We’re sounding the alarm on HB 1473, a North Dakota bill that claims to protect the 340B Drug Pricing Program but instead prioritizes hospital profits over vulnerable patients, especially in rural communities. Here’s why lawmakers should vote NO and demand real reform.

The 340B Program: Meant to Help, Failing Rural North Dakota

The 340B Drug Pricing Program was designed to provide discounted medications to rural and underserved hospitals, ensuring vulnerable patients get the care they need. But in North Dakota, that promise is falling apart. Large hospital corporations and out-of-state pharmacy chains are siphoning benefits, leaving rural patients behind.

• Out-of-State Profits: A staggering 67% of North Dakota’s largest 340B hospitals’ contract pharmacies are located outside the state—some as far as Hawaii and New York. That’s money meant for North Dakotans flowing elsewhere.
• Misplaced Priorities: 70% of 340B pharmacies serving “low-income” patients are in affluent neighborhoods, not rural communities struggling with access.
• Low Charity Care: North Dakota’s 340B hospitals offer charity care at just 0.87%, far below the national average of 2.28%.

North Dakota prides itself on resisting chain pharmacies, yet the 340B program is quietly feeding national chains through out-of-state networks. Meanwhile, residents face an average $1,551 in medical debt per person, with $490 in collections, according to the Consumer Financial Protection Bureau. Much of this burden likely ties back to 340B facilities.

How HB 1473 Makes Healthcare Costs Worse

HB 1473 doesn’t fix these problems—it locks them into law. Here’s how it fails North Dakota patients:

• No Rural Investment: The bill doesn’t require hospitals to use 340B savings to expand rural healthcare access—like clinics or patient transportation. Out-of-state pharmacy partnerships will continue unchecked.
• Higher Costs for Patients: A 2025 IQVIA analysis found the current 340B program hikes insured North Dakotans’ costs by $231 per person annually. HB 1473 would add $59 more per beneficiary.
• Taxpayer Burden: It strips North Dakota of $4.3 million in drug rebates each year—money taxpayers can’t afford to lose.

Families, farmers, and small businesses already stretched thin will bear these costs, all while hospitals enjoy tax-exempt status.

North Dakota Deserves Better: A Patient-First Approach

At Patients Rising, we’re not against the 340B program—we’re for making it work for patients. North Dakota lawmakers can reject HB 1473 and push for reforms that prioritize transparency and rural care:

• Demand Transparency: North Dakota ranks near the bottom—scoring 2 out of 10 in the Cicero Institute’s hospital accountability evaluation. Patients deserve to know how much hospitals profit from 340B and how much reaches rural communities.
• Invest in Rural Healthcare: Redirect ALL 340B funds to local solutions—think rural clinics, transportation, or patient rebates.
• Empower Patients: Let patients know if they’re getting a 340B drug and what it costs the hospital. Transparency builds trust.

Say NO to HB 1473—Put Patients Over Profits

North Dakota stands for fairness and common sense. That should include a 340B program that serves patients, not out-of-state corporations or hospital bottom lines. Lawmakers must vote NO on HB 1473 and champion reforms that tackle rural healthcare costs, boost transparency, and hold 340B hospitals accountable.

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