Kalvin Pugh, 340B policy director at Community Access National Network (CANN), is calling on Missouri lawmakers to strengthen transparency requirements for the federal 340B Drug Pricing Program, arguing that greater oversight is needed to track how savings are generated, managed, and reinvested.
In a statement, Pugh said Missouri Senate Bill 1213 would help determine whether patients, rather than large health systems or intermediary entities, are actually benefiting from the program’s discounts.
“A growing body of evidence suggests that the program has deviated from its original intent. Without meaningful transparency, policymakers, patients, and taxpayers remain unaware of who is genuinely benefiting—and who is not. Reports such as Minnesota’s recent 340B analysis have revealed that large hospital systems and for-profit entities often capture significant revenue through the program, while patients themselves experience minimal direct financial relief. Meaningful transparency doesn’t mean dismantling the 340B program; it means strengthening it,” Pugh said in comments published by the Missouri Independent.
“Missouri lawmakers have an opportunity to lead by implementing common-sense reforms. For patients in Missouri, especially those living with chronic conditions like HIV, cancer, and diabetes, this issue is not abstract. It’s about whether the promise of affordable care is being fulfilled or quietly redirected,” Pugh added.
The 340B Drug Pricing Program allows eligible hospitals, clinics, Ryan White grantees, community health centers, and other covered entities to purchase outpatient prescription drugs at discounted prices. Participating entities may distribute medications through affiliated sites and contract pharmacies but must comply with federal requirements, including serving eligible patients, preventing diversion, maintaining auditable records, and completing annual recertification, according to the National Conference of State Legislatures.
The program’s scale has continued to expand in recent years. In calendar year 2024, covered entities purchased $81.4 billion in outpatient drugs through 340B. Disproportionate share hospitals accounted for about $64.1 billion of that total, while health center programs accounted for approximately $4.7 billion. Specialty pharmaceuticals represented roughly 40% of units dispensed but more than 61% of total purchase dollars, according to the Health Resources and Services Administration.
Spending through the related Prime Vendor Program has also grown significantly, rising from $6.6 billion in 2010 to $43.9 billion in 2021. The Congressional Budget Office reports that most spending is concentrated in hospital outpatient departments and off-site clinics, with oncology drugs making up a substantial portion of utilization.
In Missouri, analysis cited by PhRMA shows that 61% of participating hospitals fall below the national average for charity care as a share of operating costs. Between 2014 and 2022, those hospitals saw a 6% increase in assets while charity care declined by 10%, raising questions about whether program savings are consistently translating into reduced costs for patients.
Pugh, a Missouri native, has also been involved in HIV advocacy efforts, including initiatives tied to Zero HIV Stigma Day, a global awareness campaign launched in 2022, according to HIV/HCV Watch.
