Why is an Elon Musk-backed PAC running an ad against Republican state legislators?

BISMARCK, N.D. (AP) — A group backed by Elon Musk is running ads targeting conservative Republican legislators in several states over their support of a federal drug pricing program. No one seems as surprised about the effort as the lawmakers themselves.

The video ad by Building America’s Future is titled “Trump Underminers.” It focuses on the federal 340B program, saying it “is now a disaster” and to “let Trump fix 340B.”

The ad groups together five lawmakers in Kentucky, Nebraska, North Dakota, South Dakota and Tennessee whom it accuses of trying to mandate expansion of the program. It is one of the first signs since Trump returned to the White House of a group linked to Musk going after Republicans in individual states.

The legislators say they want to help rural hospitals and don’t understand what is behind the criticism or why the group, of which Musk is a major donor, is singling them out.

Here's a look at the ad's claims and the mystery behind them:

What is the 340B program?

Under the program, drug manufacturers are required to provide discounts to hospitals caring for uninsured and low-income patients, according to the American Hospital Association. The program was expanded to rural hospitals in 2010.

The ad airing on local television says, “Some Republicans in your state are undermining Trump and trying to mandate expansion of 340B.”

The message goes on to say the program “helps fund gender transitions for kids, abortion procedures and health care for illegals.”

Nebraska state Sen. Brian Hardin, who is named in the ad, said there is no truth to those claims.

The program has been at a center of a yearslong lobbying battle between hospitals and pharmaceutical companies, with each side attempting to enlist lawmakers in maintaining or reforming the benefit.

What do the lawmakers think?

The claims in the ad lead Hardin to wonder whether pharmaceutical companies might be behind the effort.

“It only fuels my speculation that somebody brought a modicum of actual information to Musk and said, ‘Please throw your money behind us,’” Hardin said.

North Dakota Republican Rep. Jon Nelson said the only truthful statement in the ad is the spelling of his name. Nelson said he introduced a bill this session with a goal of continuing the 340B program as it exists.

Nelson said the pharmaceutical industry wants to get rid of the program because “long story short, they don’t want to sell their drugs at a discount.”

It's all puzzling, Nelson said, because he doesn't know of any organized effort to end the program.

“There’s absolutely no undermining that’s taking place here because there’s been no action from Washington to change 340B that I’m aware of,” Nelson said. “We’re not undermining anything that’s taking place in Washington.”

Kentucky Republican state Sen. Stephen Meredith said his legislation is not about the 340B program.

“My bill is about the fact Kentucky healthcare providers who serve a disproportionate number of economically disadvantaged people; predominately in rural communities, are being discriminated against by pharmaceutical manufacturers who are arbitrarily and capriciously withholding 340B drugs and 340B discounts which are legally due to these qualifying healthcare providers,” Meredith said in a statement.

Like the others, Hardin said he is being targeted for his bill that would preserve Nebraska hospitals’ access to the program.

Hardin said the ad has been running in Nebraska for about three weeks, but has done nothing to hurt his bill. It advanced last week from the first of three rounds of debate 41-0.

Why is this group doing this?

That's unclear. Building America's Future didn't respond to an email seeking information about their effort. A spokesperson for another Musk-funded political group acknowledged a phone message but did not respond to questions. Building America’s Future's X profile could not be messaged.

A spokesperson for the PhRMA pharmaceutical trade group did not immediately respond to an email requesting comment about the ad.

The ad has aired in broadcast markets in Nashville, North Dakota, South Dakota and Nebraska, according to media tracking firm AdImpact.

Building America's Future is also behind misleading ads and text messages to voters in a consequential upcoming Wisconsin Supreme Court election. The group also was the single funder of a political group that pushed opposing ads last year in Michigan and Pennsylvania on then-Vice President Kamala Harris' position on Israel.

Building America's Future posted a photo to X in February of a large truck outside the North Dakota Capitol in Bismarck, bearing the messages "Tell North Dakota Republicans: Stop subsidized gender transitions for kids," and “340B is subsidizing gender transitions for kids.”

In 2023, then-Gov. Doug Burgum signed a law banning gender-affirming surgeries and treatments for transgender kids.

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Associated Press writers Matthew Perrone in Washington, Margery A. Beck in Lincoln, Nebraska, and Bruce Schreiner in Frankfort, Kentucky, contributed to this story.