Advancing Health Podcast: The Future of 340B—What Hospitals and Rural Communities Need to Know

Date: November 24, 2025
Host: Tina Fries Decker (President & CEO, Corewell Health, AHA Board Chair)
Guests: Amy Kuhlman (AHA VP of Advocacy, Grassroots & Government Relations) & Paulette Davidson (CEO, Monument Health)

Episode Overview

This episode dives deep into the future of the 340B Drug Pricing Program, spotlighting looming regulatory, legislative, and legal changes in 2026—and what these mean for hospitals, especially in rural areas. Host Tina Fries Decker leads a discussion on the program’s purpose, recent government actions, ongoing challenges, misinformation and advocacy, and, critically, the real-life effects for health systems and communities using 340B savings to support vulnerable populations.

Key Discussion Points & Insights

1. What is the 340B Program and Why Is It Critical?

• Purpose: Established 30+ years ago, the 340B program requires drug manufacturers to provide discounted outpatient drugs to hospitals serving a high number of low-income or uninsured patients (00:26).
• Impact: Participating hospitals use 340B-generated savings to increase access to care, fund free/discounted medications, offer financial assistance, build clinics, and create community outreach programs.

2. Regulatory, Legal, and Legislative Updates on 340B (02:36–07:45)

Regulatory

• Rebate Model Pilot: HRSA is launching a 340B rebate model in 2026. Instead of hospitals buying drugs at a discount upfront, they’ll pay full price, submit claims data, then request a rebate. This is a major shift with potential negative effects.
  • "340B hospitals will be forced to provide drug manufacturers with an interest-free loan...significant operational expenses [are anticipated]." – Amy Kuhlman (03:30)
• OPPS Rule: The final Outpatient Prospective Payment System rule is imminent; it may contain more changes impacting 340B.

Legal

• Ongoing lawsuits over access to 340B-discount drugs at contract pharmacies. States are passing laws to protect hospitals, while drug manufacturers challenge them in court.
• The AHA works closely with state associations and AGs in defending these protections.

Legislative

• Congress shows bipartisan support, but increasing interest in transparency and possible reforms. Hearings (e.g., Senate HELP) probe program growth and patient impacts.
• Core concern: Demonstrating how 340B savings directly benefit patient care.

3. Misinformation and Advocacy (07:45–10:06)

• Common myths:
  • The program is "too big" or doesn’t serve its original intent.
  • Savings are being misapplied.
• Reality:
  • Growth is largely a result of Congressional expansion and rising drug prices (not misuse).
  • Savings stem from drug costs set by manufacturers.
• Advocacy Resources:
  • “We have a 340B advocacy alliance…I encourage all of our members, if you're not already a part of, if you are a 340B hospital, please join.” – Amy Kuhlman (09:28)

4. Real-Life Impact for Rural Hospitals: Monument Health’s Story (10:06–13:51)

• Community Benefit: $123M provided in uncompensated care and community benefit; $84M in annual 340B savings—used well beyond the savings itself.
• Program Examples:
  • $6M to neonatal ICU, only such unit within 350 miles
  • $6M to a behavioral health hospital, care for both children & adults
  • $800K in free patient transportation (essential in rural SD)
  • Vital support for keeping local pharmacies open, supporting uninsured/underinsured with nearly free drugs
  • Oncology program with free/low-cost specialized cancer drugs
• Quote:
  • “The 340B Prescription Drug Program is a vital lifeline for our ability to care for our region...We are a great example...of how we take those dollars...and we’re doing good as the program was designed, to create that lifeline for vulnerable patients.” – Paulette Davidson (10:25–13:51)

5. Transparency & Community Engagement (13:51–16:00)

• Sharing Impact, Building Support:
  • Leadership actively educates local leaders, state reps, and congressional delegates about 340B’s benefits.
  • Leaders invite policymakers to tour facilities, see clinics & patients firsthand.
• Advocacy Win: Monument Health turned back a legislative threat by illustrating the community need for contracted retail pharmacies and engaging directly with lawmakers.
• Quote:
  • “When we can show our mayors…and our federal delegation what we're doing, I think it's unifying…” – Paulette Davidson (14:11)

6. Looking Ahead: What to Watch in 2026 (16:00–18:48)

• Regulatory: Rebate pilot implementation will be closely monitored; OPPS rule could bring further changes.
• Legislative: Continued Congressional scrutiny and oversight; possible new hearings and reform bills.
• Legal: Litigation over contract pharmacy access is ongoing, with the AHA poised to support hospitals as needed.
• Advice:
  • “It's so important hospitals...are talking to their elected officials and making sure they understand what they’re able to do because they have access to the program—and what it would mean if it were taken away.” – Amy Kuhlman (17:59)
  • “If we can put a face with this program—our neighbors, our family members, our community members—that's our job. That’s what resonates.” – Paulette Davidson (17:26)

Notable Quotes & Moments

• “340B hospitals will be forced to provide drug manufacturers with an interest-free loan...significant operational expenses [are anticipated].”
  — Amy Kuhlman, on the rebate model (03:30)

• “The 340B Prescription Drug Program is a vital lifeline for our ability to care for our region.”
  — Paulette Davidson, on the necessity of 340B for rural care (10:25)

• “These are dollars coming directly from pharmaceutical corporations. They're not taxpayer dollars.”
  — Paulette Davidson, correcting misconceptions (12:47)

• “If we can put a face with this program…that's what resonates with people that care.”
  — Paulette Davidson, on effective advocacy (17:26)

• “It is so important that hospitals...are talking to their elected officials...making sure they understand what they’re able to do because they have access to the program.”
  — Amy Kuhlman, on ongoing advocacy (17:59)

Key Timestamps

• 00:01 — Introduction & overview of 340B
• 02:36 — Amy Kuhlman on current 340B landscape
• 07:45 — Addressing misinformation and advocacy
• 10:25 — Paulette Davidson: Impact for Monument Health and South Dakota
• 13:51 — Community transparency and stakeholder engagement
• 16:00 — Predictions for legislative/regulatory/legal action in 2026
• 17:26 — Final thoughts on the importance of human stories and advocacy

Tone & Takeaway

The conversation is urgent yet hopeful, blending technical insight (from AHA’s policy vantage point) with heartfelt real-world stories from a rural South Dakota health system. The speakers emphasize the necessity of robust advocacy, the need to counteract misinformation, and the critical role of community education. The podcast repeatedly calls on hospital leaders to personalize their communications with lawmakers, putting faces to statistics and demonstrating 340B’s life-saving potential.

Bottom Line:
Major changes to 340B are coming, and hospitals—especially those serving rural, vulnerable populations—must prepare for new regulatory models, continue legal/legislative vigilance, document impact, and keep telling the true story of how 340B sustains community health.