As a heart transplant survivor and longtime left ventricular assist device patient, I know what it’s like to rely on a complex and sometimes confusing health care system to stay alive. For over a decade, the HeartBrothers Foundation has supported thousands of members facing advanced heart failure, offering support as they navigate the same difficult road I have. I’ve helped our members in managing increasing health care costs and difficult decisions between lifesaving treatments and essential needs like food and housing.
Patients deserve better – and the system must do more to support them.
In 1992, Congress created the 340B drug pricing program with a clear purpose: to help safety-net providers deliver affordable care to vulnerable and low-income populations. Under the program, eligible hospitals and clinics can purchase heavily discounted medications. These savings were meant to free up resources for providers to expand services and increase charity care for vulnerable patients. At its core, the 340B program was designed to make lifesaving treatments more accessible and affordable to the patients who needed them most.
Today, however, the program has strayed from its original mission. Many large hospital systems now retain discounts for their own financial gain rather than pass the savings on to patients. Instead of reinvesting in patient care, some use 340B savings to expand networks, open new facilities – often in affluent areas – and grow their market share.
In a recent report, the Congressional Budget Office found that the 340B program contributes to hospitals’ consolidation of off-site clinics, squeezing out independent providers and trusted community clinics. Hospitals often purchase community practices and reroute prescriptions to 340B-eligible sites to maximize profits – regardless of whether patients see any savings at all. In many cases, hospital-affiliated outpatient clinics charge higher prices than independent practitioners and include additional fees. This trend undermines patient access and distorts the intent of the program.
Patients often split pills, skip doses or delay refills because of rising costs. Some even avoid seeking care altogether. The 340B program was designed to prevent this and lower barriers to care, but its misuse often stops patients from getting the benefits as intended. Many 340B hospitals bill insurance providers the full price of medicines bought at huge discounts. Studies show these hospitals also charge about 20% more for outpatient procedures than non-340B facilities. Patients are being left behind by a program made to help them. Instead of focusing on patient needs, the 340B program’s lack of oversight has let institutional interests come first.
While many states are exploring ways to expand the 340B program, these efforts risk worsening the problem if transparency and accountability aren’t included. Expanding the 340B program without clear safeguards will only strengthen systems that exploit it while community-based providers continue to struggle. Reform, not unchecked growth, is what’s needed. Without policies that prioritize patient outcomes and accountability, expansion will only deepen the divide between hospitals that profit and patients who need care.
According to the Pioneer Institute, more than half of Massachusetts’ 340B contract pharmacies are located in wealthy areas, with some even located outside the state. To restore the program to its original mission of serving patients in need, reforms must ensure that savings actually reach those patients. Senate Bill 848 represents an important step forward. The bill would require 340B hospitals to disclose how savings are used – demonstrating whether discounts are passed to patients or reinvested in care.
This transparency is essential to confirm that 340B funds support communities in need, not hospital expansion. The bill provides a balanced path toward greater accountability and patient-centered care. Since the 340B program is a federal program, it is essential that Congress acts to create consistent national standards and prevent state-by-state disparities.
I’m fortunate to have access to lifesaving treatments that give me more time with my loved ones, and every patient deserves the same chance. The 340B drug pricing program was founded on a strong idea, but it requires meaningful reform to fulfill its promise. We need a transparent, accountable and patient-focused system – one that ensures every dollar saved helps the patients it was meant to serve.
Mike Ashworth is the president and CEO of the HeartBrothers Foundation, a Northborough-based nonprofit organization dedicated to helping heart failure patients and their families.
This article originally appeared on Telegram & Gazette: Opinion/Guest column: An equal chance of care for every patient
