340B Program Surpasses $100 Billion in Purchases: DSH Hospitals Driving Majority Growth

The 340B program just crossed a threshold that would have been unimaginable when it launched: $100 billion in discounted drug purchases in a single year according to 2025 340B purchase data released by Health Resources and Services Administration (HRSA).

Ten years ago, 340B covered entities purchased $12 billion in covered outpatient drugs in a year. Today, that is roughly what they purchase every six weeks.

The growth is not evenly distributed. Nearly 9 in 10 dollars spent in 340B flow through hospitals. And within that group, one type – Disproportionate Share Hospitals, or DSHs – now accounts for $79 billion of the program's $100 billion in purchases. That is nearly the size of the entire program just one year ago.  DSHs also accounted for roughly 80% of the program's year-over-year growth.

Our study by Magnolia Market Access examined what DSHs actually did with those savings and the findings are striking.

• DSHs that joined 340B between 2016 and 2017 cut their spending on free or reduced cost care by 22%, on average, in the five years after enrolling.

• Over that same period, their financial investments – stocks, bonds, and other assets – grew by 89%.

• Furthermore, after enrolling in 340B, DSHs saw little to no meaningful increase in hiring doctors, nurses, or frontline care workers.

The pattern is consistent: as 340B purchases grow, patient benefit does not follow.

At $100 billion and compounding at 23% annually, 340B is delivering exceptional returns – just not for patients. Hospitals enrolled in the program cut spending on free and reduced-cost care while their investment portfolios grew. Congress built 340B for vulnerable patients. Somewhere along the way, Wall Street got there first.

Policymakers must require 340B covered entities to show where the money is going. Until they do, the patients 340B was built to serve will keep losing out.