{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:54:07Z","timestamp":1791262447314,"version":"4.1.0"},"reference-count":63,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000905","name":"Commonwealth Fund","doi-asserted-by":"publisher","award":["24\u201024270"],"award-info":[{"award-number":["24\u201024270"]}],"id":[{"id":"10.13039\/100000905","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:label\/>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"box\" position=\"anchor\">\n                        <jats:caption>\n                          <jats:title>Policy Points<\/jats:title>\n                        <\/jats:caption>\n                        <jats:p>\n                          <jats:list list-type=\"bullet\">\n                            <jats:list-item>\n                              <jats:p>The original purpose of the 340B program was to exempt Public Health Service Act funded clinics and state and local public hospitals from the inflationary best\u2010price component of the recently enacted Medicaid drug rebate program.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>The secondary purpose was to reduce drug prices for these clinics and hospitals in order to preserve and expand access to free and discounted care.<\/jats:p>\n                            <\/jats:list-item>\n                            <jats:list-item>\n                              <jats:p>The cutoff for the disproportionate share hospital\u2010based eligibility criteria was selected as part of\u00a0political compromises to qualify specific nonprofit hospitals.<\/jats:p>\n                            <\/jats:list-item>\n                          <\/jats:list>\n                        <\/jats:p>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>The 1992 340B Drug Pricing Program (\u201c340B\u201d) started as a narrowly focused program aimed at Public Health Service Act\u2013funded clinics and public hospitals. Today 340B includes two\u2010thirds of all nonprofit hospitals in the United States and accounts for more than $80 billion in discounted drug purchases. Statutory language authorizing 340B is sparse, and attempts to strengthen or cut the program have been stymied by lack of clarity on Congress's original intentions. The object of this study was to clarify Congress's original intentions for 340B.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Our qualitative analysis was informed by the collection and analysis of two sources: (1) 175 internal primary source documents and (2) 19 structured interviews conducted with 18 key informants with respect to the creation of 340B.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Congress had two intentions in establishing 340B in 1992. The first was to address an unintended consequence of the Medicaid Drug Rebate Program (MDRP), which raised costs on safety\u2010net clinics that received significant discounts on drugs prior to the rebate program. Such core safety\u2010net clinics operate on fixed budgets heavily dependent on federal grants, which also require them to provide free and discounted care to patients regardless of their ability to pay. The purpose of 340B was to exempt these clinics from the best price provision of the MDRP. The second was to establish minimum discounts for drug prices for core safety\u2010net providers. While public hospitals were added because of their safety\u2010net mission, the disproportionate share hospital eligibility criterion were included to qualify two specific hospitals to secure bipartisan support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Congress's original intention for 340B was to enable core safety\u2010net providers to continue to provide drugs to patients regardless of costs in the face of historic drug price increases set off by the MDRP. The current scope of the program exceeds Congress's original intent.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1468-0009.70090","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T07:30:03Z","timestamp":1779262203000},"page":"654-688","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Stretching Scarce Authorizing Legislation as Far as Possible: A Legislative History of the 340B Drug Pricing Program"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0334-0743","authenticated-orcid":false,"given":"SAYEH","family":"NIKPAY","sequence":"first","affiliation":[{"name":"University of Minnesota School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MIKAYLA","family":"REINKE","sequence":"additional","affiliation":[{"name":"University of Minnesota School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"NICOLE","family":"QUINONES","sequence":"additional","affiliation":[{"name":"University of Minnesota School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"e_1_2_4_2_1","unstructured":"Oversight of 340B Drug Pricing Program: Hearing Before the Subcommittee on Oversight and Investigations of the House Committee on Energy and Commerce 118th Cong 2nd Sess;2024. Accessed April 16 2026.https:\/\/www.congress.gov\/index.php\/event\/118th\u2010congress\/house\u2010event\/117390"},{"key":"e_1_2_4_3_1","unstructured":"Oversight of 340B Drug Pricing Program: Hearing Before the Subcommittee on Oversight and Investigations of the House Committee on Energy and Commerce 118th Cong 2nd Sess; 2024 (opening remarks of Ranking Member Castor). Accessed April 16 2026.https:\/\/democrats\u2010energycommerce.house.gov\/sites\/evo\u2010subsites\/democrats\u2010energycommerce.house.gov\/files\/evo\u2010media\u2010document\/OpeningStatement_Castor_OI_2024.06.04_0.pdf"},{"key":"e_1_2_4_4_1","unstructured":"Oversight of 340B Drug Pricing Program: Hearing Before the Subcommittee on Oversight and Investigations of the House Committee on Energy and Commerce 118th Cong 2nd Sess; 2024 (opening remarks of Committee Co\u2010Chair Rodgers). 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