Eli Lilly’s policy requiring 340B hospitals submit claims-level data in order to receive statutory drug discounts garnered a fresh wave of pushback this week from Missouri’s attorney general and a cadre of Massachusetts hospitals, joining others who have described the requirements as unlawful.

Lilly announced its controversial policy for 340B dispensations in January and first put it into effect for a subset of hospitals in June. It applies to all pharmacy and medical dispensations, including in-house pharmacy and contract pharmacy dispenses, in most states.

The company said doing so would allow it to spot instances when a drug purchase is improperly granted multiple discounts under overlapping programs. Hospitals have contended that the extra scrutiny is unnecessary and introduces substantial administrative burden.

Missouri Attorney General Catherine Hanaway has come in on the side of the opposition. On Monday, she issued a cease-and-desist letter to Lilly, writing that the policy violates the Missouri Merchandising Practices Act, a consumer protection law. If the drugmaker doesn’t end its requirement for Missouri providers, the policy “may result in subsequent legal action,” including an injunction and monetary civil penalties, the letter reads.

“Big Pharma does not get to bully Missouri hospitals or hold prescription drug prices hostage,” Hanaway said in an accompanying release. “Eli Lilly is abusing its market power to impose higher prescription prices in Missouri. These tactics fall hardest on rural communities that depend on the 340B program to keep clinics open and ensure patients receive the care they need.”

Hanaway’s letter and release highlight Lily’s decision to end discounts for University of Missouri Health Care in July.

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