Rep. Matt Marshall of the Washington State House of Representatives said that any further expansion of the federal 340B Drug Pricing Program should be accompanied by stronger transparency and accountability measures to ensure it serves its intended beneficiaries, as a similar debate grows in Missouri.
The issue centers on whether the program, which allows hospitals to purchase drugs at steep discounts, is actually helping low-income and rural patients or primarily benefiting large urban health systems. Marshall said, “The problem is that the program is not consistently serving the people it was intended to help; it’s already growing at a staggering pace, and further expansion could increase health care costs. Much of the program’s financial benefits are concentrated among large urban health systems, capturing significant 340B revenue. At the same time, smaller rural hospitals continue to struggle to maintain services and keep their doors open.”
Marshall added that “There is no requirement that 340B discounts be passed directly to low-income patients. Once a hospital qualifies to participate in the program, it can use the discounted drug pricing for any eligible patient, regardless of income. Hospitals argue that revenue generated through the program helps fund uncompensated and charitable care. National analyses have found that some 340B hospitals provide charity care at levels comparable to — or, in some cases, lower than — those of non-340B hospitals,” according to his op-ed published by AOL.
GAO reported in 2025 that the number of 340B covered-entity sites more than doubled from 2013 to 2023, even as federal oversight still has unresolved weaknesses. That matters because the program keeps getting larger without a matching system to prove the discounts are actually reaching low-income or uninsured patients, creating more room for hospitals and affiliated entities to treat 340B as a revenue stream rather than a patient-assistance tool.
Missouri’s 2025 340B profile found that 44% of contract pharmacies for the state’s top 340B hospitals are based outside Missouri, while only 36% of in-state contract pharmacy locations are in rural areas even though 52% of Missouri ZIP codes are rural—an imbalance that strengthens concerns that 340B expansion is not being targeted to the communities most at risk of losing care.
A JAMA Health Forum cohort study found that new 340B participation was associated with higher spending on outpatient oncology drugs for commercially insured patients. That is a key criticism of the program: hospitals can buy drugs at a steep discount, bill insurers at much higher rates, and keep the spread, creating incentives to expand lucrative service lines for well-insured patients rather than ensuring the subsidy is targeted to the uninsured or poor.
Marshall’s official House page says he is an Army veteran whose service shaped his approach to public office; his legislative identity emphasizes public service and advocacy for his district—a message reflected in his call for reforming how 340B supports rural and underserved communities.
