The Minnesota Legislature adjourned its 2026 session late Sunday night without passing a bill to extend and expand the state's 340B Drug Pricing Program. After months of lobbying, a 42-24 Senate vote, and a high-profile public campaign, the legislation — SF 3769 in the Senate and HF 3609 in the House — died without ever reaching the House floor.

We're not popping champagne. But we are relieved.

Not because anyone "won" or "lost." Not because we're picking a side between hospital systems and drug manufacturers — patients shouldn't have to pick a side in a fight that was never really about them. We're relieved because the bill that died this weekend wasn't going to help the patients and communities 340B was created to serve. And in a legislative session where the alternative was a bad bill becoming law, no bill is the better outcome.

Now Minnesota lawmakers have a year to come back and do this right.

Why This Bill Was the Wrong Bill

The 340B Drug Pricing Program was created in 1992 with a specific purpose: to help safety-net providers stretch scarce resources so they could serve more low-income, uninsured, and underserved patients. Rural clinics. Community health centers. Hospitals in the communities with the least access to care. That was the mission.

Three decades later, Minnesota's own data shows how far the program has drifted from it.

Our analysis of the state's most recent 340B transparency report found that in 2024, Minnesota hospitals and clinics generated at least $1.34 billion in net 340B revenue in a single year. The state acknowledges the real figure is likely higher. But the more revealing finding wasn't the size of the program — it was where the money was going:

• Disproportionate Share Hospitals captured more than 80 percent of statewide 340B revenue, despite making up only 12 percent of participating entities.
• Federally Qualified Health Centers and other safety-net clinics — the providers most closely tied to the program's original purpose — generated less than 1 percent of statewide revenue.
• Just 25 hospital systems accounted for 90 percent of total revenue. One system alone reported more than $334 million.

The Minnesota bill would not have changed any of that. It would have entrenched it. The legislation focused on enforcement against drug manufacturers — making it easier to expand the existing revenue stream — without doing anything to redirect that revenue toward the patients and communities the program was built for. There was no requirement that hospitals report how much of their 340B revenue reduces patient costs. No requirement that they direct more of it to safety-net clinics. No requirement that they prove a single underserved patient is better off.

It was a bill about protecting a revenue model. It wasn't a bill about patients.

What This Looks Like for Real Patients

While Minnesota lawmakers debated how to grow and protect 340B revenue for hospitals, patients across the country were filing for bankruptcy with 340B hospitals listed as their largest creditors.

Our Medical Bankruptcy in America investigation reviewed more than 100 publicly available bankruptcy filings in Virginia. The patterns are unmistakable:

• In a striking number of filings, the dominant creditor was a single hospital system — with balances of more than $250,000, and in some cases over $300,000, owed to one institution.
• Many of those hospital systems are active 340B participants.
• In other cases, hospital debt had already been handed off to collection agencies before the patient ever reached bankruptcy court — adding fees, aggressive recovery tactics, and stripping away any path to resolution.

These are real people who walked into 340B-participating hospitals and walked out with debt large enough to collapse their finances. Whatever discounts those hospitals captured on their medications did not follow patients home in the form of lower bills, expanded charity care, or relief from collections.

That is the gap between what 340B was built to do and what it's actually doing. Passing a bill that grows hospital 340B revenue without addressing that gap would have made the gap worse, not better.

What a Patient-Centered 340B Bill Would Look Like

This isn't a question of whether 340B should exist. It absolutely should. The patients who need it most — people who are uninsured, underinsured, or living in communities with thin healthcare infrastructure — deserve the program working the way Congress originally intended.

That requires lawmakers to start asking questions they didn't ask this session:

• Where is the money going? If safety-net clinics generate less than 1 percent of statewide 340B revenue, what does it take to redirect more of it back to them?
• Are patients seeing the discounts? When a hospital buys a drug at a steep 340B discount and bills a patient full price, what mechanism — if any — passes that discount through?
• Why are 340B hospitals showing up as the dominant creditors in patient bankruptcies? And what reforms would change that?
• What does "patient benefit" mean — and why doesn't Minnesota's transparency law require hospitals to report it?

Minnesota lawmakers were sitting on the most detailed 340B transparency data in the country and still managed to spend an entire session on a bill that ignored almost all of it. The fact that the bill failed gives them a second chance.

What Comes Next

Minnesota's existing 340B law is scheduled to sunset next year. Lawmakers will have to revisit it. When they do, we will be pushing — alongside other patient advocates — for an entirely different conversation:

1. Outcome transparency, not just revenue transparency. Hospitals participating in 340B should report how the program affects patient costs, charity care, access in underserved areas, and the share of revenue actually flowing to communities the program was built to serve.
2. Restore the program's original mission. A program where 25 large hospital systems capture 90 percent of revenue while FQHCs and safety-net clinics get less than 1 percent is not functioning the way Congress designed it. State and federal reform should rebalance that.
3. Protect patients from being billed full price for discounted drugs. Patients walking into 340B hospitals should not be walking out into collections — and certainly not into bankruptcy court — over medications their providers received at deep discounts.

The bill that died on Sunday wouldn't have advanced any of these. That's why we're relieved.

If you've experienced medical debt, collections, or bankruptcy tied to a hospital visit, share your story. Lawmakers in Minnesota — and across the country — need to see the cost of getting 340B reform wrong. And they need to see what getting it right would actually look like.

The fight over 340B isn't over. It's just finally, hopefully, about to start being about patients.