New York lawmakers do not expect to reach an agreement to expand the state's managed Medicaid prescription drug reimbursement program, known as 340B, before session ends in the next two weeks — saying Tuesday the debate will continue next year amid a push for greater oversight to ensure hospitals give adequate aid to distressed health centers.

More than 30 years ago, Congress created Medicaid's 340B program that allows safety-net hospitals and community health centers to pay discounted prices for prescription drugs and get the full-price federal reimbursement. The discounted prescriptions are sold to New Yorkers in distressed rural and urban areas where health care resources remain scarce. 

The state transitioned last year to a system to directly manage pharmacy reimbursements in attempts to rein in Medicaid spending that continues to grow at an unsustainable rate and give greater transparency into prescription drug costs. Impacted health providers say the change has led to a decrease in savings for clinics other providers that serve low-income patients.

Proposed legislation, known as the 340B Prescription Drug Anti-Discrimination Act, would ban pharmaceutical companies from imposing burdensome administrative requirements that discourage providers from participating in the program and other discriminatory practices.

But lawmakers Tuesday said the Senate and Assembly have yet to reach an agreement on the proposal and needed guardrails for hospitals. Democrats in the majority of both houses are not expected to conference the issue before session ends June 6.

"That's a very short time," Assembly Health Committee chair Amy Paulin said in the Capitol on Tuesday.

Several organizations, along with community health and faith leaders, have sent letters opposing proposed legislation to expand the program before session ends and argue the bill needs work before it heads to Gov. Kathy Hochul's desk.

"The 340B program was created to help vulnerable patients, but today the 340B program fails to lower patient drug costs or support the community the program was designed to serve," according to a letter health organizations and insurance providers recently penned to the Legislature. "Through the program, drug manufacturers provide more than $54 billion in discounted product. Yet patients only receive discounts on 1.4% of all 340B eligible prescriptions at contract pharmacies through the program."

They say before the program can accommodate additional prescriptions and facilities, lawmakers must require hospitals to publicly report much money they give organizations that serve the neediest New Yorkers under 340B. 

The Rev. Kirsten John Foy, president of The Arc of Justice, said Tuesday major hospital networks often pocket money that's intended to benefit community-based health programs. 

"There's no mechanism for transparency," Foy said. "These hospitals can collect, in some cases, hundreds of millions of dollars over the course of several years that can amass to billions of dollars with no mechanism for transparency. Where is this money going?"

Bill sponsor Sen. Gustavo Rivera declined to comment Tuesday on the pushback to his legislation and would not answer questions about his stance on requiring greater transparency for hospitals.

The 340B program allows health providers serving patients in vulnerable communities to have more money for other services, but Foy said providers will not feel secure in the program until the state implements required oversight of hospital spending.

"The absence of transparency encourages these hospital networks [the ability] to just collect this money and do with it what they will," Foy said. "...What pharmaceutical companies and whose products you're dispensing? How much are you saving? How much are you collecting? How much are you amassing and then how much are you giving away? So it's really basic."

The Greater Hospital Association of New York President and CEO Ken Raske has lobbied lawmakers to vote on the bill before session ends, pushing for its passage to end abusive policies in the program that reduce patient access and make New York a national leader in protecting the health care safety net.

"Last year, the state carved the Medicaid pharmacy benefit out of managed care, which resulted in hundreds of millions of dollars in 340B losses for safety net and community providers," according to the association. "S.8992 does not reverse that policy change, but protects these essential providers from losing more revenue to pharmaceutical companies through drugs covered by commercial insurance and Medicare. It would also cost the state nothing."

Paulin also sponsors legislation to improve transparency of hospital spending. Her bill would require hospitals release quartly reports of their compliance with federal hospital price transparency law, rules and regulations, or be subject to a civil fine. 

"It's important for us to understand what they're paying out for insurance on certain procedures, especially for plans that are self-insured plans, so they can have a benchmark," the assemblywoman said.

Expanding public reporting requirements for hospital spending is expected to be an ongoing conversation between state health leaders and stakeholders for the remainder of the year to be tackled in more detail next session.

But Paulin added legislative priorities always evolve.

"I never know what to expect session to session — I can only tell you what's happening now," she said.