Patients Rising launches the 340B Accountability Campaign with our first recorded Town Hall — and a concrete ask to Congress.

A program built for patients. In their name. Without them.

In 2024, more than $81 billion in outpatient drug discounts moved through a federal program most patients have never heard of. The program is called 340B. It was created by Congress in 1992 to help safety-net hospitals and clinics stretch scarce federal dollars and reach more vulnerable patients. The intent was elegant. The execution, three decades later, raises a question no one in the program can actually answer:

Where did the money go?

That's the question we put on the table at the first recorded Patients Rising Town Hall, "Where Did the Money Go? The 340B Accountability Town Hall." If you have 35 minutes, watch the full conversation above. If you have five minutes, here's the case — and the three concrete fixes we're bringing to Congress this year.

What 340B is supposed to do

Picture the year 1992. Congress had just expanded Medicaid's drug rebate program — good for Medicaid patients, but it had an unintended consequence: drug manufacturers facing new rebates started raising prices on the safety-net hospitals and clinics serving low-income and uninsured patients. The providers stretching the most to take care of the most vulnerable were suddenly paying more for medications.

Congress responded with Section 340B of the Public Health Service Act, part of the Veterans Health Care Act of 1992. The deal was straightforward:

If a drug manufacturer wants to sell its medications to Medicaid, it also has to offer those same medications at a deep discount — typically 25% to 50%, sometimes as high as 70% below market — to a defined list of safety-net providers.

Those providers include federally qualified health centers, disproportionate share hospitals, Ryan White HIV/AIDS clinics, children's hospitals, and rural critical access hospitals. The original intent, in the exact phrase Congress used, was to "stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services."

Hold that phrase in your mind: reaching more eligible patients. We're going to come back to it.

How it's supposed to work, in four steps

1. A manufacturer sells outpatient drugs at the deep 340B discount.
2. A safety-net provider buys the drug at the 340B price, dispenses it to a patient, and bills the patient's insurance at the normal market rate.
3. The provider keeps the difference. That's the savings 340B generates. If a drug costs the provider $30 under 340B but reimburses at $100, the provider clears $70.
4. Those savings flow into patient benefit — charity care, lower co-pays, patient assistance, transportation to appointments, expanded services in communities without other options.

Manufacturer gives a discount. Provider captures savings. Patients see the benefit. It's an elegant design — when it works.

The question every patient eventually asks once they learn about 340B is: does step four actually happen?

We don't know. And that's the problem.

The scale, and the silence

This is no longer 1992. In 2024, the most recent full year of data, covered entities purchased $81 billion in outpatient drugs under 340B — up roughly 23% in a single year. There are now more than 50,000 covered entities and more than 32,000 contract pharmacies participating.

The growth curve:

• 2014: $9 billion
• 2018: $24 billion
• 2021: $44 billion
• 2023: $66 billion
• 2024: $81 billion

340B is one of the fastest-growing components of the entire U.S. drug spend. And we're not saying it's a bad program. We're not even saying it's gotten too big — though it has. We're saying that a program this large, with this many participants, moving this much money, has to be able to answer one simple question:

Where did the savings go?

Right now, it can't.

This isn't conjecture. The Government Accountability Office (GAO) has consistently found that HRSA's oversight of 340B has been limited — the agency that runs the program hasn't had a clear ability to verify how covered entities are actually using their 340B revenue. The HHS Office of Inspector General (OIG) has reached similar conclusions: public data on 340B savings and patient benefit are insufficient to demonstrate the program is meeting its safety-net mission.

If a program of this size can't show its work, it becomes a target. Critics fill the silence. Defenders end up arguing on the back foot. And patients — the people this is all supposed to be about — are left out of the conversation entirely.

Two gaps patients face

When we got serious about this issue, we found that what patients are actually missing breaks down into two specific gaps:

The transparency gap is institutional. Where did the savings go? Covered entities are not required to publicly report how much they save under 340B, or what share of those savings reach patient care versus other institutional uses. If you're a patient, a community member, or a state legislator who wants to know what 340B is producing in your community, you mostly can't find out.

The awareness gap is personal. Was 340B even used on my prescription? The honest answer for most patients is: you have no idea. The pharmacy doesn't tell you. The receipt doesn't say so. The clinic doesn't note it on the paperwork. The discount is invisible at the point of sale. Even if a 340B drug saved your hospital $500 or $5,000 on your medication, you may have paid the same copay you'd have paid anywhere else.

Here's the painful irony: the very people the program was built to serve — low-income patients, uninsured patients, patients in underserved communities — are the people with the least information about it. Patients are essentially invisible inside a program that exists in their name.

We can fix that. Or we can try to convince Congress to.

What we're asking Congress to do

For the FY27 appropriations cycle — the Labor, HHS, Education Appropriations Bill — Patients Rising is asking Congress to include report language directing HRSA's Office of Pharmacy Affairs to take three specific actions, with $3 million in directed funding to make it possible.

$3 million in a program that moves $81 billion to finally give patients visibility.

We call this a new patient lane. Right now the conversation about 340B happens between manufacturers, hospitals, policymakers, trade associations, and in courtrooms. It mostly doesn't happen with patients, even though it all happens because of patients.

Ask #1: Show us where the savings actually go.

A public reporting framework where covered entities report annually on:

• Total 340B savings generated. A number.
• Allocation of those savings to direct patient benefit. How much actually translated into care, cost relief, and support for patients?
• Share of savings used for patient care relative to other institutional purposes.

Three numbers, public, annually. You can't fix what you can't see, and right now no one can see it.

To make the reporting meaningful, we also define "direct patient benefit" so it can't be quietly stretched to mean anything. Five specific categories:

1. Lower out-of-pocket cost — reduced copays, deductibles, self-pay prices.
2. Charity care — free or reduced-cost care for low-income and uninsured patients.
3. Patient assistance programs that touch the patient, not just the entity's procurement.
4. Transportation and patient support services — rides to appointments, language services, care coordination, patient navigators.
5. Expanded access in medically underserved areas — new clinics, extended hours, mobile health services in communities that don't already have abundant care options. Not new centers in wealthy neighborhoods where well-resourced facilities already exist.

Ask #2: Tell patients at the point of sale.

We're asking HRSA to develop and pilot ways to inform patients when their medication was purchased under 340B. The exact design comes out of the pilot — it might be a flag on a pharmacy receipt, a line in a patient portal, a notation on a printed summary. We're not prescribing the answer. We're asking HRSA to figure out the best way.

Imagine, for the first time, patients actually knowing when 340B touches their care. Not as a footnote in a federal report. Right there on the receipt in their hand.

Ask #3: A 180-day report back to Congress.

Within 180 days of enactment, HRSA reports to the Appropriations Committee on implementation progress, identified challenges, and any legislative changes needed to fulfill 340B's safety-net mission. We don't want this to become a study that sits on a shelf. We want feedback loops on the record.

What this is — and what it isn't

The moment anyone proposes anything on 340B, the room lines up to swing. So let's be crystal clear.

This is: transparency and accountability. Public reporting on where savings go. Clear definitions so "patient benefit" means something specific and measurable. Letting patients know when 340B applies to them. A 180-day report back to Congress.

This is not: changing who's eligible for 340B. Rolling back coverage on safety-net providers. Cutting hospital or clinic funding. Picking a side in the ongoing litigation between manufacturers and hospitals. A vehicle for unrelated policy changes.

Patients Rising supports 340B's mission. Hospitals and clinics serving safety-net populations are doing essential work, and we want them to have the resources they need. We just want patients to have a seat at the table — and we want the program to be able to demonstrate publicly that the patients it was built for are actually being served.

Why this matters in your life

1. You deserve to see the savings. If your medication was discounted through 340B, you should be able to see whether that discount reached you. You're generating the revenue with your prescription.
2. Patients funded this promise. The entire rationale for 340B's growth has been a public good for patient care. Transparency is how that promise stays honest.
3. Underserved communities benefit most from clarity. Rural areas, low-income neighborhoods, communities with high rates of chronic illness — these are where the safety net matters most. Clearer data shows whether 340B is actually reaching them, or whether the dollars are being absorbed elsewhere.
4. Good programs survive scrutiny. If you believe in 340B — and we do — you should want it to be able to defend itself in the open.
5. Patients get a real seat at the table. For too long this debate has happened over patients' heads. This proposal builds the lane.
6. Trust is rebuilt by showing your work. Silence corrodes trust. Transparency restores it.

What you can do

Three things, starting this week.

Call your member of Congress or Senator. Tell them in your own words that you support including patient transparency and accountability report language in the FY27 Labor, HHS, Education Appropriations Bill. Constituents on the relevant subcommittees carry the most weight — the toolkit lists who's on them.

Share your 340B story. If you've ever wondered where a discount went, paid more than you expected at the pharmacy, struggled to understand the financial side of your care, or left a hospital with bills that didn't add up — that's the kind of story that moves this conversation. Stories drive policy. Email us, post about it, tell us in the community.

Join the Patients Rising Community. We're building a coalition of patients who want visibility, accountability, and a real seat at the table on 340B. The more of us there are, the harder we are to ignore.

That's the whole ask. Make a call. Share a story. Join the coalition.