Missouri
Drugmakers sue to block Missouri law on federal prescription discounts • Missouri Independent
Three major pharmaceutical companies and their national lobbying organization are suing Missouri to block enforcement of a new state law requiring them to give medical providers unlimited access to discounted drugs for their pharmacies.
In four federal lawsuits filed over the past month, Novartis, AstraZeneca, Abbvie and PhRMA, the lobbying arm of the pharmaceutical industry, argue that Missouri lawmakers unconstitutionally intruded into interstate commerce with the bill passed this year.
Under the bill, drugmakers must accept orders to deliver medications to providers eligible for discounts under the 340B program, named for the section of law where it is authorized. The bill allows eligible providers to have an unlimited number of contracts with pharmacies to dispense their prescriptions of drugs purchased under the program.
“Under the Supremacy Clause of the United States Constitution, Missouri has no authority to define who has access to 340B-priced drugs,” states the lawsuit filed last week by PhRMA in the Western District of Missouri.
The law takes effect on Wednesday. The plaintiffs in each case have asked for a preliminary injunction to block enforcement, but no hearings on the requests have been scheduled and only one case, filed Aug. 2 by Novartis, has had enough activity for the judge to schedule any proceedings.
Abbvie went first, filing its lawsuit July 22 in the Eastern District — 10 days after Gov. Mike Parson declined to sign the bill and instead allowed it to become law despite his misgivings. The other three cases are filed with the Western District, which includes Jefferson City.
The lawsuits name Attorney General Andrew Bailey and members of the state Board of Pharmacy, which is responsible for enforcing the law. The board is given authority to investigate violations of the law and the attorney general has enforcement powers through the state Merchandising Practices Act.
“It is difficult to convincingly argue that doing what a federal program requires is an irreparable harm,” Maria Lanahan, deputy solicitor general in the attorney general’s office, wrote in a filing arguing against a preliminary injunction in the Novartis lawsuit. “To the contrary, when Novartis complies with S.B. 751, it is helping covered entities that serve vulnerable populations.”
Bailey’s office did not respond to an email seeking comment on the cases.
The board is relying on Bailey to respond to the lawsuit. The law is self-enforcing and while the board could write rules about how it is to be followed, Executive Director Kimberly Brinston said.
“The board does not have a timeline to promulgate rules and has not made a decision on whether rules would be promulgated,” she said.
The Missouri Hospital Association and the Missouri Primary Care Association have asked to intervene in the Novartis lawsuit and will likely seek to join the other three, hospital association spokesman Dave Dillon said Monday.
“We are evaluating each case and intend to reinforce the work done by the General Assembly on behalf of Missouri’s hospitals, other providers and the communities they serve,” Dillon said.
The 340B program was created in 1992. It had two components — drug manufacturers had to deliver their products at a discount to eligible providers and eligible providers could only use the program to provide prescriptions to patients they treated directly.
Eligible providers included children’s hospitals, as well as hospitals that were sole providers in their community or designated “critical access hospitals” by providing care that would otherwise be absent, and those serving large numbers of indigent patients known as “disproportionate share hospitals.”
Other qualifying providers include federally qualified health care centers — clinics that receive grants to support operations so they can base charges on ability to pay — as well as clinics that serve AIDS patients, black lung victims and other debilitating diseases.
The use of contract pharmacies started in 1996, when the U.S. Department of Health and Human Services began allowing one contractor per provider as recognition that many providers did not have in-house pharmacies. But a change to allow unlimited contracting increased the number of contract pharmacies from 2,321 in 2010 to 205,340 in 2024, according to data from PhRMA provided to The Independent in June.
Nationally, pharmaceutical manufacturers sold nearly $100 billion in discounted drugs in 2021 and 2022. Discounts averaged 60% from regular wholesale prices, the lobbying organization stated.
The pharmaceutical companies focus their criticism on the disproportionate share hospitals, who often contract with for-profit pharmacies to dispense the drugs. Those hospitals account for about 80% of all drugs purchased through the 340B program, $41.8 billion in 2022 and $34.3 billion the year before.
Pharmaceutical companies complain that the discounts are rarely passed on to patients. Instead, insurance companies and consumers pay retail prices and the extra profit is often split between the pharmacy and the provider.
“Make no mistake, the boom in contract pharmacies has been fueled by the prospect of outsized profit margins on 340B-discounted drugs,” AstraZeneca’s lawyers wrote in the complaint filed last week. “In short, the widespread proliferation of contract pharmacy arrangements since 2010 has transformed the 340B program from one intended to assist vulnerable patients into a multi-billion-dollar arbitrage scheme.”
The drugmakers have fought the expansion of contract pharmacies in a variety of ways. When Novartis sought in 2020 to limit the contracts to pharmacies within 40 miles of an eligible provider, the U.S. Department of Health and Human Services issued a notice that it considered the limit a violation of the program’s rules.
An advisory opinion on contracting, later withdrawn, said the 340B program required delivery to a pharmacy on “the lunar surface, low-earth orbit, or a neighborhood…”
The 3rd U.S. Circuit Court of Appeals in Pennsylvania ruled in January 2023 in a case against the federal agency that pharmaceutical companies could impose limits on the number of pharmacies they would allow to purchase the discounted drugs.
After the 2023 ruling, Novartis tightened its rules to allow only one contracted pharmacy per covered provider, but only if the provider did not have an in-house pharmacy. Other manufacturers have imposed variations on the Novartis policies.
State efforts to counter the limits have ramped up in the past two years. Missouri is one of eight states to pass laws requiring drugmakers to deliver discounted medications to contract pharmacies.
Arkansas was one of the first. In March, the 8th Circuit Court of Appeals in St. Louis upheld the Arkansas law requiring drugmakers to allow covered providers to have an unlimited number of contract pharmacies.
In the motion to dismiss the Novartis lawsuit, the Missouri attorney general’s office relied heavily on that ruling, writing that it shows federal law does not prevent Missouri from passing a similar law.
The four lawsuits use a variety of legal theories to assail Missouri’s new law. Along with allegations of interfering with interstate commerce and regulating in an area reserved for federal action, the Abbvie lawsuit argues that its property rights are being violated.
“These abuses of the federal 340B program raise obvious concerns because the U.S. Constitution prohibits the government from forcing the transfer of property at confiscatory prices to private parties for their own private benefit,” the lawsuit states.
In the filing seeking to intervene in the Novartis case, the hospitals and primary care associations argued that the revenue from profits on 340B medications are essential support for their operations.
“Reducing access to those savings,” the filing states, “means hospitals are unable to underwrite critical but under-reimbursed services lines.”
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Missouri, although landlocked, is a Midwestern paradise full of gems, spectacular history, and an amazing culture. These elements enchant visitors who come to the state to experience Midwestern flavor and relax. The big cities like Springfield and Kansas City, no doubt, outshine the others and sit in the front line as options for visitors. However, there are also quaint, laid-back, scantily populated towns across the state where tourists can relish a sense of oneness and communal life. From Arrow Rock, with a population below 100, to the stunning Rocheport on a bluff, discover nine charming, close-knit, and neighborly towns in Missouri to visit.
Rocheport
Rocheport is a close-knit town of just around 200 people, where everyone is valued and recognized. Although small, the town is full of adventures and memorable experiences. Adventure buffs and cycling enthusiasts can embark on the Katy Trail near the town to cycle and relish the charming scenery of a quintessential Midwest state.
Relaxed visitors can taste wines and enjoy meals at Les Bourgeois Winery and Vineyards or enjoy picnics at the park’s A-frame Wine Garden on the Manitou bluffs overlooking the Missouri River. More adventures like boating, kayaking, and fishing are available at the Missouri River, and for a touch of history, visitors can head to the Friends of Rocheport Historical Museum to explore its exhibits, including historical documents from the area’s past.
Ste. Genevieve
Ste. Genevieve sits along the Mississippi River and was founded by French Canadian colonists in 1735, making it the first permanent European settlement West of the Mississippi. Although it hosts almost 5,000 people, the town still sets the stage for visitors to experience communal bonding and a range of historic and natural attractions. For starters, it is home to the Ste. Genevieve National Historic Park hosts a large collection of French colonial architecture and other Historic buildings, such as the Green Tree Tavern.
For outdoor recreation, tourists can head to the Hickory Canyons Natural Area to hike on magnificent box canyons, sandstone cliffs, and creeks. Pickle Springs Natural Area is an alternative option, featuring a two-mile trail that winds through and bypasses creeks, ravines, bluffs, and small waterfalls. Later, art lovers can chill at the Ste. Genevieve Art Center and Museum exploring its local collection of artworks.
Hermann
Hermann is a lovely small town founded by German immigrants and steeped in German roots along the Missouri River. This warm and welcoming, close-knit community of around 2,000 people boasts a few attention-grabbing attractions for locals and visitors. The Deutschheim State Historic Site is a worthy first mention as it reflects the town’s German roots, which date back nearly two centuries. It features several brick homes including the Pommer-Gentner house (1840) and Carl Strehly house (1842) where visitors can experience the daily life of the town’s early German immigrants. The Hermann Farm Museum and Hermann Historic Museum are also great places to delve into the town’s early days as a German settlement through historic buildings and several exhibits.
In the meantime, unwind and have fun at the Hermann Riverfront Park by fishing, boating, kayaking, and canoeing on the Missouri River or hiking along the Riverfront Walking Trail. When hungry, head to the restored Tin Mill Restaurant to enjoy German specialties and tasty steaks.
Boonville
Boonville is a tightly bonded town of around 7,800 people in Cooper County, with plenty of things to see and do. The town sits atop a wooded bluff overlooking the Missouri River, where tourists can enjoy boating, canoeing, fishing, kayaking, and picnicking experiences. For those who love to cycle, the town hosts a part of the Katy Trail, a 240-mile trail, and a state park for cycling with gorgeous views.
Away from adventures and nature, history buffs in town can head to the Historic Depot District to explore the Rivers, Rails, & Trails Museum, Mitchell Antique Motorcar Museum, and the Katy Trail Railroad Bridge, all of which tell stories of the area’s early days. Afterward, grab a delicious pizza for lunch at Breadeaux Pizza.
Excelsior Springs
Excelsior Springs is a town built on mineral springs that grew into a community of lovely and friendly people. Today, visitors here can visit the Hall of Waters that once piped mineral water from the town’s several springs into one of the world’s longest mineral water bars for the community to bathe. Similarly, visit the Superior Well and Pagoda (1901) to marvel at the historic spring under a wooden pagoda structure, which is the last remaining mineral water well in the town.
When hungry, Ray’s Diner is an amazing spot to enjoy lunch, with views of artifacts on its walls. Don’t forget to delve into the town’s historic days and the rise of its mineral springs at the Excelsior Springs Museum, featuring a vast collection of artifacts and artworks. Afterward, head to the Fishing River near the town to immerse in a scenic natural ambiance.
Branson
Branson is a town in the Ozark Mountains, renowned as the Live Entertainment Capital of the World, while its friendly, close-knit aura remains a draw. Here, visitors will get to see and explore the Titanic Museum, a replica of the iconic ship and iceberg filled with hundreds of artifacts related to the original ship’s tragic journey on the Atlantic. The town also hosts Ripley’s Believe It or Not, a quirky attraction featuring a collapsing structure and hundreds of unusual artifacts. More interesting attractions in this town include – the Runaway Mountain Coaster, the Track Family Fun Park, and the 1880s Silver Dollar City amusement park. All of these attractions are incredibly exciting and unending.
There are also several museums in town, such as the Dinosaur Museum and Prehistoric Fossils. When it comes to dining and shopping, the town is chock-full with numerous options, including Saltgrass Steakhouse (for delicious steak lunch) and the Grand Village Shops.
Arrow Rock
Arrow Rock has just 60 residents, and no community could be more closely bonded. But beyond its pronounced sense of oneness, this Saline County town is a treasure trove of history and is entirely designated a National Historic Landmark known as the Arrow Rock Historic District. Visitors here can head to the Arrow Rock State Historic Site to explore some of the town’s most iconic attractions, including George Caleb Bingham House (1837), J. Huston Tavern (1834), the Courthouse, and Old Jail.
The site sits on a 167-acre area and also features a fishing lake, a visitor center & museum, a picnic area, and a short hiking trail. Elsewhere, the Arrow Rock Lyceum Theatre has been entertaining visitors with shows and musicals for over 55 years, making it the oldest of its kind in Missouri.
Van Buren
Van Buren is a charming, laid-back Ozark community of around 800 people, where everyone sees each other as family. The town lies along the Current River and next to Mark Twain National Forest, giving its residents and visitors less crowded options when they decide to enjoy nature. For starters, the beautiful and lucid waters of Current River offer recreational activities like boating, fishing, rafting, tubing, kayaking, and canoeing.
Big Springs is just four miles from the town and is one of the largest natural springs in the world. Here, tourists can hike, fish, and boat, and enjoy lunch at its restaurant. For something different, head to the Missouri Down Under Adventure Zoo to see and interact with animals such as Kangaroos, birds, and lemurs and tour the Current River Cave. Enjoy a movie later at 21 Drive-in Theatre to relax.
Carthage
Carthage is a small town of about 15,000 people with many things to love, including its close-knit community character and its reputation as America’s Maple Leaf City. Historically, this town was the site of the Battle of Carthage, the first full-scale battle of the Civil War. Today, the Battle of Carthage State Historic Site preserves its wartime history and is worth visiting. History lovers can also learn more about the war at the Civil War Museum through various war artifacts and exhibits.
Away from history, the town invites visitors to the Precious Moments Chapel and Gardens to explore beautiful paintings, stained glass windows, and figurines that serve as backdrops for iconic pictures and picnics. For those who want to enjoy a movie while in town, the Route 66 Drive-in Theatre is a great stop. Also, just walking through this town, especially in the fall, is incredibly satisfying as enchanting colors are on display everywhere.
Find absolute serenity, comfort, and the true spirit of camaraderie across these small towns in Missouri, where it is possible to know at least most of the residents. In some towns like Van Buren and Arrow Rock, it is possible to know everyone as these towns share unbreakable bonds and live like one big happy family. Plus, they offer blissful experiences with natural, historical, and cultural attractions, making them anything but boring. In a world where neighbors in most cities around the world live like strangers, these Missouri towns are the perfect places to recline if you want to feel like part of a large extended family.
Missouri
‘Enough is enough’: Missouri voters form bipartisan group to quash Republican initiative petition changes
JEFFERSON CITY, Mo. (KY3) – Missouri Republican lawmakers have once again put forth efforts to curtail the process for citizen-led ballot initiatives following successful campaigns to enshrine abortion rights, raise the state’s minimum wage, and create a legal sports wagering market.
In response, a newly formed political group called the “Respect Voters Coalition” is sponsoring a 2026 initiative to prevent state officials from meddling in the process altogether.
The group’s argument is rooted in the very first section of the first article of the state’s Constitution, which reads as follows:
“[We declare] that all political power is vested in and derived from the people; that all government of right originates from the people, is founded upon their will only, and is instituted solely for the good of the whole.” – Missouri Const. of 1875, Art. I, Sec. 1.
Ben Singer, who leads Show Me Integrity, co-founded RVC to oppose efforts to roll back the IP process. He noted that both parties have pushed this when they were in the majority.
“When Democrats were trying to attack the citizens initiative process because they didn’t like the Conservatives, who also used the citizens initiative process, Governor Ashcroft vetoed the Democrats’ attack on the ballot initiative process,” Singer said.
Ashcroft issued that veto in June 1992, writing the following in his explanation:
“It is through the initiative process that those who have no influence with elective representatives may take their cause directly to the people. The General Assembly should be reluctant, therefore, to enact legislation which places any impediments on the initiative power which are inconsistent with the reservation found in the Constitution.” – Gov. John Ashcroft, Veto Message, June 27, 1992.
Efforts to reform the state’s initiative petition process consumed much of the 2024 legislative session, including days-long filibusters by a faction of 6 Republicans demanding the issue be given priority and Democrats working to block it from passage. The process arguably deprived the House and Senate of sufficient time to review and amend the $51 billion state budget.
“These politicians who’ve taken an oath to protect the Missouri Constitution need to be reminded of that, and so that’s why groups and citizens across the state, in unbelievable momentum I’ve never seen before, are banding together to say enough is enough, and we are going to stop politicians from attacking the will of the people once and for all,” Singer said.
The Missouri House and Senate will convene on January 8 to begin the 103rd General Assembly’s first regular session.
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Copyright 2024 KY3. All rights reserved.
ST. LOUIS (First Alert 4) — Missouri Republican lawmakers have once again put forth efforts to curtail the process for citizen-led ballot initiatives following successful campaigns to enshrine abortion rights, raise the state’s minimum wage, and create a legal sports wagering market.
In response, a newly formed political group called the “Respect Voters Coalition” is sponsoring a 2026 initiative to prevent state officials from meddling in the process altogether.
The group’s argument is rooted in the very first section of the first article of the state’s Constitution, which reads as follows:
“[We declare] that all political power is vested in and derived from the people; that all government of right originates from the people, is founded upon their will only, and is instituted solely for the good of the whole.” – Missouri Const. of 1875, Art. I, Sec. 1.
Ben Singer, who leads Show Me Integrity, co-founded RVC as a measure to push back against efforts to roll back the IP process which, he noted, have been pushed by both parties when they’ve been in the majority.
“When Democrats were trying to attack the citizens initiative process because they didn’t like the Conservatives also used the citizens initiative process, Governor Ashcroft vetoed the Democrats’ attack on the ballot initiative process,” Singer said.
Ashcroft issued that veto in June 1992, writing the following in his explanation:
“It is through the initiative process that those who have no influence with elective representatives may take their cause directly to the people. The General Assembly should be reluctant, therefore, to enact legislation which places any impediments on the initiative power which are inconsistent with the reservation found in the Constitution.” – Gov. John Ashcroft, Veto Message, June 27, 1992.
Efforts to reform the state’s initiative petition process consumed much of the 2024 legislative session, including days-long filibusters by a faction of six Republicans demanding the issue be given priority and Democrats working to block it from passage. The process arguably deprived the House and Senate of sufficient time to perform a final review and amendment of the $51 billion state budget.
“These politicians who’ve taken an oath to protect the Missouri Constitution need to be reminded of that, and so that’s why groups and citizens across the state, in unbelievable momentum I’ve never seen before, are banding together to say enough is enough, and we are going to stop politicians from attacking the will of the people once and for all,” Singer said.
The Missouri House and Senate are set to convene on January 8 to begin the First Regular Session of the 103rd General Assembly.
Copyright 2024 KMOV. All rights reserved.
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