# Pass 340B discounts on cancer drugs through to the patient's bill

Source: https://onco.cc/ideas/idea-cost-340b-pass-through/  
OnCo record `idea-cost-340b-pass-through` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Hospitals in the 340B programme buy cancer drugs at steep discounts but usually bill patients and insurers the full price; requiring the discount to reach low-income patients would turn a hospital subsidy into patient relief.

## Summary

The 340B programme lets qualifying hospitals buy outpatient drugs at discounts of 25% to 50% or more, with no requirement that the saving reach the patient. HRSA reported $66.3 billion of purchases at 340B prices in 2023. A pass-through rule would require covered entities to charge uninsured and under-insured patients no more than the 340B acquisition cost plus a dispensing fee for oncology drugs, with the hospital keeping the margin only on insured patients.

## Fields

- Kind: Idea
- Last checked: 2026-09-10
- Hypothesis: A pass-through requirement for uninsured and under-insured patients will reduce out-of-pocket oncology drug bills at 340B hospitals by more than half for those patients without reducing hospital participation in the programme.
- Rationale: The programme's statutory purpose is to stretch scarce resources for vulnerable patients; the mechanism exists (some hospitals already do this voluntarily) but is not required.
- Proposed test: State-level pass-through laws in two or three states, evaluated against neighbouring states on patient charges, charity care and hospital participation.
- Maturity: speculative
- Actor: policy

## Sources

- HRSA: 340B Drug Pricing Program: https://www.hrsa.gov/opa
- GAO-15-442: Medicare Part B drugs and 340B hospitals (2015): https://www.gao.gov/products/gao-15-442

## Connected records

- terms: [340B Drug Pricing Program](https://onco.cc/terms/340b-program/), [Financial toxicity](https://onco.cc/terms/financial-toxicity/)
- bottlenecks: [Incentives reward me-too drugs and marginal gains](https://onco.cc/bottlenecks/b-incentive-misalignment/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/)

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