This drug discount bill puts profits ahead of Washington patients | Opinion
Washingtonians deserve a 340B Drug Pricing Program that works for patients — especially those living with HIV, viral hepatitis, cancer and other chronic health conditions, where uninterrupted access to medication is lifesaving, not optional.
Senate Bill 5981 does not advance that mission. Instead, it is legislation that masquerades profits and revenue as a health care access bill.
Congress created the 340B program to “...stretch limited federal resources to serve more eligible patients…” and expand care for historically underserved populations. But in practice, the program has grown dramatically without corresponding guardrails or tangible results for patients.
The 340B program has exploded over the past decade into one of the largest federal drug discount programs, second only to Medicare Part D. Yet hospitals and contract pharmacies are not required to pass those savings directly to patients at the pharmacy counter, nor must they publicly account for how the revenue is used.
This is to the detriment of lower-income patients, the state and taxpayers.
Washington loses tens of millions of dollars each year in Apple Health (our state’s Medicaid program) drug rebates when prescriptions are billed through 340B rather than the Medicaid Drug Rebate Program. Those lost rebates represent dollars that could fund behavioral health services, rural access, housing support,or expanded coverage for lower-income residents all while providing financial stability for our Medicaid program.
In addition, the physical locations of 340B activity raises serious concerns. Why are the majority of 340B contract pharmacies in increasingly concentrated in higher-income areas, serving commercially insured patients high-cost specialty drugs? Shouldn’t they be in lower-income or underserved communities? And too often, patients pay the same copay they would have paid if 340B didn’t exist, while hospitals, pharmacies and third-party administrators pocket the spread between deeply discounted prices from manufacturers and insurance reimbursement. That is not patient care — that is profit maximization.
By limiting basic oversight tools that help flag misuse and abuse, the bill would make it harder for the state to distinguish claims, weakening safeguards against duplicate discounts and obscuring the true fiscal impact on Apple Health. This matters because Apple Health is already under strain, and policymakers have a duty to protect taxpayer funds — not quietly redirect them through hidden billing tricks.
For people living with HIV, these policies have real-world consequences. Stable access to antiretroviral therapy is the foundation of both individual health and public health. Programs like the AIDS Drug Assistance Program (ADAP) show that 340B can work when savings are clearly tied to patient benefit, transparent rules and direct accountability. ADAPs deliver medications at little or no cost to patients, with some of the strongest compliance records in the entire 340B system. That success did not happen by accident; it happened because patients, not skyrocketing profits, were the priority.
CANN supports efforts to help Washington’s lower-income, underinsured, and rural residents have access to life-saving care. SB 5981 is not the answer. Instead, the bill allows hospitals, health systems and contract pharmacies to double down on a revenue stream on the backs of patients and taxpayers.
We deserve a strong, sustainable 340B program, focused on patient care. We should reject unchecked expansion or shielding money from scrutiny.
Other states have shown a better path forward, requiring 340B entities report acquisition costs, reimbursements and payments to contract pharmacies and third-party administrators. Those disclosures revealed that a relatively small number of large hospital systems take the overwhelming majority of 340B revenue, while the benefit to charity care or reduced patient out-of-pocket costs remains unclear.
Washington should learn from that experience.
Legislators must reject SB 5981.
If guaranteeing access to affordable prescription drugs and health care is policymakers ’ true intent, then any 340B program-related legislation must require transparency to ensure the program directly benefits historically underinvested populations, including rural communities and lower-income and uninsured patients.
Washingtonians deserve reforms that ensure 340B savings are used to reduce costs, expand access and improve patients’ lives — not legislation that doubles down on a broken status quo.
Ryan Carpenter is a Seattle resident and board member of Community Access National Network, a national nonprofit dedicated to improving healthcare for people living with HIV/AIDS and viral hepatitis.