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What is 340B?
340B is a federal drug discount program: eligible hospitals and clinics buy certain outpatient drugs at reduced prices from manufacturers and reinvest savings in care for underserved patients and community services—without using federal appropriations. PBM means pharmacy benefit manager (the middlemen who administer many drug plans). A contract pharmacy is a retail or specialty pharmacy a covered entity partners with so patients can fill prescriptions in their community.
“The pharmacy at my hospital is the only reason I can afford my insulin. Without 340B, I don’t know what I would do.”
— Pennsylvania patient, safety-net hospital (name withheld)
Why it matters: When margins are thin, 340B savings help fund prescriptions, screening, and access in rural and underserved communities.
HAP position
Lawmaker actions
Protect 340B, protect patients.
"Pennsylvania hospitals reinvest every dollar of 340B savings into the communities that need it most. Restricting this program doesn't save money — it closes doors for patients who have nowhere else to go."
— Nicole Stallings, President and Chief Executive Officer, Hospital and Healthsystem Association of Pennsylvania
Contract pharmacy access is under pressure from manufacturers and Congress. HAP is asking Pennsylvania's lawmakers to act before the window closes.
Federal asks
What lawmakers can do
Three actions tied to patient and hospital impact.
-
Protect the 340B discount
Hospitals keep access to the outpatient drug prices Congress set for charity care, and community benefit.
-
Defend contract pharmacy partnerships
Patients fill prescriptions through local and network pharmacies hospitals contract with, not only one distant site.
-
Oppose rules that shrink access for safety-net patients
Rural and underserved communities keep an affordable path to medications hospitals are required to support.
Pennsylvania asks
HAP's ask of Pennsylvania government
State-level asks in Harrisburg, aligned with HAP March 2026 materials.
-
Sustain DHS duplicate-discount safeguards
DHS should maintain the Medicaid Exclusion File and Drug Exclusion List so covered entities can be tracked, and duplicate discounts are prevented.
-
Protect 340B integrity—contract pharmacies
Preventing manufacturer limits keeps hospitals and clinics connected to the pricing Congress intended.
-
Preserve access in rural and underserved communities
Many providers rely on contract and specialty pharmacies; one-pharmacy limits constrain access for Pennsylvania's most vulnerable patients.
Data sources (expand under Methodology on the map) and methodology. Headline figures trace to named sources.
Pennsylvania legislative status — 340B
Key committee members
Illustrative outreach examples for hospital advocates. Labels describe engagement posture—not instructions to legislators.
House
| Name | District | Party | Hospital engagement | Outreach ideas |
|---|---|---|---|---|
| Rep. Dan Frankel | District 23 | D | Supportive | Schedule policy meeting |
| Rep. Kathy L. Rapp | District 65 | R | Engage | Request district visit |
| Rep. Arvind Venkat | District 30 | D | Supportive | Send thank-you and co-sponsor ask |
| Rep. Tim Twardzik | District 123 | R | Engage | Schedule constituent call |
| Rep. Timothy Bonner | District 17 | R | Opposed | Targeted follow-up with member hospitals |
Senate
| Name | District | Party | Hospital engagement | Outreach ideas |
|---|---|---|---|---|
| Sen. Michele Brooks | District 50 | R | Engage | Schedule chair briefing |
| Sen. Art Haywood | District 4 | D | Supportive | Coordinate floor support |
| Sen. Lynda Schlegel Culver | District 27 | R | Engage | Request district-level impact meeting |
| Sen. Judy Ward | District 30 | R | Opposed | Targeted member outreach before vote |
| Sen. Maria Collett | District 12 | D | Supportive | Send thank-you and hearing prep |
Key findings
The numbers that matter
Issue: uneven state protection and market pressure. Impact: access and financing. Action: pass protections, defend partnerships.
21
with law
29
without protection
States with contract pharmacy protection
Law locks in access; the rest of the map stays exposed to manufacturer limits.
Source: MultiState, ASHP, America's Essential Hospitals — HAP verification March 2026.
$7.95B
Reported community benefit (2024)
Program-scale reinvestment in care, workforce, and community services.
Source: 340B Health and AHA reported totals — aligned with HAP 340B talking points (March 2026).
72
Pennsylvania hospitals in 340B
Pennsylvania's exposure in this policy fight is statewide.
Source: HRSA OPAIS participation file, reconciled by HAP (January 2026); HAP PA fact sheet (March 2026).
7%
Share of total U.S. drug market (340B)
HAP’s March 2026 talking points describe this as 7% of the total U.S. drug market, citing the Commonwealth Fund.
Source: Commonwealth Fund explainer (per HAP talking points, March 2026).
Data sources
(expand under Methodology): metric-to-source table. State counts come from state-data.js (50 states; D.C. in data only).
Oversight gap
Scrutiny tilts toward hospitals, not drugmakers
Issue: audit load is asymmetric. Impact: equity in program integrity. Action: parity for covered entities and manufacturers.
179
Covered-entity audits (FY 2024)
5
Manufacturer audits (FY 2024)
Hospitals and covered entities face far more federal audits than manufacturers do.
Source: HRSA Program Integrity FY 2024 (public record).
Policy landscape
21 states have contract pharmacy protections in law
Most states still have no statutory protection, so policy risk stays elevated for hospitals and patients.
Source: same as state map — MultiState, ASHP, America's Essential Hospitals.
Pennsylvania exposure
72 Pennsylvania hospitals participate in 340B
Contract pharmacy restrictions hit statewide patient access and safety-net capacity.
Source: HRSA OPAIS, HAP reconciliation; HAP PA fact sheet (March 2026).
State map
Who protects contract pharmacy, and who does not
Issue: state law gaps. Impact: patient access. Action: enact protection where gray.
Blue states have contract pharmacy protection laws; gray states do not. Select any state for briefing notes.
Click the map or a list chip; use All, Protection, or No protection to filter.
State
No state selected yet
Pick a state on the map or from the lists to see protection status and notes.
No state selected yet. Pick a state on the map to see protection status and notes.
Congressional tracker
Pennsylvania Congressional Delegation — 340B status
| Member | Chamber | District | Party | 340B position | Last outreach | Next step |
|---|
Legal landscape
Courts back state protections; PA still has no contract-pharmacy shield statute
Policy briefing · Not legal advice · March 2026
Courts
Manufacturers often lose
Challenges to state contract-pharmacy laws have generally failed. Commonly cited states: AR, LA, MO, MN, TN, RI.1
2025 trend
Access + reporting
Five states paired protections with transparency or reporting: CO, ME, OH, RI, VT.
Pennsylvania
Gray on the map
No freestanding shield like blue states. PA DHS runs the 340B Drug Exclusion List for Medicaid duplicate discounts.
More detail (tap a topic)
Federal courts have rejected many manufacturer suits against state laws that protect contract pharmacy. Examples: PCMA v. Wehbi (8th Cir. 2022); Louisiana Hospital Association v. Greenstein; district rulings in MO, MN, TN, RI. Confirm current posture with HAP Finance & Legal Affairs before testimony or filings.
Capitols and federal conversations reference these 2025 frameworks as a possible balance: keep contract pharmacy access, add reporting on how 340B-related savings are used.
Executive: Some governors vetoed bills that would expand contract-pharmacy protections (Virginia reported).
Pennsylvania: No statute matching the blue “protected” states on this dashboard’s map. PA DHS administers the 340B Drug Exclusion List to prevent duplicate Medicaid discounts on the same claim.
Framing question & footnote
Framing for stakeholders: Could a federal hybrid—preserve contract pharmacy access and add audited, standardized reporting—address oversight concerns without cutting patient access?
1 Illustrative decisions only; litigation changes. Not for pleadings. Coordinate with HAP Finance & Legal Affairs for approved language.
What manufacturers argue — and the hospital response
These are common objections in Congressional hearings. This section is for briefing preparation — not HAP’s position.
| Manufacturer claim | Hospital / HAP response | Evidence |
|---|---|---|
| 340B creates duplicate discounts — hospitals collect both a 340B discount and a Medicaid rebate on the same drug. | Pennsylvania DHS already runs a 340B Drug Exclusion List that prevents this. Manufacturers are not required to give both discounts on the same drug. | PA DHS 340B Drug Exclusion List; HRSA program integrity rules |
| Hospitals use 340B savings for profit, not patient care. | $7.95B in reported community benefit (2024, up 9%) funds free prescriptions, mobile mammography, dental care, and rural services — reinvestment is documented and growing. | HAP 340B talking points (March 2026); 340B Health · AHA reported totals |
| Contract pharmacy networks are too large and unaudited. | HRSA conducted 179 covered-entity audits in FY 2024 vs. only 5 manufacturer audits. Hospitals face far more scrutiny than the manufacturers restricting access. | HRSA Program Integrity FY 2024 audit results |
Sources: HAP March 2026 PA fact sheet & 340B talking points · MultiState · ASHP · America's Essential Hospitals (state law) · 340B Health · AHA (community benefit) · Commonwealth Fund (7% market context, per HAP) · HRSA Program Integrity FY 2024 (audit counts)
Limitations: State law counts change as legislatures meet. Community benefit totals are self-reported aggregates, not independently audited.
Data transparency & methodology
Priority HAP briefings (March 2026): 340B protects access to care in Pennsylvania · 340B talking points. Other sources: MultiState · ASHP · America's Essential Hospitals (state law) · 340B Health · AHA (community benefit) · Commonwealth Fund (7% total U.S. drug market, per HAP talking points) · HRSA Program Integrity FY 2024 (audit counts)
Verification order (state law): MultiState, then ASHP, then America's Essential Hospitals.
Limitations: State law counts change as legislatures meet. Community benefit totals are self-reported aggregates, not independently audited.
Data sources Metric → primary source (expand)
Priority citations: HAP March 2026 PA fact sheet and talking points (PDFs alongside this page). Other metrics: cited reports or HAP verification. Simulator stays in its panel; legal band is briefing material (see that section before citing).
| Metric | Source | As of |
|---|---|---|
| State map & protection counts (50 states; D.C. in data, not in headline totals) | MultiState → ASHP → America's Essential Hospitals; state-data.js |
Mar 2026 |
| $7.95B community benefit (2024); ~9% YoY in narrative | HAP talking points (Mar 2026); 340B Health · AHA reported totals | 2024 / Mar 2026 |
| 179 entity vs 5 manufacturer audits (FY24) | HRSA FY24 audits | FY 2024 |
| 72 PA hospitals; 30% of 235 hospitals; 7% total U.S. drug market (340B) | HRSA OPAIS + HAP; HAP talking points (Mar 2026); Commonwealth Fund | Jan 2026 / Mar 2026 |
| PA 49% / 53% / 49% (rural, loss, L&D) | HAP talking points (Mar 2026); Oliver Wyman for HAP | Mar 2026 / OW report vintage |
| 23% Rx savings (survey avg.) | 340B Health · AHA survey (not audited) | Survey cycle |
| PA district map | HAP points + PA LRC districts · data/pa-districts/ |
File updates |
| Legal landscape text | HAP Finance & Legal review | Mar 2026 |
Independent government reviews (oversight context)
HAP’s figures and asks on this page trace to HAP materials and the sources listed above. For readers who want agency and advisory perspectives alongside hospital voices, these are common independent entry points (not endorsements):
- U.S. Government Accountability Office — 340B program oversight and integrity (example product).
- HHS Office of Inspector General — OIG reports on 340B-related topics (search the site).
- Medicaid and CHIP Payment and Access Commission (MACPAC) — federal advisory context on the drug program landscape.
Eligible providers
Who depends on 340B
Safety-net hospitals, children's and cancer centers, and community clinics use the discount to fund care.
- Children's and cancer hospitals
- Rural critical-access hospitals and safety-net hospitals
- Federally qualified health centers
Community benefit
Reinvesting savings in patient care
Issue: funding for safety-net services. Impact: prescriptions, screening, and access programs. Action: protect the discount that funds them. Data as of March 2026.
Source for $7.95B hero figure: 340B Health and AHA reported totals (2024), summarized in HAP 340B talking points (March 2026). Source for 23 percent line item: 340B Health and AHA survey methodology (reported average; not independently audited).
23 percent reported average savings on drug purchases, reinvested in care.
Free or reduced-price prescriptions
Mobile mammography and cancer screening
Dental care and preventive services
Total community benefits (2024), reported
"The pharmacy at my hospital is the only reason I can afford my insulin. Without 340B, I don't know what I would do."— Pennsylvania patient, safety-net hospital (name withheld)
$7.95B
Nine percent increase over 2023, reinvested in community health.
Source: 340B Health and American Hospital Association reported community benefit totals.
340B hospitals by PA legislative district
House and Senate districts are color-coded by number of 340B participating hospitals in the district.
Explore: Hover districts for a quick readout. Spotlight: Tap a color to highlight only that hospital-density band. Orange dots are 340B hospitals—click a dot to open its district.
Click any district for legislator, 340B hospital count and names, hospital engagement, and outreach ideas.
PA Senate districts — priority tracking
| Senate District | Senator | Party | # 340B Hospitals | HAP Priority | Action |
|---|---|---|---|---|---|
| SD 10 | Steve Santarsiero | D | 3 | Cosponsor | Schedule meeting |
| SD 18 | Lisa Boscola | D | 2 | Supportive | Send brief |
| SD 24 | Tracy Pennycuick | R | 1 | Unknown | Call |
| SD 32 | Patrick Stefano | R | 0 | Opposed | Call |
| SD 41 | Joe Pittman | R | 4 | Cosponsor | Schedule meeting |
How this simulator works (read before briefing)
This tool shows three fixed advocacy scenarios for the 340B Program. It is a plain-language briefing aid, not a forecast or financial model.
What you see for each scenario
- Hospital–pharmacy partnerships: Rounded illustrative counts from the dashboard scenario data (about 12K under a full-protection storyline, about 4.5K under today’s national mix). The “remove protections” path labels partnerships as at risk instead of a count.
- Patient access and hospital program stability use the qualitative labels and notes defined in that same scenario data (for example, Strong / Mixed / Weak).
Limitations
- Does not reflect individual hospital variation in drug mix, payer mix, or contract pharmacy reliance
- Does not model behavioral responses (for example, hospitals changing pharmacy networks)
- Not a CBO score, CMS estimate, or actuarial projection
- Should not be cited as an official HAP facility-level estimate without HAP review
For testimony, member briefings, or facility-specific analysis, contact HAP through haponline.org.
Policy & access
Duplicate discount safeguards, patient-access impacts, and Pennsylvania protections in one section.
Myth vs. fact
How duplicate discounts are prevented
Myth: duplicate discounts are not already addressed.
Fact: federal law already prohibits duplicate discounts; HRSA/CMS coordinate exclusion files.
- Policy question: whether manufacturers can restrict contract pharmacy access as an enforcement tool (beyond what the statute requires).
Access to care
340B protects access to care in Pennsylvania
Decision needed
Adopt state and federal guardrails that prevent manufacturer restrictions on contract pharmacy access.
Why now
Pennsylvania has 72 participating hospitals and peer states have already enacted protections.
Consequence without action
Without policy clarity, medication access and community services are at higher risk in rural and underserved areas.
Pennsylvania impact
72
PA hospitals rely on 340B
States are stepping up to protect contract pharmacy access. Pennsylvania should not fall behind.
Data as of March 2026. Sources: HRSA OPAIS participation file; National Academy for State Health Policy contract pharmacy legislation tracker.
Defined trend metric
21 states have enacted protections, while 29 states have not enacted protections yet.
Metric definition: enacted state protections / total states. Data as of March 2026.
View programs and services supported
Programs and services supported with 340B savings
These services are often the first at risk when 340B support is reduced.
- Housing stability
- Behavioral health
- Maternal health
- Chronic disease management
- Preventative care
- Transportation services
- Early childhood development
- Public health education
In Pennsylvania, 72 hospitals rely on 340B to keep care within reach.
HAP position
Protect access, stop manufacturer restrictions, and keep care local.
Critical lifeline
340B supports care access in rural and underserved communities.
Hospitals and clinics serving Pennsylvania's most vulnerable patients rely on 340B to sustain patient-facing services.
Manufacturers limiting access
Restrictions on contract pharmacy use can reduce medication access.
Restrictions can narrow where patients fill prescriptions and increase medication delays for high-need communities.
HAP's ask: state and federal action
Protect program integrity by preventing manufacturer restrictions.
State ask: Enact Pennsylvania protections for contract pharmacy access and preserve DHS duplicate-discount safeguards.
Federal ask: Reinforce HRSA oversight and maintain statutory protections for covered entities serving safety-net populations.
Protect 340B, Protect Patients Without 340B savings, Pennsylvania hospitals may limit patient services and already at-risk communities could lose access to care. Pennsylvania needs policies that protect 340B integrity and preserve access to medications.
Pennsylvania safeguards
PA already prevents duplicate discounts
- Manufacturers are not required to give both a 340B discount and a Medicaid rebate for the same drug.[2]
- PA DHS runs the 340B Drug Exclusion List to prevent duplicate Medicaid discounts.
- Contract pharmacy claims are structured to avoid duplicate discounts; DHS bills manufacturers for rebates where applicable.
Sources & statute
[2] Statutory basis: Veterans Health Care Act of 1992, codified at 42 U.S.C. § 256b. HRSA and CMS coordinate Medicaid exclusion files at the federal level to prevent duplicate discounts. PA DHS operates the state-level 340B Drug Exclusion List in parallel with the federal mechanism. Source: 42 U.S.C. § 256b; HRSA-CMS guidance.
Briefing Q&A
Q1: Isn't 340B just a hospital slush fund?
No. $7.95B in reported community benefit (2024) is documented reinvestment in free prescriptions, cancer screening, dental care, and rural services — up 9% from 2023. HRSA audits 179 covered entities annually to verify compliance.
Q2: Why should manufacturers have to give discounts to large health systems?
340B eligibility is tied to DSH percentage and safety-net status — not system size. Eligible hospitals must serve a disproportionate share of low-income and uninsured patients to qualify. Large systems that qualify do so because of their charity care load.
Q3: Doesn't 340B create duplicate discounts?
Federal law already prohibits it. HRSA and CMS coordinate exclusion lists so manufacturers cannot be required to provide both a 340B price and a Medicaid rebate on the same drug. Pennsylvania runs its own exclusion list through DHS as an added safeguard.
Q4: Shouldn't manufacturers be able to limit contract pharmacies?
The statute doesn't give manufacturers that authority. Courts in 6 states (AR, LA, MO, MN, TN, RI) have upheld state protections against manufacturer restrictions. Unilateral restrictions by manufacturers go beyond what federal law requires and reduce patient access.
Q5: Is 340B too big — 7% of the U.S. drug market?
HAP’s March 2026 talking points frame 7% as the share of the total U.S. drug market flowing through 340B, citing the Commonwealth Fund — a bounded scale context, not “program overreach.” Federal oversight (179 covered-entity audits in FY 2024) continues to verify that covered entities use the program as intended.
"Pennsylvania hospitals reinvest every dollar of 340B savings into the communities that need it most. Restricting this program doesn't save money — it closes doors for patients who have nowhere else to go."
— Nicole Stallings, President and Chief Executive Officer, Hospital and Healthsystem Association of Pennsylvania
Reported community benefit (2024)
$7.95B
Impact: Hospitals retain billions in reported savings to fund patient care and community programs.
Pennsylvania hospitals in 340B
72
Impact: Pennsylvania’s program footprint—pair with the map for state law status.
States with contract pharmacy protection
21
Impact: State law backs hospital–pharmacy networks where protections are enacted.
Share of total U.S. drug market (340B)
7%
Impact: Benchmarks program scale; HAP Mar 2026 materials cite Commonwealth Fund.
-
Protect the 340B discount
Impact: Keeps hospital access to prices Congress set for charity care and community benefit.
-
Defend contract pharmacy partnerships
Impact: Lets patients fill prescriptions through local and network pharmacies, not one distant site.
-
Oppose rules that shrink access for safety-net patients
Impact: Preserves affordable medication access in rural and underserved communities.
-
Sustain DHS duplicate-discount safeguards
Impact: DHS should maintain the Medicaid Exclusion File and Drug Exclusion List so covered entities can be tracked and duplicate discounts are prevented.
-
Protect 340B integrity—contract pharmacies
Impact: Preventing manufacturer limits keeps hospitals and clinics connected to the pricing Congress intended.
-
Preserve access in rural and underserved communities
Impact: Many providers rely on contract and specialty pharmacies; one-pharmacy limits constrain access for Pennsylvania's most vulnerable patients.
Key facts for your meeting
HRSA Program Integrity FY 2024
Covered entity audits
179
Manufacturer audits
5
Legal landscape (at a glance)
Courts
Manufacturer challenges to state contract-pharmacy laws have generally failed (e.g. AR, LA, MO, MN, TN, RI; PCMA v. Wehbi, LHA v. Greenstein). Confirm dockets with HAP Legal.
2025 state models
CO, ME, OH, RI, VT paired protections with reporting or transparency.
PA & executive
No PA shield statute yet (see map). Some governors vetoed similar bills (VA reported). PA DHS: 340B Drug Exclusion List for Medicaid duplicate discounts.
Counterargument rebuttal
| Manufacturer claim | Hospital / HAP response | Evidence |
|---|---|---|
| 340B creates duplicate discounts — hospitals collect both a 340B discount and a Medicaid rebate on the same drug. | Pennsylvania DHS already runs a 340B Drug Exclusion List that prevents this. Manufacturers are not required to give both discounts on the same drug. | PA DHS 340B Drug Exclusion List; HRSA program integrity rules |
| Hospitals use 340B savings for profit, not patient care. | $7.95B in reported community benefit (2024, up 9%) funds free prescriptions, mobile mammography, dental care, and rural services — reinvestment is documented and growing. | 340B Health 2024 community benefit report |
| Contract pharmacy networks are too large and unaudited. | HRSA conducted 179 covered-entity audits in FY 2024 vs. only 5 manufacturer audits. Hospitals face far more scrutiny than the manufacturers restricting access. | HRSA Program Integrity FY 2024 audit results |
PA safeguards
PA already prevents duplicate discounts
- Manufacturers are not required to give both a 340B discount and a Medicaid rebate for the same drug.[2]
- State DHS (Department of Human Services) runs the 340B Drug Exclusion List and bills manufacturers for Medicaid rebates, so hospitals may not use 340B-priced drugs on this list.
- Contract pharmacies give non-340B drugs to Medicare Advantage patients, and DHS bills manufacturers for rebates.
Sources: MultiState · ASHP · America's Essential Hospitals (state law) · 340B Health · AHA (community benefit) · HRSA Program Integrity FY 2024 (audit counts). Limitations: state law counts change as legislatures meet; community benefit totals are self-reported aggregates, not independently audited.