On Feb. 18, 2026, Building America’s Future said a powerful lobbying group is actively blocking reforms to the federal 340B Drug Pricing Program in order to conceal what it alleges are "108,000%" profit margins on medicines intended for low-income patients.
The organization argues that the current debate over the 340B program centers on maintaining opacity rather than protecting patients. "Building America’s Future argues the current fight over 340B is not about protecting patients but about protecting opacity, saying a 'powerful lobby' is actively blocking reform. In the group’s framing, 340B was meant to benefit the poor, yet opponents of reform allegedly want to keep pricing and markups hidden to preserve profits," according to Building America’s Future.
The federal 340B Drug Pricing Program was established by Congress in 1992 and requires drug manufacturers participating in Medicaid to offer discounted outpatient drugs to eligible health care providers. The Health Resources and Services Administration (HRSA) oversees the program. However, the Government Accountability Office (GAO) has identified ongoing risks such as duplicate discounts and oversight gaps involving contract pharmacies, recommending additional steps for tighter supervision.
A report from North Carolina State Treasurer found that hospitals participating in the program charged the state employee health plan more than five times the discounted cost for cancer drugs. This resulted in profit spreads reaching thousands of dollars per claim for certain treatments and higher overall net profit margins among participating facilities compared with non-participants between 2013 and 2021 (North Carolina State Treasurer).
In calendar year 2024, HRSA reported that covered entities purchased $81.4 billion in outpatient drugs under the program. These purchases are largely financed through payers including Medicare and Medicaid, meaning taxpayers bear much of the cost when discounts are not shared at point of sale—leading to increased calls for transparency regarding how savings are used (gov/opa/updates/2024-340b-covered-entity-purchases'>HRSA reports).
Building America’s Future describes itself as a conservative nonprofit aligned with President Trump’s agenda and has advocated for changes to the program. In an October 23, 2025 release ahead of a Senate Health, Education, Labor & Pensions hearing, it announced an ad campaign calling for reforms due to vulnerabilities related to "waste, fraud, and abuse" (Building America’s Future).
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