By David Applebaum / For The Herald
As a medical provider serving families in Everett, north King County and across Washington state, I’ve witnessed firsthand how access to affordable medications can be life-changing for patients in need.
Unfortunately, the federal 340B Drug Pricing Program, originally designed to help underserved patients, is falling short. The program must be reformed to ensure its benefits reach those who need them most.
The 340B program allows certain hospitals and clinics to purchase prescription drugs at significantly reduced prices. This was intended to help facilities such as children’s hospitals and critical access hospitals; institutions that serve vulnerable, low-income populations. Yet, a troubling pattern has emerged; the savings from 340B are often absorbed by the health care system rather than passed on to the patients the program was meant to help.
In Washington state, where 340B reporting is required, the system still falls short. For example, in 2022, several local hospitals were sued for failing to provide free or discounted care to low-income patients, despite receiving millions in 340B-related savings. These institutions ultimately refunded over $21 million in medical bills. While this restitution was a step in the right direction, it highlights the systemic flaws that allow such abuses to occur in the first place.
Hospitals in Everett rely on the 340B program to keep drug costs manageable for their patients, yet they’re competing with larger systems that exploit the program for profit. Many hospitals can bill insurers or patients at full price for drugs purchased at steep 340B discounts and brazenly pocket the difference. Without a requirement to reinvest those profits into patient care, the intended beneficiaries — underserved patients — are left behind.
Efforts to reform the 340B program, such as implementing a rebate model where discounts are applied retroactively and transparently, have been met with resistance. Surprisingly, even the Health Resources and Services Administration, which oversees the program, has opposed such measures despite finding widespread noncompliance in their audits.
The consequences of inaction are clear. Critical access hospitals in north King County and across rural Washington struggle to maintain services due to financial constraints, even as larger systems exploit 340B savings for profit. Meanwhile, families in our community face higher medical bills and limited access to affordable medications.
It’s time for change. Lawmakers must prioritize reforms that increase transparency and accountability in the 340B program. Hospitals benefiting from 340B should be required to document how savings are used to support low-income patients. Implementing stricter oversight and enforcing compliance with program requirements will ensure that the financial benefits of 340B flow directly to the patients and communities it was designed to serve.
Washington’s Sen. Patty Murray and her colleagues in Congress have a critical role to play in addressing these issues. By championing 340B reform, they can help ensure that Everett’s children’s hospitals, critical access facilities, and the underserved patients they serve truly benefit from this vital program. Reforming 340B is not just an administrative necessity; it’s a moral imperative to put patients first.
David Applbaum is a certified physician assistant. He lives in Edmonds.
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