RiverView Health, a critical access hospital in Crookston, Minnesota, relies heavily on the federal 340B Drug Pricing Program, which allows qualifying hospitals to purchase certain outpatient medications at discounts and reinvest the savings into patient care. For rural communities like Crookston, a community of about 7,500 people, the program is essential to maintaining emergency care, pharmacy services, behavioral health, and treatment for uninsured and publicly insured patients.
The financial pressure on rural hospitals in Minnesota is severe. Medicaid reimburses about 68 cents for every dollar it costs to deliver care. Forty-four percent of 340B hospitals in Minnesota are operating at a loss, and eighteen rural hospitals are at risk of closure. Nineteen Minnesota facilities have already lost obstetric services, representing the second-largest decline of any state in the country.
More than 20 multinational for-profit drug manufacturers have imposed restrictions that block hospitals like RiverView from accessing 340B discounts through contract pharmacies. For rural hospitals, these restrictions mean losing $500,000 or more every year—a loss that directly affects staffing and equipment. The drug manufacturers imposing these restrictions reported tens of billions of dollars in profits last year, yet they are attempting to reclaim discounts they previously agreed to provide as part of federal health care programs.
Minnesota passed a law in 2023 to protect 340B contract pharmacy access, and the Minnesota Court of Appeals upheld it in February. However, the law is set to expire in July 2027, and drug companies are using the courts to delay enforcement. Legislation before the state legislature would remove the sunset provision and make these protections permanent, while also giving the Attorney General enforcement tools. According to RiverView’s president and CEO, the 340B program requires no taxpayer dollars and was created by Congress specifically to help safety-net providers serve patients who have nowhere else to go.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.inforum.com/opinion/columns/guest-column-without-340b-my-hospital-faces-an-impossible-choice