Dutch Rojas, Founder of Bliksem Health, has expressed concerns regarding the structure of the 340B Drug Pricing Program. According to Rojas, this structure allows health systems to capture financial spreads rather than ensuring that discounts benefit patients. His statement comes amid ongoing discussions among policymakers about reforms in pharmacy benefit management (PBM) and contract-pharmacy operations.
"health systems buy drugs at steep discounts, bill insurance at full price, and pocket the spread," said Rojas. "They use the profits for expansion, real estate, anything but charity care. independent doctors who actually serve low-income communities can't access the program. we created a profit opportunity and didn't restrict how the profits could be used."
The 340B Drug Pricing Program was established by Congress in 1992. It mandates drug manufacturers to provide significant outpatient-drug discounts to eligible safety-net hospitals and clinics with the aim of helping them "stretch scarce resources." However, oversight gaps and a rapid increase in contract-pharmacy usage have been flagged by watchdogs, raising issues such as diversion, duplicate discounts, and whether savings are reaching patients. These concerns have intensified calls for reform.
According to the PBM Accountability Project, the three largest PBMs control approximately 80% of U.S. prescriptions. Increasingly, 340B hospitals are contracting with specialty pharmacies owned by these PBMs. Within the 340B framework, PBMs can achieve profit margins three to four times higher than those in the commercial market by redirecting savings away from patients through fees, spread pricing, and steering.
Analyses referenced by PhRMA (Pharmaceutical Research and Manufacturers of America) suggest that more than half of the profits accrued by contract pharmacies from the 340B program flow to four major PBM/pharmacy corporations: CVS Health, Express Scripts, Walgreens, and Walmart. This situation highlights how vertically integrated intermediaries are capturing program value, raising concerns that intended patient benefits are being diluted by corporate profit-taking.
Rojas is also noted for founding Bliksem Health, a federation focused on physicians that aids independent doctors in gaining negotiating leverage, accessing capital, and receiving operational support while maintaining autonomy. The platform aims to create alternatives to networks dominated by hospitals and PBMs and seeks to channel value back into patient care through coordinated models led by physicians.
