CARH Letter to Senate HELP Committee Ahead of 340B Hearing

October 22, 2025

The Honorable Bill Cassidy, Chair

The Honorable Bernie Sanders, Ranking Member

Senate Committee on Health, Education, Labor, and Pensions

428 Senate Dirksen Office Building

Washington, DC 20510

Dear Chair Cassidy, Ranking Member Sanders, and Members of the Committee:

On behalf of Community Action for Responsible Hospitals (CARH), representing the interests of workers, faith leaders, healthcare providers, and patient advocates, we appreciate the Committee’s attention to the 340B Program. We commend you for convening this week’s hearing, “The 340B Program: Examining Its Growth and Impact on Patients,” and for including testimony from the Government Accountability Office (GAO), the Congressional Budget Office (CBO), and leading academic researchers.

Today, large hospital systems and their corporate partners exploit their access to 340B discounts, yet there remain no meaningful safeguards to ensure those savings reach patients.

The abuse of the 340B program is not an isolated issue – it’s a clear symptom of a broader trend: the corporatization of our healthcare system, where profit comes before patients.

Under 340B, hospitals take steep discounts on drugs with the intent that they use the savings to make medications accessible and affordable for low-income and uninsured patients – and reinvest in improving care. However, extensive evidence shows that mission is not being fulfilled despite hospitals capturing more than $66 billion in 340B savings in 2023.

As highlighted in a recent Wall Street Journal editorial, findings from a CARH study conducted by Magnolia Access Research reveal that many disproportionate share hospitals (DSHs) are

diverting 340B revenue away from patient care and into Wall Street portfolios. Approximately one- third of their 340B discounts are being funneled into stocks, bonds, and other financial investments rather than used to lower drug costs or expand charity care.

DSHs that joined 340B between 2016 and 2017 cut their spending on free or reduced cost care by 22%, on average, while increasing financial investments by 89% in the five years following enrollment.

DSHs that entered the 340B program before 2005 provided more uncompensated care than newer participants, with declining levels since 2015.

After enrolling in 340B, DSHs saw little to no increase in staffing levels – showing no meaningful changes in hiring doctors, nurses, or frontline care workers.

Earlier this year, the CBO released a report confirming that that the program is inflating costs for both federal and state Medicaid programs, increasing financial pressures on hardworking Americans, and putting additional strain on already limited healthcare resources.

Your Committee’s year-long investigation has echoed these concerns, documenting how the 340B program’s unchecked growth has fueled hospital consolidation and enriched corporate systems at the expense of patients and independent providers.

Together, these assessments send a clear and urgent signal: Congress must enact bipartisan reforms to restore transparency, accountability, and patient-centered outcomes in 340B.

Without meaningful oversight, big hospitals and their corporate partners will continue to exploit the program as a revenue stream rather than a lifeline for vulnerable patients. The 340B ACCESS Act is a step in the right direction – it finally starts reining in the big hospital systems that have turned a patient-focused program into their own profit machine.

CARH and our partners stand ready to assist Congress in realigning 340B with its intended purpose and ensure that every dollar delivers genuine relief to the working American families who need it most.

We thank the Committee for holding this important hearing and for its continued oversight of the 340B program. Your leadership is critical to ensuring that this program serves the patients and communities it was created to help.

Sincerely,

Community Action for Responsible Hospitals