Equipping Patients with Tools to Reclaim the Promise of 340B

The 340B Drug Pricing Program was created with a clear and compelling purpose: to “stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.”s. For decades, the program has played an important role in supporting access to medications for people living with chronic and life-threatening conditions, including HIV, by providing medications at a steep discount to safety-net providers tasked with fulfilling the program’s statutory intent

But today, that clear and compelling purpose has been thwarted, the safety net with its growing wear and tear from years of abuse and margin-motivated cuts have created the moment we find ourselves in. 

Today, instead of consistently benefiting patients, the program has increasingly become a financial engine for large hospital systems and for-profit entities—often with no transparency or accountability to demonstrate how savings are being used to improve patient care. With continued misguided state-level legislation, and without meaningful federal reform, 340B risks drifting even further away from its legislative intent and deeper into a system that prioritizes padded pockets over patient outcomes.

Program Growth —Without Guardrails

Since its creation in 1992, 340B has grown dramatically in size and complexity. Covered entities have expanded, contract pharmacy arrangements have multiplied, and revenue tied to discounted drugs has surged into the tens of billions of dollars annually.

Yet the statute itself remains narrowly focused: 340B was never intended to be a profit center. Congress designed it to benefit patients, not to subsidize hospital consolidation, executive compensation, or unrelated capital expansion.

Today, patients are frequently left with pressing questions: Why are my drug costs still increasing at the pharmacy counter?  “Why isn’t 340B being used to make my meds cheaper for me?” Why do patients receiving care at 340B hospitals still encounter medical debt, often sent to aggressive collection agencies, and face access challenges?

The uncomfortable truth is that there are too many loopholes that are being exploited, no federal requirement for hospitals to pass savings directly to patients—or even to report how those savings are used. This lack of transparency allows patient benefit to become optional rather than required.

State-level efforts to address 340B challenges have created a patchwork of laws that deepen confusion and conflict, particularly with other federal policies like the Inflation Reduction Act (IRA). These fragmented approaches fail to address the core issue: the absence of clear federal standards that define patient benefit, accountability, and program integrity.

The harsher truth? State-Level Legislation has not improved patient outcomes. Recent data from IQVIA demonstrates that access to medications, nor medication abandonment rates have improved in states that have passed contract pharmacy expansion. These truths reveal that patchwork state laws cannot fix a federal problem.

Federal reform is essential to: recenter patients as the primary beneficiaries of 340B, establish transparency and reporting requirements tied to patient outcomes, prevent misuse by for-profit entities operating under the guise of safety-net care, and ensure any program growth aligns with access, affordability, and equity—not consolidation.  Without reform, patients will continue to be excluded from decisions made in their name, while the program’s credibility—and long-term sustainability—remains at risk. There are solutions on the table including the recently introduced ACCESS Act but it remains stagnant in the halls of congress. 

Patients Must Have a Real, Meaningful Seat at the Table

The reality is the federal government is slow at enacting reform, and one of the most glaring gaps in the 340B debate at all levels is the absence of patient voices. Policymakers hear regularly from well-monied interests like hospitals, pharmaceutical manufacturers, and pharmacies—but far too rarely from the people the program was meant to serve.

Patients deserve more than rhetoric. They deserve real tools to engage, educate, and advocate.

That’s why we at Community Access National Network (CANN) are expanding the 340B Patient Advocacy Toolbox—adding to our growing collection of resources designed to empower patients and community advocates with the knowledge and language needed to participate meaningfully in policy conversations.

Adding to our existing infographics, state legislation tracking, and state fact sheets we are adding: 

• Policy Brief: Conflicts Between State 340B Laws & Proposed Federal Reforms

• A comprehensive guide to the conflicts between state legislation and 340B ACCESS Act (HR 5256), the SUSTAIN 340B discussion draft, the 340B Rebate Model Pilot introduced by the Health Resources & Services Administration (HRSA), downstream effects of drug pricing provisions within the Inflation Reduction Act (IRA), and Medicare Part D’s as-of-current “voluntary” claims submissions form.

• Accompanying this brief are two infographics that highlight the prohibitions states have enacted, and the conflicts that arise between these state-level laws and these proposed federal reforms. 

• Policy Brief: State 340B Mandates Do Not Improve Patient Access/Cost

• An insightful, IQVIA data-driven look at the impact of state-level mandates, their impact on patient access and medication abandonment rates following the enactment of these laws. 

All of CANN’s 340B tools are rooted in a simple belief: informed patients are powerful advocates. By equipping patients with these tools, CANN is working to shift the 340B conversation away from institutional protectionism and toward patient-driven reform.

The Road Ahead

As state legislative efforts continue, the future of 340B depends on whether policymakers are willing to listen to patients and act with clarity and courage. CANN is committed to ensuring that patient voices are not just included—but prioritized.

By advocating for federal reform and equipping patients with the tools to engage, CANN is committed to reclaiming the promise of 340B and realign it with its original mission: putting patients first.

Patients should not have to guess whether they benefit from a program designed in their name.

Because safety-net programs only work when the safety net actually reaches the people it was built for.