As originally reported in The New York Times, a Latina in New Mexico battling cancer seeks treatment from her local hospital. Coming from an underserved community, she believes she will benefit from the 340B Drug Pricing Program, a federal initiative intended to help vulnerable patients access affordable medications and care. She expects the program’s discounted drug prices to ease the financial burden of treatment and make a difficult journey a little more manageable. As she will soon learn, however, this is not the reality. Her hospital receives a 340B discount on her medication and purchases it for $2,700. Regardless, they bill her insurer for $22,700, and when her insurer covers only $10,000, she is forced to pay the remainder out of pocket. In this case, as in many others, a program designed to lower costs for vulnerable patients instead generates substantial profits for healthcare institutions, while doing nothing to reduce the financial burden on the people it was intended to help. Her experience highlights the reality: after three decades, the 340B program continues to fail the Latino communities it was created to assist.

Congress created the 340B Drug Pricing Program in 1992 to help safety-net hospitals serve low-income communities. Under the program, eligible healthcare providers purchase outpatient prescription drugs at significantly discounted prices. In return, they are expected to use the savings to expand access to care, improve services, and reduce costs for the patients and communities in need. For Latino communities, 340B represented a promise: a promise that underserved populations would have greater access to affordable healthcare and life-saving medications. Yet, more than thirty years later, Latinos are still waiting to see the benefits. As hospitals generate billions and profit margins grow, one question remains: who is the real beneficiary of 340B?

The data shows how far the 340B program has strayed from its intended purpose. Rather than expanding access to affordable medications in underserved communities, the program’s benefits are flowing elsewhere. One study found that contract pharmacy presence declined in predominantly Latino and Black communities while increasing in wealthier, predominantly white communities. If it is meant to improve access for underserved populations, it is moving in the wrong direction. At the same time, only 38 percent of 340B hospitals are located in medically underserved areas, raising questions about whether their services are even reaching the communities they are designed to serve.

Outcomes are equally concerning. Despite decades of growth and billions of dollars in savings for hospitals and clinics, there has been no statistically significant reduction in health disparities among non-white and low-income asthma patients. This is alarming for Latino families, since asthma disproportionately affects Latino children and can have lasting consequences on their health, education, and quality of life. Together, these findings suggest a fundamental disconnect between 340B’s mission and results. A program created to strengthen healthcare access for underserved communities should be improving outcomes for Latino patients. Instead, the evidence shows that the patients are being left unassisted.

Rather than going to Latino patients, evidence shows that the billions of dollars in savings from the 340B program are staying in the pockets of hospitals and their business partners. In 2022, Disproportionate Share Hospitals (DSH) generated $44 billion in profits through 340B, but only 42 percent of that was spent on charity care. Nearly 80 percent of non-profit hospitals spent less on charity care than the value of tax exemptions they received. Many hospitals that benefit from both taxpayer support and 340B discounts give back less to their communities than the communities provide to them. In another study, 64 of 75 340B hospitals examined included debt collection practices in their financial assistance policies. Meanwhile, 340B providers and their for-profit partners generate 18 times as much revenue from the program as they did ten years ago. Despite this explosion, there is still no requirement that hospitals demonstrate how their savings are improving care for underserved patients. As a result, the program generates billions in profits with no accountability for whether those savings are helping the communities 340B was created to serve.

The solution is not to repeal 340B; it is to reform it and ensure the program serves its original purpose: helping vulnerable patients access affordable healthcare. The 340B Access Act holistically reform the 340B program to better align with Congress’ original intent. Billions of dollars in tax benefits and 340B-related profits flow to these institutions each year, yet the public does not know how these resources are used. Latino communities must demand Congress pass this legislation, reject half-solutions, and eliminate the waste, fraud and abuse that have allowed hospitals to profit while patients struggle.

Policymakers should also support the 340B Rebate Model Pilot. A rebate-based approach would mark a meaningful improvement over the program's current structure, shifting from upfront discounts to a claims-based rebate model that brings greater transparency to the program and helps address long-standing concerns about diversion and duplicate discounts. This would strengthen accountability while ensuring savings reach the patients who need them most.

The Latina cancer patient in New Mexico was not seeking special treatment; she was seeking the help that 340B promised her and millions of other vulnerable Americans. Like countless Latino families across the country, she expected 340B to ease her burden, not add to it. The measures currently being considered represent an important first step towards restoring that mission. Congress must seize this opportunity.