H.R. 10937: Preserving Rules Ordered for The Entities Covered Through 340B Act of 2026

This bill would change how the 340B drug discount program is handled in several ways.

What the bill does

• It would create a new federal rule saying that health plans, health insurers, and pharmacy benefit managers (PBMs) cannot treat 340B hospitals, clinics, health centers, or their contract pharmacies differently just because they participate in 340B.
• It would bar a range of practices the bill considers discriminatory, including:
  • paying 340B providers or pharmacies less than similarly situated non-340B providers or pharmacies,
  • charging special fees, clawbacks, or other assessments because a drug is a 340B drug,
  • imposing different professional dispensing fees, network rules, or audit/inventory requirements,
  • requiring providers or pharmacies to identify 340B drugs,
  • blocking patients from getting 340B drugs from their covered entity or contract pharmacy by mail, delivery, or in person,
  • refusing to contract with a 340B entity or pharmacy for reasons tied to 340B status, and
  • denying coverage for a drug simply because it is a 340B drug.
• It would apply these protections not just to commercial health plans and PBMs, but also to Medicare Part D and Medicare Advantage arrangements, with the same basic rules extended to those programs.
• It would require the federal government to impose civil monetary penalties on PBMs that violate the new rules, up to $5,000 per violation per day.
• It would direct the Department of Health and Human Services to issue regulations to carry out these protections.

Medicaid-related changes

• The bill would require HHS to hire a third-party entity to help prevent Medicaid duplicate discounts, which happen when the same drug gets both a 340B discount and a Medicaid rebate in a way that is not allowed.
• That contractor would review claims data from covered entities and state Medicaid agencies to identify 340B drugs that should not be included in rebate requests.
• Covered entities would have to provide certain claims data when requested, and states would have to create a process to share rebate-file data and remove claims that are identified as problematic.
• The bill would allow covered entities to submit certain data retrospectively, rather than requiring only point-of-sale identification.

Other provisions

• It would block federal funds from being used to implement a 2020 executive order that sought to limit what covered entities charge patients for 340B drugs.
• It would end the HHS 340B Rebate Model Pilot Program and prohibit a substantially similar program from being created in the future.

Relevant Companies

• CI — Cigna, through its pharmacy benefit management operations, could be affected by new limits on PBM pricing, audit, network, and reimbursement practices involving 340B entities.
• ELV — Elevance Health could be affected through its health insurance and PBM-related operations if 340B-related reimbursement and contracting rules change.
• UNH — UnitedHealth Group, including Optum’s PBM and pharmacy-related businesses, could be directly affected by the bill’s restrictions on PBM conduct toward 340B participants.
• CVS — CVS Health could be affected through Caremark and its pharmacy network operations, especially where 340B reimbursement or contract pharmacy arrangements are involved.
• HUM — Humana could be affected through Medicare Part D operations because the bill applies 340B rules to Part D sponsors and their PBMs.