Six senators have introduced sweeping 340B reform legislation, just two days after the Health Resources and Services Administration revived its rebate model pilot program. The introduction also adds a Senate counterpart to a House bill introduced a month earlier, giving Congress three active 340B proposals to weigh at once. Here’s what to know about the SUSTAIN 340B Act and the broader legislative landscape.
The SUSTAIN 340B Act
Sens. Jerry Moran, R-Kan., Tammy Baldwin, D-Wis., Shelley Moore Capito, R-W.Va., Tim Kaine, D-Va., John Boozman, R-Ark., and John Hickenlooper, D-Colo. — members of the Senate 340B Bipartisan Working Group — introduced the Supporting Underserved and Strengthening Transparency, Accountability, and Integrity Now and for the Future of 340B Act, or SUSTAIN 340B Act, on Aug. 5. The bill would make several structural changes to the program:
- It would let covered entities use wholly owned pharmacies alongside contract pharmacies, while requiring entities to cancel contracts with pharmacies that haven’t dispensed 340B drugs to patients in the prior 12 months, with exceptions for ownership changes or service area shifts.
- It would establish a new statutory definition of “patient,” tying eligibility to an outpatient health care service received from the covered entity within the preceding two years, a documented provider relationship and a prescription resulting from that service.
- It would sunset HHS’ 340B Rebate Model Pilot Program one year after enactment and replace it with a third-party data clearinghouse under a new Social Security Act section, funded by covered entity user fees beginning in fiscal year 2031.
- It would create a nondiscrimination provision barring group health plans, insurers and pharmacy benefit managers from reimbursing 340B covered entities or contract pharmacies differently than other providers, or from interfering with a patient’s choice to use a 340B pharmacy.
- It would require covered entities to report annual program-savings data, including how discounts are used to benefit patients, and would apply new audit authority to both covered entities and manufacturers.
In an Aug. 5 statement, the American Hospital Association said it appreciates the leadership of the Senate 340B Bipartisan Working Group, with Aimee Kuhlman, the association’s group vice president of advocacy and grassroots, adding that AHA looks forward to reviewing the bill in detail and working with lawmakers to keep the program strong for patients, communities and providers.
The University of Arkansas for Medical Sciences applauded the bill, with Chief Pharmacy Officer Brian Jolly, PharmD, thanking Sen. Boozman and the bipartisan coalition for advancing what he called meaningful legislation to improve the program, according to an Aug. 6 news release.
The National Association of Counties, which represents county governments that own many of the hospitals and health systems relying on 340B savings, backed the bill’s rebate-model provisions as well, citing an independent analysis that found a shift to a rebate-based model would force the average disproportionate share hospital to front more than $72 million a year to drug manufacturers while awaiting reimbursement, according to an Aug. 7 statement.
Advocates for Community Health, a membership organization for federally qualified health centers, said legislation to bring clarity, transparency and accountability to the program is urgently needed, particularly given HRSA’s move to advance its rebate model pilot, according to an Aug. 5 news release. The group said it supports the bill’s recognition of contract pharmacies’ role in patient access and its preservation of upfront discounts over a rebate approach.
A crowded legislative field
The SUSTAIN 340B Act arrives alongside several other 340B proposals now circulating in Congress:
- 340B ACCESS Act — Reps. Buddy Carter, R-Ga., and Diana Harshbarger, R-Tenn., introduced the 340B Affording Care for Communities and Ensuring a Strong Safety-Net Act, or 340B ACCESS Act, in September 2025, one day after the Congressional Budget Office released a report finding the program costs taxpayers without clear evidence patients benefit. The bill would add patient affordability requirements tying 340B discounts to lower out-of-pocket costs, codify a statutory patient definition, set new hospital and child site eligibility standards, and restrict pharmacy benefit managers and other third-party administrators from profiting off the program.
- SECURE 340B Act (H.R. 9599) — Reps. Scott Peters, D-Calif., and John Joyce, R-Pa., introduced this House bill July 6, calling it the first comprehensive, bipartisan proposal to modernize the 340B program since its 1992 creation. Co-sponsors include Reps. Jake Auchincloss, D-Mass., Dan Crenshaw, R-Texas, and Nanette Barragán, D-Calif. The bill would pause manufacturer rebates for several years, establish a new patient definition and create contract pharmacy standards.
- 340B Drug Pricing Integrity and Affordability for Patients Act — Then-Senate Health, Education, Labor and Pensions Committee Chairman Bill Cassidy, R-La., released a discussion draft June 25, framed as the first proposed statutory update to the program in fifteen years. It would let manufacturers choose among discounts, rebates or a claims-repository model, and remains open for stakeholder comment through Aug. 28.
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