{"entity":{"id":"idea-cost-340b-pass-through","kind":"idea","name":"Pass 340B discounts on cancer drugs through to the patient's bill","aka":[],"tldr":"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.","asOf":"2026-09-10","links":[{"label":"HRSA: 340B Drug Pricing Program","url":"https://www.hrsa.gov/opa"},{"label":"GAO-15-442: Medicare Part B drugs and 340B hospitals (2015)","url":"https://www.gao.gov/products/gao-15-442"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["340b-program","financial-toxicity"],"trials":[],"people":[],"bottlenecks":["b-drug-pricing","b-incentive-misalignment"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"medium","horizonYears":3},"route":"/ideas/idea-cost-340b-pass-through/","neighbours":{"term":[{"id":"340b-program","kind":"term","name":"340B Drug Pricing Program","route":"/terms/340b-program/"},{"id":"financial-toxicity","kind":"term","name":"Financial toxicity","route":"/terms/financial-toxicity/"}],"bottleneck":[{"id":"b-incentive-misalignment","kind":"bottleneck","name":"Incentives reward me-too drugs and marginal gains","route":"/bottlenecks/b-incentive-misalignment/"},{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/"}]}}