West Cuthbert, Senior Fellow at American Resolve Action, said on May 4 that congressional Republicans should support the Trump administration’s effort to increase transparency in the 340B Drug Pricing Program through a rebate-based pilot.
“President Trump and his administration are pushing ahead with a reform that could prevent billions of dollars in annual waste, fraud, and abuse. The reform would introduce much-needed transparency to the 340B Drug Pricing Program, a once-obscure federal initiative that has grown so large, it's driving inflation across the healthcare sector," Cuthbert wrote in RealClearHealth.
"340B has grown far beyond lawmakers' original purpose. Collectively, hospitals and other program participants secured an estimated $66.4 billion in drug discounts in 2024 alone. Federal law doesn't require hospitals to pass these discounts on to patients,” he added.
The 340B program requires drug manufacturers to sell outpatient drugs at discounted prices to eligible safety-net hospitals and clinics. It was designed to help providers serving low-income and uninsured patients stretch limited resources, though it does not require discounts to be passed directly to patients or savings to be used for specific services, according to JAMA Health Forum.
Discounted 340B purchases reached $81.4 billion in 2024, up $15.1 billion from 2023, according to Drug Channels. The gap between list-price value and 340B discounted purchases reached $66.4 billion, while hospitals accounted for 87% of purchases. That scale makes transparency over eligibility, claims, and patient benefit central to any reform discussion.
Federal oversight gaps remain central to 340B compliance concerns.
According to the U.S. Government Accountability Office, program audits do not fully test whether covered entities prevent duplicate discounts, the audit closure process does not ensure that all noncompliance has been corrected, and oversight does not ensure that only eligible hospitals participate. Those gaps affect requirements tied to diversion, Medicaid rebates, and program eligibility.
At an October 2025 Senate Health Committee hearing, Chairman Bill Cassidy said the 340B program had “ballooned with limited oversight,” raising questions about how revenue is used and whether it directly benefits low-income patients. Cassidy said program growth is tied to higher health care costs and pointed to concerns involving contract pharmacies, hospital consolidation, duplicate discounts, and weak transparency requirements.
American Resolve Action describes itself as a veteran-led team of advisors focused on protecting national interests and values through advocacy at the state and federal levels. Its public-facing agenda positions the organization around working families, national strength, and policy advocacy aimed at federal and state decision-makers.
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