It’s Time For Congress To Get 340B Out Of Its Blind Spot

BusinessPolicyIt’s Time For Congress To Get 340B Out Of Its Blind SpotBySally Pipes,Contributor.Forbes contributors publish independent expert analyses and insights. Sally Pipes is a scholar and think tank CEO who writes on health care.Follow AuthorMay 21, 2026, 08:00am EDT“When a program designed to deliver targeted assistance drives up system-wide costs, reform is no longer optional,” says health expert Sally Pipes. “It's necessary.”Getty ImagesIf a charity organization collected billions of dollars with little evidence that needy people benefited, regulators and the public would quickly demand answers.Yet many large hospital systems participating in the federal 340B Drug Pricing Program are quietly doing just that—extracting billions in drug discounts with scarce oversight and no obligation to prove vulnerable patients benefit.That should alarm anyone concerned about rising healthcare costs, misuse of taxpayer dollars, financial burdens on employers, or the integrity of our nation’s safety net. Congress must stop ignoring this problem and inject some badly needed transparency into 340B.Data show that hospitals—not the patients 340B was meant to serve—are capturing the program’s benefits. In Minnesota, hospitals captured roughly 98% of net 340B profits in 2024, according to one report. In Illinois, hospitals’ 340B revenues were more than 2.5 times what they spent on care for low-income and uninsured patients in 2022.Such misuse has become rampant largely because policymakers and regulators lack access to the routine data 340B providers already collect. Without that data, it’s almost impossible to determine whether the program is achieving its intended purpose.MORE FOR YOUPrograms of this size and importance typically come with clear rules, consistent reporting, and measurable outcomes. With 340B, those guardrails are largely absent.The program requires manufacturers to give safety‑net providers steep discounts on outpatient drugs. Providers can then bill insu...