COA pushes Congress to tighten 340B reform for cancer patients

The Community Oncology Alliance submitted comments to Sen. Bill Cassidy on a 340B reform discussion draft, backing key transparency and accountability changes while urging lawmakers to make discounts directly benefit patients. COA says the final bill should curb middlemen, limit hospital consolidation, and keep cancer care affordable and close to home.

Why it matters: - The 340B drug pricing program now touches a much larger share of U.S. drug spending, and COA argues the current structure can steer cancer care toward higher-cost hospital settings instead of helping vulnerable patients directly. - Community oncology says meaningful reform could lower patient costs, preserve local competition, and reduce incentives for hospital acquisitions of independent practices.

What happened: - The Community Oncology Alliance submitted comments to Senate Health, Education, Labor, and Pensions Committee Chairman Bill Cassidy, MD, on the 340B Drug Pricing Integrity and Affordability for Patients Act discussion draft. - COA called the proposal a serious foundation for reform, but said Congress should strengthen it so 340B delivers direct, measurable benefits to patients. - COA released its comments on Aug. 19, 2026. - The organization also linked to the full comment letter.

The details: - COA supports patient-affordability requirements, public reporting of drug margins, stronger standards for hospital child sites, direct accountability for contract pharmacies, limits on percentage-based middleman compensation, stronger enforcement, and more oversight of the Prime Vendor Program. - COA says transparency alone will not ensure that patients receive the value of 340B discounts. - Ted Okon, COA’s executive director, said 340B reform should be judged by whether the discount follows the patient, lowers costs, and preserves affordable cancer care in the community. - COA says Congress should not extend 340B eligibility to independent community oncology practices. - The organization wants the program refocused on eligible patients and genuine safety-net providers while preserving reimbursement for the clinical, operational, inventory, and financial risks of furnishing cancer treatment. - COA’s eight recommendations call for making the discount follow the patient and ensuring low-income and medically vulnerable patients, including Medicare beneficiaries, get a direct benefit tied to the actual 340B discount. - COA wants patient eligibility defined for each prescription or drug order through a contemporaneous, clinically relevant relationship, rather than a years-old encounter or referral. - COA urges comprehensive transparency, including reporting gross 340B spread, itemized expenses, net margin, patient savings, charity care, and related data, with streamlined reporting for small, low-volume, mission-based providers. - COA supports the bill’s shortage-area, charity-care, Medicaid, ownership, and provider-based child-site requirements, while applying absolute safety-net thresholds separately to each location. - COA wants contract pharmacies limited to demonstrated patient-access needs, with periodic review of whether each arrangement improves access. - COA says PBM-owned mail-order pharmacies should be excluded from serving as 340B contract pharmacies. - COA recommends a single federal claims process and authoritative data standards instead of manufacturer-specific portals, duplicative audits, and conflicting vendor rules. - COA wants hospital eligibility tied to meaningful, auditable outpatient safety-net performance. - COA says remaining revenue, after the direct patient benefit, should be limited to documented services for low-income, uninsured, and medically vulnerable patients. - COA also wants reduced consolidation treated as an outcome measure, including whether reform reduces hospital acquisition of independent community oncology practices and shifts of care into higher-cost hospital outpatient settings. - COA said hospital 340B margins can combine with higher site-of-service payments to encourage those acquisitions and shifts in care. - HRSA reported 340B drug purchases reached $100 billion in 2025, more than 50% above 2023, with disproportionate share hospitals accounting for nearly four-fifths of the total. - The number of 340B contract pharmacy locations grew from 789 in 2009 to 25,775 in 2022. - The Federal Trade Commission reports that pharmacies affiliated with the three largest PBMs now account for nearly 70% of specialty drug revenue. - COA thanked Chairman Cassidy and the committee and said it wants to keep working on durable reform that reduces costs and keeps cancer care close to home.

Between the lines: - COA is not just arguing for more disclosure; it is trying to redirect the program toward direct patient relief and away from institutional capture. - The group’s emphasis on site-of-service payment and hospital acquisition suggests the real fight is over where patients receive care and who captures the margin. - The comments frame 340B as a competition and consolidation issue as much as a drug-pricing issue.

What's next: - Congress will continue weighing changes to the 340B program as lawmakers assess whether the draft protects patients, limits middlemen, and restrains incentives to move cancer care into more expensive settings. - COA said it is prepared to keep working with Congress on final legislation.