The 340B Drug Pricing Program was built on a sound premise of giving hospitals that serve vulnerable populations access to discounted drugs, so they can extend care further and charge patients less. Its implementation has drifted badly from that purpose, and Congress needs to pull it back.
What’s happening now is that large hospital systems have figured out how to participate in 340B at scale, all while oversight mechanisms have stayed weak. They collect discounts, but patients aren’t seeing the benefits in their bills. Rural hospitals and federally qualified health centers that serve genuinely low-income populations often benefit far less than large, profitable urban systems. The Wall Street Journal recently noted that 340B revenue at some of the country’s wealthiest hospital systems has ballooned dramatically — money that studies show flows largely into financial investments and acquisitions, not patient care.
Some in Congress have proposed most-favored-nation pricing as an answer to high drug costs, but that’s the wrong direction. Tying U.S. prices to what foreign governments pay could drain investment in pharmaceutical research and slow the development of new treatments — without lowering what patients actually pay at the pharmacy. It trades one problem for a worse one.
The right answer is fixing 340B from the inside. Congress should require hospitals to demonstrate that patients are benefiting from the discounts they receive and impose real consequences when they can’t. That’s the kind of accountability that would make a meaningful difference for the underserved communities this program was always meant to support.
Liz Simpson
Middletown
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
