B requires more than simply preserving existing arrangements. It requires transparency, accountability, and a clear connection between savings and patient benefit. And though Mended Hearts is a national organization, we have a strong presence in Georgia. Our national headquarters is in Leesburg. We have eight community chapters across the state and over 2,000 Georgia members. Our mission is to inspire hope and improve the quality of life of cardiovascular disease patients and improve their family, uh, and, and, and their families through ongoing peer-to-peer support, education, and advocacy. [2:04:48](https://vimeo.com/1170834056#t=7488s) Our 501[c][3] nonprofit is the USA's second oldest nonprofit support organization, and for over 75 years, we've been offering hope, support, and encouragement to patients and families of all ages, from prenatal diagnosis and across the lifespan. On behalf of both organizations and our Georgia members, we respectfully urge you today to pause on HB 139 and instead consider a more comprehensive approach that more, that aligns more closely with the principles reflected in the Federal Reform Act. [2:05:21](https://vimeo.com/1170834056#t=7521s) Thank you. [2:05:23](https://vimeo.com/1170834056#t=7523s) Thank you. [2:05:23](https://vimeo.com/1170834056#t=7523s) Uh, that, uh, we've heard from all those that have signed- Thank you. We've heard from all those who have signed up, so I ask the author if he'd like to do a wrap-up. [2:05:34](https://vimeo.com/1170834056#t=7534s) I agree. [2:05:35](https://vimeo.com/1170834056#t=7535s) Within a reasonable time limit. [2:05:36](https://vimeo.com/1170834056#t=7536s) Absolutely, sir. I promised you 10 minutes. I'll do that. [2:05:39](https://vimeo.com/1170834056#t=7539s) Yes, you did. [2:05:47](https://vimeo.com/1170834056#t=7547s) You ready? [2:05:47](https://vimeo.com/1170834056#t=7547s) Yes. [2:05:48](https://vimeo.com/1170834056#t=7548s) Yes, sir. Uh, Mr. Chairman, thank, thank you very much for the opportunity to wrap up. Um, let me just hit... I just have literally six points. Uh, first, um, my observation of this is that they can't get 340B changed. I've already told you, I think 340B should be changed, but they can't get it changed, so basically they're coming down to the states to basically squeeze, exactly as the gentl- gentleman described, in terms of shutting down the contract pharmacies, which we need more tentacles, not less tentacles. The second thing, I feel for the independent oncologist. [2:06:19](https://vimeo.com/1170834056#t=7579s) I wish I'd had an opportunity to speak with him. Uh, I, we cannot find in the statute where he would be a covered entity. So maybe we have to help him, but if he's not a covered entity, then it doesn't apply to 340B. So I think at the end of the day, his comment that we're expanding the program, that's a false statement. We're the General Assembly of the State of Georgia. We can't expand a federal program, as you all know. So at the end of the day, respectfully... The next thing is, is that the criticism that is coming on 340B, respectfully, is just cr- criticism on 340B. [2:06:50](https://vimeo.com/1170834056#t=7610s) I appreciate the last speaker who did finally come down to the b- to, to the bill. But again, no one is here to say that we're here to debate 340B. What we're here to say is this bill is absolutely what we need. Keep the meds flowing, keep the contract pharmacies in place, especially in our rural areas, and let's not get into the pact that we're doing more than just what the feds and the state, uh, are requiring. A Georgia hospital got ahold of me and their pharmacy director during the conversations that the speakers were doing. One hospital has one pharmacy director here in Georgia that did 30 audits. [2:07:24](https://vimeo.com/1170834056#t=7644s) So I'm not suggesting that the speaker who said only 200 audits were done last year is incorrect, but if one Georgia pharmacy director did 30, either he did 15% of them, or this, that number is, let's just say, a little bit off. The last thing that I wanna make sure that everyone understands is this idea on transparency and where the money's going, and this is my final point. I alone, just on my PowerPoint, handed you four or five specific use cases, Crisp County, Colquitt County, St. Mary's, et cetera, on how this money is being used. [2:07:55](https://vimeo.com/1170834056#t=7675s) That's about as transparent as we can get. But in addition, every one of these are filing-- Well, not every one. Nearly every one of them is filing a 990. We can follow the money and how it's being used. So I will end it with this, and I love an LLM. Sir, the intent of the 340B drug pricing program is to allow certain healthcare providers that serve vulnerable and low-income populations to purchase outpatient drugs at significantly reduced prices so they can stretch limited resources and expand care for underserved patients. [2:08:27](https://vimeo.com/1170834056#t=7707s) So effectively, it talks about providing those comprehensive services like dialysis and oncology and pre, uh, prenatal, et cetera, to make sure that those populations that need it most have that funding. Thank you very much. Mr. Chairman, that ends my comments. [2:08:42](https://vimeo.com/1170834056#t=7722s) Thank you. Committee, we're sitting here trying to figure out what the federal government did and didn't do, and as you can see, it's a mess. But we are asked to make some decision on this, this issue. Um, uh, can I finish, and then I'll recognize you. Thanks. One moment. Yeah. No, that's okay. Um, I'm gonna recognize Representative Douglas, but let me just finish this. I have great faith in you. [2:09:14](https://vimeo.com/1170834056#t=7754s) In these last two years, I think you're some of the smartest people at this Capitol, and you're doing great committee. And I'm sorry, and I apologize about sitting this one in your lap, but this is what we're challenged to do when we come down here. So f- that's all I have to say. Representative Douglas? [2:09:32](https://vimeo.com/1170834056#t=7772s) Thank you, Mr. Chairman. Um, I would just like to say, since I've, I've heard all the testimony, uh, I respect the author of the bill and love the author, the, uh, author of the bill, uh, immensely. Um, but it's hard to pick winners, winners and losers at this point. And so since this, that is a federal, uh, obligation that we can't touch and we can't do, um, I'm gonna ask that we put it on the table and study it a little bit more. [2:10:03](https://vimeo.com/1170834056#t=7803s) Maybe we can get some, some more decisions here locally that we can make a better decision for the people that's in the State of Georgia, 'cause it's gonna affect all of us at some point. And like they said in all the testimony, that if this bill goes forward or not, the program is still gonna run the way it's run, so nobody's gonna lose, you know, that's on the program right now. [2:10:27](https://vimeo.com/1170834056#t=7827s) Right. By the rules, I'm, I, I, I'm, I'm obliged to take that motion, but with this caveat. Is there someone else who would like to speak to this on this committee? [2:10:40](https://vimeo.com/1170834056#t=7840s) We didn't hear you, that is- I see none. I'm sorry? Uh, we didn't hear you. Oh, all right, Sarge, but I apologize. Yeah, I, uh... What I said was, does anyone else like to speak on this committee? No? Okay, do I hear a second to the motion to table? All those in favor to table, say hi. Hi. All those that, uh, say- No ... that disagree, say no. No. Okay, show of hands. All those that, uh, wish to table say, or raise your hand. [2:11:20](https://vimeo.com/1170834056#t=7880s) Okay. All those that disagree, raise your hand. There's one behind. Okay, four. [2:11:33](https://vimeo.com/1170834056#t=7893s) Motion carries. Thank you all very much for spending the day with us. This meeting's adjourned. This meeting is adjourned.