Congress is circling—but not yet landing—on long-sought reforms to the federal 340B drug discount program, which provides steep medication discounts to hospitals serving large numbers of low-income patients.
At a recent Senate HELP Committee hearing, lawmakers outlined potential bipartisan updates to the 30-year-old program, which has ballooned to over $54 billion in value, according to the Health Resources and Services Administration (HRSA). Senators from both parties acknowledged the program’s vital role in sustaining safety-net care while also citing concerns over transparency and uneven benefit distribution.
The draft framework circulating in the Senate would require hospitals to publicly report how 340B savings are used, while shielding providers from excessive manufacturer restrictions. Drugmakers have increasingly limited discounts for contract pharmacies, arguing that hospitals are profiting from the program. HRSA, meanwhile, recently approved eight drugmakers to participate in a rebate-based 340B pilot—seen as a potential model for balancing oversight with patient access.
Still, progress toward a vote remains elusive. Lawmakers are split over whether new reporting mandates could discourage participation among rural and safety-net hospitals, which rely on 340B margins to fund uncompensated care.
Key Takeaways for Hospital Leaders
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Prepare for more scrutiny: Expect future reporting requirements detailing how 340B funds support patient care and community benefit programs.
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Track HRSA pilots: The new rebate model could influence future reimbursement structures and compliance expectations.
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Engage early: Senators have invited feedback from hospitals to shape fair and sustainable reform—particularly regarding rural access and pharmacy partnerships.
The debate underscores a growing consensus: reform is inevitable, but must preserve the program’s original intent—supporting hospitals that care for the nation’s most vulnerable.