JEFFERSON CITY (LN) — A Missouri federal judge on Tuesday blocked AstraZeneca Pharmaceuticals LP from forcing six hospital systems to hand over internal records on how they account for and spend their 340B drug-pricing savings, ruling the company's subpoenas had little bearing on its constitutional claim that the state's contract pharmacy protection law unlawfully expands its obligations under a federal pricing agreement.
U.S. District Judge Douglas Harpool denied AstraZeneca's motion to compel compliance with third-party subpoenas served on Mercy Health, SSM Health Care Corporation, the Curators of the University of Missouri, University Health, CoxHealth, and Citizens Memorial Hospital District.
The case centers on Missouri Senate Bill 751, codified at Mo. Rev. Stat. § 376.414, which prohibits drug manufacturers from restricting the number of contract pharmacies a hospital or federally qualified health center can use while still receiving 340B discount pricing. AstraZeneca argues the law impermissibly expands its obligations under its Pharmaceutical Pricing Agreement with the federal government, in violation of the Contract Clause of the U.S. Constitution.
AstraZeneca served the six covered entities with subpoenas on September 5, 2025, seeking three categories of documents: 340B policy and procedure records, representative contract pharmacy arrangements, and documents showing how the entities account for and use 340B revenue. The company argued the materials would show that S.B. 751 substantially impairs its existing contractual obligations, serves an impermissible redistributive purpose, and is not sufficiently well-tailored to survive constitutional scrutiny.
Harpool rejected each rationale. On substantial impairment, he wrote that AstraZeneca "can satisfy its claim through information that can be gathered through its own PPA and data ascertained by the wholesaler who supplies Plaintiff's drugs to the various covered entities and their contract pharmacies." Whether a hospital uses a replenishment-model accounting system with its contract pharmacies, he found, "would not further whether the alleged impairment Plaintiff suffers is substantial."
On the redistribution argument, Harpool quoted a Fourth Circuit decision for the proposition that covered entities are not required to pass 340B savings on to patients or insurers. The court then concluded on its own that Missouri did not enact S.B. 751 with that rationale. "Even if Plaintiff can show that the benefits from the cost savings do not go directly back to patients or insurers," he wrote, that "has no bearing on whether the state law was enacted for an impermissible reason."
The court noted that Missouri enacted S.B. 751 in response to two federal appellate decisions — Sanofi Aventis U.S. LLC v. United States Department of Health and Human Services from the Third Circuit and Novartis Pharmaceuticals Corp. v. Johnson from the D.C. Circuit — that had addressed manufacturer restrictions on contract pharmacy arrangements.
Intervenors Missouri Hospital Association and Missouri Primary Care Association, along with the hospital respondents, had argued that the Contract Clause's substantial-impairment inquiry turns on an objective standard focused on whether AstraZeneca's reasonable contract expectations were disrupted — information that would come from AstraZeneca and its drug manufacturer peers, not from hospital systems.
Having found the requested documents irrelevant, Harpool declined to reach the hospitals' separate arguments that the subpoenas were unduly burdensome and raised confidentiality concerns.
The underlying constitutional challenge remains pending before Harpool, with the discovery deadline subject to extension only if the motion to compel had been granted — a condition that no longer applies.