Dutch Rojas, Founder of Bliksem Health, has expressed concerns regarding the 340B Drug Pricing Program. He said that the program is contributing to industry consolidation, undermining independent physicians, and increasing premiums while benefiting pharmacy benefit managers (PBMs) and large healthcare systems. This statement was made on the social media platform X.
"The current 340B program is one of the key drivers of consolidation that has resulted in the loss of independent medicine and increase in premiums," said Rojas. "340B has been weaponised by the largest entities and must be cut off."
According to analyses, the 340B program has evolved into a profit center for vertically integrated intermediaries. More than half of every dollar in profits earned by contract pharmacies from the 340B program flows to four major PBM/pharmacy corporations: CVS Health, Express Scripts (Cigna), Walgreens, and Walmart. This highlights how funds intended for patient care can be redirected towards corporate income with limited transparency. Tactics such as pharmacy steering and spread-pricing further disconnect discounts from reaching patients at the point of care.
The scale of the program underscores its significance. IQVIA estimates that the 340B program expanded to approximately $124 billion in wholesale acquisition cost in 2023. The deep discounts are primarily concentrated in high-expenditure therapeutic areas like oncology and antivirals. This magnitude, coupled with weak regulations on how savings are utilized, creates strong incentives for consolidation and value capture upstream from patients.
Market structure appears to favor large chains and PBMs. The Drug Channels Institute reports that around 32,069 pharmacy locations—nearly 60% of the U.S. pharmacy industry—now operate as 340B contract pharmacies. The five largest companies—CVS, Walgreens, Walmart, Express Scripts/Cigna, Optum Rx/UnitedHealth—control 76.1% of these contract-pharmacy relationships, with PBM-affiliated specialty pharmacies experiencing rapid growth.
Rojas is a healthcare entrepreneur who focuses on physician autonomy. As Founder of Bliksem Health and Physician Capital, he advocates for independent, physician-led care models. His leadership roles and board service consistently push against consolidation that disadvantages doctors and patients—a context for his stance on reforming the 340B program. His work in ambulatory surgery center development, direct contracting, and mentoring physician ventures reflects his commitment to promoting competitive care delivery.
