National Grange urges reform of 340B drug discount program to protect rural providers
On Oct. 5, 2026 RealClearHealth published an interview in which editor Jerry Rogers spoke with Christine Hamp, president of the National Grange, about the organization’s new campaign to reform the federal 340B drug discount program.
Hamp said the Grange believes large hospitals are using 340B discounts to generate substantial revenue while rural health providers—who the program was designed to help—see little benefit. She explained that the group is taking a leading role in health policy to protect rural communities from what it calls “profit‑driven misuse” of the subsidy.
The 340B program allows qualifying hospitals and other providers to purchase outpatient drugs at deep discounts and then bill insurers at regular rates, keeping the difference. In 2024, discounted purchases under the program reached roughly $81 billion, according to industry data. Critics argue that without mandatory reporting, hospitals can retain the revenue without demonstrable savings for patients.
National Grange leaders point to studies showing that large health systems generate the bulk of net 340B revenue. A Minnesota transparency report found participating providers earned about $630 million in net revenue, with most of the earnings flowing to large hospitals rather than traditional safety‑net providers.
Hamp highlighted that the current rules permit hospitals to claim 340B discounts for patients who are well‑insured and affluent, diluting the program’s original goal of aiding low‑income and uninsured patients. She called for tighter definitions of eligible patients and stricter oversight of “child sites” and contract pharmacies, which often operate in wealthy neighborhoods far from the hospitals that qualify them.
The Grange’s policy push includes a demand that hospitals disclose annual data on drug acquisition costs, reimbursements, net revenue, and how any savings are used for charity care or patient discounts. Hamp said the organization will lobby Congress to require such transparency and to ensure a meaningful portion of 340B savings is passed directly to low‑income patients.
Congressional reform, according to the Grange, would return the program to its intended purpose—supporting safety‑net providers that serve vulnerable populations—while preventing large health systems from profiting at the expense of rural health infrastructure.
Hamp concluded that the National Grange will continue to press for legislative changes and look to state-level transparency efforts as models for a national solution.
