A federal drug program worth $81 billion was built to help patients like you. Here's what the data says — and why the answer matters right now.

If you are a patient managing a serious illness in Illinois — cancer, diabetes, a rare disease, a chronic condition that requires specialty medications — there is a federal program that was specifically designed to help you. It is called the 340B prescription drug program. And there is a significant chance you have never heard of it, even though billions of dollars flow through it every year in your name.

That is a problem. And it is one Illinois patients need to understand.

What Is the 340B Program?

Congress created the 340B program in 1992 with a clear and worthy purpose: allow safety-net hospitals and federally qualified health centers to purchase outpatient medications at steep discounts — sometimes 25 to 50 percent below market price — and use those savings to help uninsured and underinsured patients access the care they need.

The logic was simple. Help the hospitals serving the most vulnerable patients stretch their resources further. Pass the savings on to the people who need them most.

What Congress did not do was require anyone to prove it was actually happening.

There are no federal rules mandating how the savings must be used. No consistent reporting requirements. No benchmarks for how much of the program's revenue must reach patients in need. The program was built on good intentions — and then left to operate largely in the dark.

How Big Has It Gotten?

The scale of 340B today would be almost unrecognizable to the legislators who created it. In 2010, following the passage of the Affordable Care Act, the program processed approximately $6.6 billion in discounted drug purchases. By 2024 that number had grown to $81.4 billion.

Today 340B includes thousands of hospitals, their satellite facilities, and for-profit contract pharmacies — many of them operating far from the underserved communities the program was designed to serve.

What Is Happening in Illinois?

The data on Illinois's 340B program raises questions that patients — and policymakers — deserve to have answered.

Illinois 340B hospitals now earn roughly 2.7 times more in program profits than they spend on charity care. Statewide, these hospitals provide charity care at just 1.74% of their costs — below the national average. Nearly 69% of Illinois 340B hospitals fall short on charity care benchmarks compared to hospitals not participating in the program at all.

Read that again: the hospitals benefiting most from a program designed for vulnerable patients are providing less charity care than hospitals not even in the program.

The University of Chicago Medical Center — one of the wealthiest hospital systems in the state — generates an estimated $208 million annually in 340B program profits. It operates in Hyde Park, a neighborhood bordered by Woodlawn and Englewood — two of the most medically underserved communities in Illinois, home to residents who were exactly the people this program was built to serve.

Illinois 340B hospitals maintain thousands of contract pharmacy agreements that route program activity — and the profits that come with it — to locations in Palm Beach, Hawaii, California, and Washington. Meanwhile, rural Illinois patients are still driving hours to reach a specialist. Patients on Chicago's South and West Sides are navigating healthcare deserts created in part by the consolidation of the very hospital systems profiting from 340B.

There are documented cases in which hospitals purchased critical medications through 340B at heavily discounted prices — sometimes as low as $3,400 — and billed insurers at dramatically higher rates — sometimes exceeding $25,000 — with no requirement that any portion of the profit return to patient care.

What Does This Cost Illinois Patients and Families?

Research suggests that 340B hospitals charge higher prices for outpatient care overall and have financial incentives to prescribe more expensive medications. These dynamics drive up costs for everyone — through higher insurance premiums, increased employer health expenses, and greater out-of-pocket burdens on patients.

Illinois businesses already absorb an estimated $224 million annually in costs tied to the 340B program. Those costs do not stay with employers — they flow downstream to patients through higher premiums and reduced coverage options.

What Is HB 2371?

The Illinois General Assembly is currently considering House Bill 2371 — the Patient Access to Pharmacy Protection Act. The bill would prohibit pharmaceutical manufacturers from restricting how 340B hospitals and clinics use contract pharmacies or manage certain program data.

Supporters argue the bill protects patient access to medications by preventing manufacturer restrictions on the 340B program. The Illinois Hospital Association and healthcare providers have been active advocates for its passage.

Critics — including employer groups and patient accountability advocates — raise a different concern: the bill extends new protections to 340B hospitals and clinics without adding any new requirements for how program savings are used, without establishing charity care benchmarks, and without mandating public reporting on whether program revenue is reaching the patients it was designed to serve. Employer groups warn the bill could add an estimated $89 million in new annual costs to Illinois families and businesses.

The debate comes down to a fundamental question: should a program that operates with this level of opacity receive expanded legal protections before it is required to demonstrate it is working for patients?

What Are Other States Doing?

Minnesota offers a cautionary example. The state recently passed legislation requiring hospitals to publicly report how much revenue they generate from the 340B program. The results were revealing: participating Minnesota hospitals earned $1.3 billion from the program in a single year. Even with that reporting in place, there is still no clear accounting of how much of that revenue reached uninsured or underinsured patients in need.

Minnesota's experience illustrates both what transparency can reveal — and how much more accountability is still needed.

What Do Patients Deserve?

At Patients Rising, we believe in the 340B program's mission. We believe safety-net providers need resources to serve the most vulnerable patients. We believe access to affordable medications is not a luxury — it is a necessity for millions of Americans managing serious illness.

And we believe patients deserve to know that a program operating in their name is actually reaching them.

That means mandatory public reporting on how 340B revenue is spent on patient care. It means charity care benchmarks tied to program participation. It means transparency about where contract pharmacy profits are going — and whether any of it is coming back to the communities that need it most.

Whether you are a cancer patient in rural Streator, a family navigating a chronic illness on Chicago's South Side, or an employer trying to provide affordable coverage for your workforce — the 340B program's accountability gap affects you.

340B is profitable for hospitals and other covered entities because patients have prescriptions. They deserve to know it is working for them.

Patients Rising is a national patient advocacy organization working to ensure patients and caregivers are informed, empowered, and influential voices in healthcare. We educate, organize, and advocate for policies that expand access, strengthen affordability, encourage innovation, and put patients back at the center of healthcare decision-making.