Tell Congress: Exempt FQHCs from the 340B Rebate Pilot - Senate

Congressional offices are currently telling us they are not hearing concerns about the 340B Rebate Pilot. Without urgency and outreach from health centers, lawmakers will assume that the pilot poses no risk to patient access or to FQHC financial stability. Thus, your engagement is what informs Congress that the rebate model is neither a small tweak or a technical adjustment; it is a structural change that threatens medication affordability, cashflow, core services, and often, staff salaries, which are funded through 340B savings. If legislators do not hear directly from FQHCs, they will not understand the real-world impact of forcing centers to front the full cost of high-cost drugs and wait for rebates that may take weeks or months.

Put simply: if we don’t communicate the consequences, no one else will. Your outreach truly matters.

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Your Message to the legislators

Dear (name and title inserted automatically),

On behalf of Virginia's Federally Qualified Health Centers (FQHCs), I am writing to request your support for the inclusion of language exempting Federally Qualified Health Centers (FQHCs) from HRSA’s 340B Rebate Pilot, which is scheduled for implementation on January 1, 2026, in the bipartisan affordability package currently under development.

As announced on October 30, the rebate model would force FQHCs to purchase drugs at full list price upfront, then pursue rebates after dispensing to patients. This model applies to ten drugs selected for Medicare price negotiation, representing roughly one-third of total Medicare Part D spending, and places significant financial and operational burden on health centers.

If the pilot moves forward as designed, the impact will be deeply harmful:

- Unmanageable cashflow obligations that many centers cannot finance.
- High administrative cost and complexity needed to track every rebate-eligible unit.
- Restricted medication access as pharmacies decline participation due to unsustainable risk.
- Substantial loss of 340B savings that currently protect patient access and fund essential services.

The result will be service reductions, pharmacy closures, and diminished access to affordable medications, harming patients who rely most on safety-net care.

Please support the adoption of language exempting FQHCs from the 340B rebate pilot in the upcoming affordability package or in any legislative vehicle moving this month. Protecting health centers from this model is vital to preserving access to care, particularly for low-income and rural communities.

While a Senate lead sponsor is expected soon, we urge your office to begin reviewing this issue now. Our organization would be glad to meet at your convenience to share data, patient impact examples, and operational concerns.

Thank you for your time, consideration, and commitment to protecting community health.