An October report from Berkeley Research Group estimates how much patients and payers spend on 340B drugs, beyond what covered entities pay to acquire them.
Here are six findings to know:
- Patients and payers spent an estimated $244.3 billion in 2025 on drugs purchased through the 340B program, more than double the $108.4 billion spent in 2021.
- That figure far exceeds HRSA’s reported 340B sales total of $100 billion for 2025 because HRSA’s number reflects what covered entities paid to acquire the drugs at the discounted 340B price, not what patients and payers were later charged for them.
- BRG calculates the gap between acquisition cost and reimbursement, which it calls “340B drug margin,” at $142.2 billion in 2025, more than double the $63.6 billion margin in 2021.
- Private and commercial insurers covered the largest share of that margin (63%), followed by Medicare (25%) and Medicaid managed care plans (7%). Medicaid fee-for-service generates no margin because it reimburses covered entities at acquisition cost.
- As a share of the overall U.S. pharmaceutical market, 340B prescriptions now account for 27% of net spending, up from about 18% in 2021. BRG attributed the program’s growth mainly to hospitals acquiring off-site clinics, expanded hospital participation following the Affordable Care Act and growing use of contract pharmacies, which now number roughly 35,000 nationally, up from about 1,300 in 2010.
- The findings add to a broader, ongoing body of research tracking the program’s growth: a separate CBO analysis found 340B spending rose 565% between 2010 and 2021, concentrated heavily in cancer drugs.
