Policymakers Should Support Patients With Chronic Conditions

Jen Laws is the President and CEO of Community Access National Network, a nonprofit dedicated to improving access to health care services for people living with HIV/AIDS and viral hepatitis.Oregon stands at a crossroads in its effort to make healthcare more equitable and accessible. As an organization that advocates for people living with HIV/AIDS and viral hepatitis, the Community Access National Network urges lawmakers to reject HB 2385 and oppose the unchecked expansion of the 340B Drug Pricing Program in Oregon.

340B Program fails to meet its purpose

The 340B Program was established with good intentions. Enacted by Congress in 1992, its purpose was to enable safety-net providers to purchase prescription medications at steep discounts and to use those savings to expand access to care for vulnerable populations. But the program has strayed far from this mission. As it exists today, 340B too often serves institutional financial gain rather than directly benefiting patients, leaving patients to ask “What about me?”

This misalignment is dangerous for people living with HIV and hepatitis. We face chronic health needs and depend on consistent, affordable access to life-saving medications. Expanding a broken system under HB 2385 threatens to deepen healthcare disparities rather than alleviate them.

Patients often still pay full price

The HIV and hepatitis communities depend on highly coordinated, accessible care. Yet in many cases, patients served through the 340B network are not actually seeing the benefits of discounted drugs. For example, when a hospital purchases a medicine at a 340B discount and then partners with a contract pharmacy to dispense it, the patient is often charged the full retail price.

The savings are instead shared between the hospital and pharmacy, not passed on to the person in need.

Studies have found that 340B revenues incentivize consolidation by driving 340B hospitals to acquire physician practices in wealthy areas. Meanwhile, 340B contract pharmacy arrangements are increasingly consolidated into large pharmacy chains located in higher-income communities. This consolidation reduces access to care, particularly for marginalized and rural populations, who often find themselves excluded from expanded 340B networks.

HB 2385 would permit further expansion of 340B contract pharmacy arrangements without adding transparency or accountability. 48% of Oregon 340B hospital contracts are with out-of-state pharmacies, and only 26% of in-state contract pharmacies are located in medically underserved areas. Simply expanding the program’s footprint without reform will not improve care for rural or underserved populations.

It will, however, increase opportunities for markup and profiteering, further inflating drug costs and reducing the affordability of care. Expanding contract pharmacies defeats the program’s goal of expanding access to care by rewarding profiteering entities rather than constraining them, putting more resources in the hands of those least accountable to vulnerable patients.

A recent report reveals how 340B participants are using the program to markup drug prices significantly by as much as 700%, sometimes more, while pocketing the difference instead of lowering costs for patients. In 2023 alone, $6.6 billion in employer healthcare costs were attributed to lost rebates on 340B prescriptions, and $1.8 billion in state and federal tax revenue was lost in 2021 due to this misalignment. These numbers speak to a system spiraling away from its core mission and becoming a hidden tax on patients, employers, and taxpayers alike.

OHA notes racial and geographical disparities

In Oregon, these problems are compounded by healthcare challenges. The Oregon Health Authority has noted persistent racial and geographic disparities in access to primary and specialty care, especially in rural areas and among Black, Indigenous, and other communities of color. Meanwhile, the state’s healthcare costs remain high. Many residents face significant out-of-pocket healthcare costs that can contribute to delayed or avoided medical treatment.

The patients we represent cannot afford to be collateral damage in a system that is increasingly opaque and profit-driven, rather than mission-driven. What we need is targeted support, community-based care, and policies that ensure resources are actually reaching our communities. Instead of expanding a broken system, Oregon lawmakers should focus on reforming 340B by requiring sufficient reporting, clarifying patient eligibility, and mandating that savings are transparently reinvested in patient care.

By rejecting HB 2385, Oregon can take a stand for true patient-centered care. The Community Access National Network urges legislators to pause, reassess, and reform before expanding a program that, in its current form, risks doing more harm than good. Let’s fix 340B before we grow it.