New data from the Health Resources and Services Administration shows that hospitals and other covered entities purchased more than $100 billion in discounted drugs through the 340B program in 2025.
That represents a 23% increase in a single year and over eight times the $12 billion purchased through the program in 2015.
The pace of growth is striking. It took more than two decades for annual 340B purchases to reach $12 billion. In recent years, the program has added roughly that much in new purchases annually.
As the program has grown, its accountability rules have barely changed. Congress created 340B to help safety-net providers stretch limited resources and serve vulnerable patients. But federal law does not require participating hospitals to pass their discounts on to patients or use the savings to provide additional charity care. Hospitals can purchase medicines at deeply discounted prices, charge patients and insurers far more, and keep the difference.
That lack of accountability is increasingly difficult to defend as the program crosses the $100 billion threshold.
The House Ways and Means Committee recently advanced basic hospital transparency requirements, a critical step to understanding the scope of the issue. The Centers for Medicare and Medicaid Services also recently proposed changes to how it pays for drugs purchased under 340B, “to better reflect what hospitals pay for these medications.” Both important steps toward transparency, accountability, and reducing fraud.
Additionally, the Trump administration’s proposed 340B rebate pilot would introduce a basic level of verification. Under the current system, hospitals receive discounts before regulators can confirm that a prescription qualifies for 340B pricing. The pilot would require hospitals to pay the standard price and submit documentation showing that a purchase was eligible before receiving the discount as a rebate.
The change would not prevent qualifying hospitals from receiving the discounts Congress authorized. It would simply require them to demonstrate that each discounted purchase complied with the program’s rules.
That is a modest reform for a program of this size. It would give regulators greater visibility into how 340B discounts are claimed and make it harder for ineligible purchases to pass through the program unchecked.
A federal program that has grown from $12 billion to more than $100 billion in a decade warrants greater scrutiny. Congress should support efforts to bring basic transparency and accountability to 340B, rather than shielding it from oversight.