U.S. Senator Tommy Tuberville (R-AL) questioned experts during a Senate Health, Education, Labor & Pensions (HELP) Committee hearing about the 340B drug pricing program and its impact on Alabama hospitals. Tuberville highlighted the significance of the 340B program for many hospitals in his state, particularly those serving uninsured patients.
Tuberville stated, “The 340[B] Program is [one of] the only—and I repeat only—source of income for America’s hospitals that isn’t taxpayer funded. Taxpayers are carrying the whole load other than this here. We should be expanding this, not reforming it. I’ve got a hospital, East Alabama [Medical Center], in Opelika, Alabama that shared with me that in 2025, they provided almost $100 million dollars in uninsured care. Majority of that was [for] illegals. During the same period, they received $70 million in 340B savings. In the past years, 340B revenue does not cover the loss from uncompensated care. Additionally, there is pressure to expand healthcare services all over my state. We’re dropping beds. We are sinking. Thank goodness, we’ve got the $50 billion coming for rural health care from the One Big Beautiful Bill. East Alabama [Medical Center], along with many hospitals, know that the 340B program is working as intended to help offset uninsured losses. The 340B program established a clear and fair expectation that pharmaceutical manufacturers want their drugs covered by Medicare and Medicaid.”
He then asked Michelle Rosenberg, Director of Health Care at the U.S. Government Accountability Office (GAO), whether reforms to 340B could undermine hospitals’ ability to provide for uninsured patients.
Rosenberg responded: “Thank you for the question. I would note [that] the statute doesn’t specify what the purpose of the program is. What individuals have relied on is something in House report language for a bill that was similar to that implemented 340B program, which was to enable covered entities to stretch scarce federal resources, to reach more eligible patients and provide more comprehensive services.
So, it would seem that if that’s the intent, then the 340B program is allowing entities to do that.”
Tuberville further questioned what non-taxpayer-funded discounts or assistance at-risk hospitals receive.
Rosenberg said: “I don’t have full knowledge of all of those programs, but there’s none that I’m aware of.”
Citing financial struggles faced by rural hospitals in Alabama—where he noted “83% of rural hospitals in my state operate at a loss”—Tuberville urged caution against reforms targeting facilities already struggling financially.
He asked Rosenberg what meaningful reform might look like for states with rural and poor populations relying heavily on 340B discounts.
Rosenberg replied: “So, our recommendations really focuses on HRSA’s oversight of the program, and so that’s making sure that the entities that participate are eligible to participate and making sure that they follow program requirements. So, don’t divert drugs to individuals who aren’t patients of the entity and also don’t create duplicate discounts in which manufacturers are required to pay both a rebate under the Medicaid Rebate Program and the discounted 340B price.”
Turning to Dr. Aditi Sen from the Congressional Budget Office (CBO), Tuberville sought ways community health centers could ensure their use of savings directly benefits patients rather than being redirected elsewhere.
Sen answered: “Thank you for that question. So, at the Congressional Budget Office, we would not recommend specific policy approaches. But I will say that for our work, better data on how covered entities are using 340B revenues could inform that policy discussion.”
Asked about wasteful or fraudulent use within hospital participation in 340B programs, Sen said: “To date, we do not have the data to be able to track how 340B entities are using 340B revenues generated by their program. In general, [those] revenues enter the covered entities of general revenue pot, and we can’t see exactly how they’re using them.”
Dr. William Feldman from UCLA also told Tuberville he had not seen any fraudulent use: “I have not, Senator.”
Senator Tuberville concluded by thanking witnesses and committee members.
