Sally Joan Greenberg, CEO of the National Consumers League, said on May 20 that 340B drug discounts are disproportionately benefiting large hospitals and pharmacies rather than the patients the program was intended to support.
“340B drug discounts are fattening the coffers of large hospitals and pharmacies at the expense of patients—and it’s a scandal," Greenberg said in comments published in The Wall Street Journal. "A growing wealth of data show that profits are soaring for so-called charity-care hospitals, and that 340B hospitals with the highest share of cancer patients pursue aggressive medical-debt collection tactics against those the program was created to support. Yet state lawmakers continue to propose and pass reforms at the behest of hospitals to protect this unintended windfall."
The 340B program requires drug manufacturers to sell outpatient drugs at discounted prices to eligible safety-net hospitals and clinics. It was designed to help providers serving low-income and uninsured patients stretch limited resources, but it does not require discounts to be passed directly to patients or savings to be used for specific services.
Peer-reviewed commentary has raised concerns about limited transparency, rapid program growth, expansion of contract pharmacies, and whether savings consistently translate into measurable patient benefit, according to JAMA Health Forum.
Federal oversight gaps remain central to compliance concerns within the program.
The Government Accountability Office has found that audits do not fully test whether covered entities prevent duplicate discounts, that audit closure processes do not ensure all noncompliance has been corrected, and that oversight does not consistently ensure only eligible hospitals participate. These gaps affect requirements tied to diversion, Medicaid rebates, and program eligibility.
At an October 2025 Senate Health, Education, Labor and Pensions Committee hearing, Chairman Bill Cassidy said the 340B program had “ballooned with limited oversight,” raising questions about how program revenue is used and whether it reaches low-income patients. He also pointed to concerns involving contract pharmacies, hospital consolidation, duplicate discounts, and transparency requirements.
A 2026 National Consumers League issue brief found that 75% of 340B hospitals may take legal action against patients, compared with 62% of non-340B hospitals. The analysis also found that 72% of 340B hospitals may report medical debt to credit agencies, while 48% may sell medical debt to third parties.
The National Consumers League is a nonprofit organization based in Washington, D.C. Greenberg joined as executive director in 2007 and became CEO in 2022. She has testified before Congress and federal agencies on consumer protection issues including prescription drug access, privacy, fraud, and product safety.
