"Eternal vigilance is the price of liberty." – quote attributed to Thomas Jefferson and John Philpot Curran
Over the past two years, nearly three dozen states have considered legislation requiring drug manufacturers to comply with state contract laws allowing pharmacies to receive and dispense 340B drugs on behalf of safety-net nonprofit hospitals, community health centers, and other federal grantee clinics. As of this writing, ten states have enacted such laws.1
These statutes have significantly curbed the unilateral restrictions drug manufacturers have attempted to impose on the distribution of 340B drugs to contract pharmacies. In many cases, most drug manufacturers have lifted their restrictions but for a handful strategically left in place to preserve standing for ongoing legal challenges in federal court.
But hard-won victories require ongoing defense. Stakeholders in the 340B community must remain vigilant even after state protections are passed. Manufacturers continue to challenge these laws in court, aiming to create a split of opinions among the Circuit Courts that could lead to the U.S. Supreme Court review.2 Meanwhile, dark money groups fuel disinformation campaigns, and the pharmaceutical industry seeks to weaken protections through seemingly.3
Take Mississippi, an early adopter of state 340B contract pharmacy protections. There, manufacturer representatives recently sought to introduce an amendment exempting drug wholesalers or distributors from the entire section of Mississippi's code prohibiting deceptive business practices—the very code in which Mississippi just happens to plan to codify its 340B contract pharmacy protections. This exemption would effectively enable manufacturers to pressure wholesalers and distributors to stop delivering 340B drugs, and thereby accomplish the manufacturers' objective indirectly.
After Mississippi's legislators wised up to the tactic, the industry tried again. This time, the pharmaceutical industry sought to give the state board of pharmacy control over "pharmacy services administrative organizations," a term defined to mean "any entity that contracts with a pharmacy or pharmacist to assist with third party interactions."
Again, such a definition would include 340B covered entities that contract with pharmacies for the delivery and dispensing of 340B drugs to the covered entities' patients. Industry's representatives and the state board of pharmacy "gave up the game," as it were, when they opposed a clarifying amendment that would exempt 340B covered entities from that definition.
As of this writing, Mississippi's legislative session remains ongoing, and it is unclear whether these or other industry tactics to undermine Mississippi's 340B contract pharmacy protections will succeed.
The takeaway for 340B covered entities and the state associations that represent them is twofold: first, always verify your sources—especially when quoting famous phrases. And second, remain vigilant. The fight to protect 340B access doesn't end with the passage of a law.
Footnotes
1 Brar, S. (2025, January 20). Contract Pharmacy Protection Bill – 340B Report. 340B Report. https://340breport.com/legislative-map/contract-pharmacy-protection-bill/
2 Newton, W., & Newton, W. (2025, March 13). State Contract Pharmacy Bill Updates: Anti-340B Ads Anger Okla. Lawmakers; Key Changes to N.M. Legislation; and Bill Killed in N.H. – 340B Report. 340B Report. https://340breport.com/state-contract-pharmacy-bill-updates-anti-340b-ads-anger-okla-lawmakers-key-changes-to-n-m-legislation-and-bill-killed-in-n-h/
3 Newton, W., & Newton, W. (2025, March 13). State Contract Pharmacy Bill Updates: Anti-340B Ads Anger Okla. Lawmakers; Key Changes to N.M. Legislation; and Bill Killed in N.H. – 340B Report. 340B Report. https://340breport.com/state-contract-pharmacy-bill-updates-anti-340b-ads-anger-okla-lawmakers-key-changes-to-n-m-legislation-and-bill-killed-in-n-h/
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
