By Sharon D. Allison, MD, Rev. Kimberly L. Williams and Shari Beagelman
Congress created the 340B Drug Pricing Program in 1992 to help safety-net providers care for low-income patients by allowing qualified hospitals, clinics, and other health care organizations to purchase medicines at discounted prices. These providers often serve communities facing the greatest barriers to care, including communities with high proportions of Black patients. The idea is simple and worth defending: a hospital serving patients with the greatest needs buys medicine for less, and the savings are intended to support their care. The question before Maryland is whether that promise is being fulfilled.
The state’s Prescription Drug Affordability Board was directed by the General Assembly through House Bill 1056 in 2024 to examine how the 340B program operates across Maryland and report its findings by July 1, 2026. The Board sought to better understand the program’s reach, financial impact, and, most importantly, how participating organizations are using 340B savings to benefit patients.
This was not simply a survey about hospital operations, but an effort to follow the money in a program that affects patients, employers, taxpayers, and the state’s health care system. When a hospital or clinic buys a medicine at a discounted 340B price, an insurer, employer health plan, taxpayer-funded program, or patient may still pay a much higher amount. The difference between the discounted price and the reimbursement can generate significant revenue for the 340B entity and their contract pharmacies. That financial flow is key to determine whether those dollars are lowering out-of-pocket costs, expanding services in underserved communities, or being retained elsewhere in the health care system.
To answer those questions, the Board requested information that participating organizations already maintain as part of their compliance with federal requirements. Organizations were not being asked to create new data or develop new reporting systems. They were asked to provide basic information about how much 340B generates and how those savings are used.
While 340B is a federal program, Maryland has a role in understanding how it operates within the state. Maryland patients receive the care. Maryland employers help pay for coverage. Maryland taxpayers support public programs. Maryland licenses hospitals, clinics and pharmacies, and the insurers and public employee plans it regulates are part of the payment system. The state cannot set the federal discount, but it can ask whether savings generated in Maryland are helping Maryland patients.
Maryland has 185 covered entities, 289 affiliated locations, or “child sites,” and more than 1,700 contract pharmacy relationships. Yet only 24 organizations responded to the Board’s request for information. When the Board met this summer to approve the report requested by the legislature, the meeting lasted about ten minutes. There was little to discuss. The report concluded that Maryland does not have the information needed to meaningfully understand the program’s size, implementation, or impact.
As a physician, a patient advocate and leaders working in trusted community spaces, we see people delay appointments, skip medications or leave prescriptions unfilled because they cannot afford the cost. In the churches where Choose Healthy Life works, Health Navigators meet families facing these choices every day. BlackDoctor hears from communities navigating the same barriers to care, and physicians see the consequences when patients go without needed treatments. These are the very patients 340B was designed to support.
A hospital or clinic involved in that patient’s care may have purchased medicine at a 340B discount. The patient, her insurer, an employer plan or a taxpayer-funded program may still have paid a much higher amount. The savings from that difference may have supported medication assistance, transportation, translation services, charity care or a clinic in her neighborhood. We hope they did. But without basic reporting, Maryland cannot show patients where those savings went or whether they benefited.
That is why transparency matters. If 340B is fulfilling its purpose, families should be able to see its impact through lower out-of-pocket costs, shorter waits, stronger charity care or services that did not exist in their neighborhoods before. Right now, that impact is too difficult to measure.
The safety-net organizations using 340B savings to expand access to care have an opportunity to demonstrate the impact of their work, and we would gladly help tell that story. What we are proposing is not another lengthy report destined for a shelf. It is a brief, standardized disclosure showing what 340B generated and how those savings were used, available for legislators, reporters, and patients to review. Minnesota already asks the same of its hospitals.
Lawmakers have taken the first step by asking a simple question: how is 340B benefiting patients in Maryland? The answer should not be difficult to find. We believe 340B has a valuable story to tell. We would like to see that story told through data, so families across the state, whether in pews, waiting rooms, or around kitchen tables, can see the program’s impact in the communities it was created to support.
Sharon D. Allison, MD is a Health Strategist/Advocate/Physician
Rev. Kimberly L. Williams, is President and CEO, Choose Healthy Life
Shari Beagelman is Director of Policy and Advocacy, BlackDoctor
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