Missouri took an important step this legislative session toward a simple but essential goal: ensuring that vulnerable patients can access affordable, life-saving medications. 

Recognizing the extraordinary costs imposed on the healthcare system—and the resulting financial strain and reduced access for patients—the legislature has called for greater transparency (HB 2011) into one of Missouri’s and the country’s most misused healthcare programs. 

At the center of this effort is the federal 340B drug pricing program. Created in 1992, 340B was designed with a clear and commendable purpose—to stretch limited healthcare resources and expand access to pharmaceuticals for patients facing serious conditions such as cancer and immune disorders. That mission remains as urgent today as it was more than three decades ago.

But the program has changed dramatically.

What began as a targeted initiative has grown into one of the largest federal drug programs in the country. In 2024 alone, discounted drug purchases under 340B exceeded $81 billion—second only to Medicare Part D. At the same time, the structure of the program has shifted. Contract pharmacy arrangements have increased by 4,000 percent since 2010, with nearly three-quarters now involving large chain pharmacies or those owned by pharmacy benefit managers.

In Missouri, these national trends are reflected—and magnified. The state now has more than 4,400 contract pharmacy arrangements, nearly half of which are located outside its borders. Despite the program’s intent to support underserved communities, only a small share of in-state contract pharmacies operate in rural or lower-income areas, even though more than half of Missouri ZIP codes are rural.

Meanwhile, oversight has not kept pace. Since 2015, federal authorities have conducted just 55 audits of Missouri entities participating in the program. More than half of those audits identified violations, including improper distribution of 340B drugs.
The result is a growing gap between the program’s purpose and its operation—and a fundamental problem for policymakers: a lack of reliable data. Without clear, consistent reporting, it is impossible to determine whether the financial benefits generated by 340B are reaching the patients and communities it was designed to serve.
This is where Missouri has an opportunity to lead.
The state’s $50B budget has been compromised by increasing healthcare costs driven by the 340B program. In response, legislators have called for the Department of Social Services to investigate how the program’s receipts and expenditures are impacting Missourians.
In addition, legislation was introduced this session (HB 2081, SB 1178, and SB 1213) that would not have altered the structure of the 340B program or restricted its use, but instead, have established straightforward transparency requirements. Covered entities would report basic, aggregated information—such as the cost of drugs, payments received, fees paid to contract pharmacies, and how resulting savings are used to benefit communities.
Crucially, patient privacy would remain fully protected. The legislation required that all data be reported only in aggregate form, with no collection or disclosure of patient-specific information.
Missouri would not be alone in taking this step. Eleven states have already adopted similar transparency measures, recognizing a simple truth: sound public policy depends on sound information.
Transparency is not a threat to 340B—it is a safeguard. Providers using the program as intended should welcome reasonable reporting requirements. Greater visibility can strengthen public trust, demonstrate the program’s value, and ensure that its benefits are directed where they are needed most.
The stakes are too high to rely on assumptions. The 340B program involves substantial resources and serves patients with serious, often life-threatening conditions. Ensuring its integrity is not about politics or bureaucracy—it is about accountability.
Most importantly, it is about refocusing on the people the program was created to help.
Missouri has taken a meaningful step forward. The next step is clear: ensure that transparency and accountability keep pace with the program’s growth, so that 340B continues to serve patients—not just in principle, but in practice.