Missouri patients deserve transparency in the 340B program

The 340B Drug Pricing Program was established with a clear and crucial objective: to assist safety-net providers in efficiently utilizing limited federal resources and expanding healthcare access for vulnerable patients.

At its core, the 340B program enables eligible healthcare providers to purchase medications at substantial discounts. In return, these providers are expected to utilize the savings to enhance access to care and provide discounted medications to my low-income and underserved neighbors in Missouri.

However, the law does not mandate that large hospital systems disclose how these savings are utilized. This lack of accountability has created an environment where financial gains can be achieved without providing clear evidence of patient benefit. Consequently, a growing body of evidence suggests that the program has deviated from its original intent. Without meaningful transparency, policymakers, patients, and taxpayers remain unaware of who is genuinely benefiting—and who is not.

This opacity is no longer a theoretical concern; it is a documented issue. Reports such as Minnesota’s recent 340B analysis have revealed that large hospital systems and for-profit entities often capture significant revenue through the program, while patients themselves experience minimal direct financial relief. Contract pharmacies, their Third-Party Administrators (TPAs), and pharmacy benefit managers (PBMs) have also emerged as major beneficiaries, further complicating the flow of funds and obscuring the ultimate destination of savings.

My home state of Missouri faces the same challenges.

Without transparency requirements, it becomes challenging to answer fundamental questions: Are uninsured or underinsured patients receiving discounted medications? Are 340B savings being reinvested into community health programs? How much revenue is being generated—and by whom?

The absence of answers undermines public trust and weakens the program’s credibility. More importantly, it poses a risk to patients who are being sidelined in a program that was intended to benefit them.

Meaningful transparency doesn’t mean dismantling the 340B program; it means strengthening it. Missouri lawmakers have an opportunity to lead by implementing common-sense reforms that align the program with its original intent. These reforms should include:

• Clear reporting requirements on how 340B savings are generated and spent.
• Patient-level benefit standards to ensure discounts translate into reduced costs for those in need.
• Disclosure of financial relationships between hospitals, contract pharmacies, and third-party administrators.
• Standardized definitions of terms like “community benefit” and “charity care.”

Missouri has the opportunity to do just that with SB 1213 offering a timely and necessary pathway to bring accountability to the 340B program within the state.

SB 1213 represents a critical step toward ensuring that the program works as intended—by requiring greater visibility into how 340B revenues are generated, managed, and reinvested. By establishing reporting standards and shedding light on financial flows between covered entities, contract pharmacies, and third-party vendors, the legislation would help policymakers and the public better understand whether patients are truly benefiting.

Just as importantly, SB 1213 would begin to center my neighbors. Right now, the lack of transparency disproportionately benefits large hospital systems and corporate intermediaries that have the scale and leverage to maximize profits. Meanwhile, smaller safety-net providers—like community health centers and Ryan White clinics—often lack that same leverage and operate with far greater mission accountability.

Transparency helps level that playing field. SB 1213 would send a clear message: Missouri is committed to protecting patients, safeguarding public resources, and ensuring that healthcare programs fulfill their intended purpose.

Critics predictably will argue that additional reporting creates administrative burden. However, transparency is not a burden; it’s a responsibility, especially when public programs intersect with private profit. Other healthcare sectors already operate with far greater disclosure requirements. The 340B program should be no exception.

Importantly, transparency also protects the providers who are doing the right thing. Many rural hospitals, community health centers, and Ryan White clinics rely on 340B savings to deliver lifesaving services. They deserve a system that distinguishes their mission-driven work from entities that may be exploiting loopholes.

For patients in Missouri, especially those living with chronic conditions like HIV, cancer, and diabetes, this issue is not abstract. It’s about whether the promise of affordable care is being fulfilled or quietly redirected.

The 340B program can still be a powerful tool for health equity. However, without transparency, it risks becoming just another revenue stream untethered from its purpose. At the end of the day, transparency isn’t just good policy; it’s a prerequisite for trust.