As someone who leads a community cancer center and works with hematology and oncology practices nationwide, I see firsthand how fragile access to care can be outside major metropolitan areas. In rural Mississippi, hospitals and physician practices are not just healthcare providers; they are lifelines. When these facilities close or are absorbed by distant health systems, patients lose access to timely cancer care, trusted relationships and in many cases, their only realistic option for treatment closer to home.
That’s why the conversation around reforming the federal 340B Drug Pricing Program matters for rural communities. It’s also why I am asking Congress to support the Health Resources and Services Administration’s 340B Rebate Model Pilot Program.
A Federal Program That Has Lost Its Way
Congress established the 340B program in 1992 to ensure that low-income, uninsured, and rural patients have access to affordable medicines. With 15.8% of rural Mississippians lacking health insurance, it is more important than ever that 340B savings are directed toward lowering costs and expanding access for the patients the program was created to serve.
Unfortunately, decades of limited transparency and accountability have allowed the program to stray far from that original purpose.
Today, large urban health systems generate significant revenue through 340B with little public accounting of how those funds are used or whether they are helping the patients and communities the program was designed to support. That imbalance has real consequences. When major health systems can leverage 340B profits at scale, smaller providers cannot compete.
This dynamic has contributed to hospital consolidation and the closure of less profitable services at rural hospitals. The strain on Mississippi’s healthcare infrastructure is growing, with a recent report finding that 54% of the state’s rural hospitals are at risk of closure. As consolidation accelerates, Mississippi’s patients in rural areas are forced to travel farther for treatment, endure longer wait times or delay lifesaving care altogether.
For cancer patients, those delays can be devastating.
The lack of transparency in 340B has rewarded scale over need and put rural healthcare at risk. That is why HRSA’s 340B rebate pilot represents such an important step forward.
A Better Way to Track 340B Savings
By shifting toward a rebate-based model, the pilot introduces claims-level visibility that simply doesn’t exist in the current system. That visibility matters. It creates the ability to track where 340B dollars are going, who they are benefiting, and whether they’re being used in ways that align with the program’s intent.
Just as importantly, a rebate model helps ensure that 340B funding is not disproportionately captured by large, well-resourced health systems, but that it is directed toward the providers and patients the program is intended to support. When transparency is built into the structure, it becomes far more difficult for major systems to profit off dollars intended to support rural hospitals and community-based providers.
The rebate pilot would allow HRSA to test a more transparent model while ensuring that providers who serve vulnerable patients can continue doing so. It’s a measured, responsible approach to oversight that will strengthen the 340B program by grounding future decisions in data and evidence.
Ensuring 340B Savings Reach Mississippi Patients
The success of the 340B program should ultimately be measured by one question: Are the savings reaching the Mississippi patients it was designed to help? A 340B rebate model pilot program would create a clear connection between program savings and patient benefits. When 340B resources are directed toward reducing out-of-pocket costs, expanding access to medications, and supporting services for low-income, rural and medically vulnerable populations, Mississippi patients are more likely to receive the affordable care they need. For these patients who already face significant financial and geographic barriers to treatment, ensuring that 340B savings are used to lower costs and improve access can make a meaningful difference.
Let your representative and senators in Congress know about the need for the 340B Rebate Model Pilot Program and encourage them to use the information it uncovers to inform meaningful, patient-focused 340B reforms. The future of Mississippi’s rural practices and patients depends on it.
This MFP Voices opinion essay reflects the personal opinion of its author(s). The column does not necessarily represent the views of the Mississippi Free Press, its staff or board members. To submit an opinion for the MFP Voices section, send up to 1,200 words and sources fact-checking the included information to voices@mississippifreepress.org. We welcome a wide variety of viewpoints.
Mississippi Free Press stories are always free because we believe everyone should have access to quality journalism. Donations from readers like you make that possible. Please click here to give to help sustain and grow vital, people-over-power journalism for Mississippians.
Readers can sign up for our free newsletters here.
