Dutch Rojas, the founder of Bliksem Health, has raised concerns about the challenges faced by independent physicians. He said that these professionals are being "out-regulated and out-subsidized" due to policies such as 340B spread-pricing and site-based payment differentials, which he says direct revenue towards large health systems. This statement was made on the social media platform X.
"Independent physicians are not failing. They are being out-regulated and out-subsidized," said Rojas. "This isn't a market outcome. It's a policy choice. 340B was supposed to help safety-net hospitals serve the poor. $54 billion. Every year. Same doctor. Same service. Same stethoscope."
According to the USC Schaeffer Center, meaningful reform of the 340B program must address "spread pricing." This practice involves eligible hospitals and clinics purchasing outpatient drugs at significant federal discounts and then billing insurers at higher rates while retaining the margin. The center argues that this misalignment generates revenues without clear benefits for patients, particularly those requiring indigent care, highlighting the need for reform.
A study published in JAMA Health Forum indicates a significant expansion of the 340B program across retail pharmacies. The number of contract-participating retail pharmacies increased from 789 in 2009 to 25,775 in 2022, representing a rise from 1.3% to 40.9% of all retail pharmacies. By 2022, approximately 60% of contract pharmacies held multiple 340B contracts. This growth was notably concentrated in areas with lower uninsured rates, suggesting a focus on revenue generation.
A study by Health Affairs Scholar in 2024 found that hospitals participating in the 340B Drug Pricing Program generated substantial profits from discounted drug purchases. However, there was limited evidence that these savings were used to improve access or affordability for low-income patients. The researchers concluded that most hospitals within the program did not provide higher levels of charity care compared to non-340B institutions.
Rojas is known as a healthcare entrepreneur advocating for physician-led care. He founded Bliksem Health with a federation model designed to preserve practice independence by pooling leverage and capital while maintaining clinician autonomy. Rojas has also held leadership roles in direct-care ventures and frequently comments on payment policy, price transparency, and consolidation dynamics within U.S. healthcare.
