Dutch Rojas, Founder of Bliksem Health, has said that the 340B drug discount program has expanded significantly while many participating hospitals provide below-average charity care, highlighting the need for reform and transparency.
"340B was created in 1992 for a few hundred safety-net hospitals serving disproportionate shares of low-income and uninsured patients," said Rojas. "Today: $54 billion in annual purchases, 36,000+ child sites (up from 1,339 in 2010), 33,000+ contract pharmacy locations. 69% of 340B hospitals provide LESS charity care than the national average, 36% spend under 1% on charity care. The hospitals with the largest 340B discounts show ZERO correlation with higher charity care."
According to a peer-reviewed study in the New England Journal of Medicine, hospitals eligible for the 340B program experienced financial gains. However, these gains did not result in increased care or reduced death rates for low-income patients. The study also observed an increase in hospital-physician partnerships and hospital-based drug administration, but vulnerable patients did not clearly benefit. This reflects concerns that the program's savings are not reaching those who need them most.
The 340B program has seen significant growth. IQVIA estimates that discounted 340B drug sales reached approximately $124 billion in 2023, marking a 16.5% increase from around $54–55 billion in 2022. When measured at list prices, the program's reach is even more extensive. This rapid growth is one reason policymakers and watchdogs are closely monitoring whether patients are actually benefiting from the savings.
The network behind 340B profits has expanded dramatically. According to USC Schaeffer, the number of "child sites" affiliated with hospitals increased from about 1,339 in 2010 to over 36,000 today—approximately 13 for each 340B hospital. The program now collaborates with more than 33,000 contract pharmacies in 2024, which constitutes over half of all U.S. pharmacies. This extensive network raises questions about oversight and helps explain why charity-care results often lag despite larger discounts.
Rojas is a healthcare entrepreneur and reform advocate who founded Bliksem Health and serves on the board of Physician-Led Healthcare of America (PHA). PHA’s announcement details his background in building physician-led organizations and advocating for market transparency—context for his call to realign the 340B program with patient benefits and accountable charity care.
