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Opinion | Cancer patients like me need 340B drug-pricing reform that puts us first
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When I was diagnosed with metastatic breast cancer at 36, my world changed overnight. My focus shifted from my family and career to the terrifying question of whether I was going to live. Then, the next terrifying question: How will I pay for this?
Through my journey, I’ve seen the brutal financial reality of cancer up close. I’ve held the hand of a woman skipping a treatment she couldn’t afford and lain awake at night worried about paying for my own.
This struggle is why programs like the federal 340B Drug Pricing Program are so vital. Created in 1992, 340B was designed to help safety-net providers stretch scarce resources by purchasing outpatient drugs at significant discounts. The goal was simple: use those savings to help vulnerable patients afford lifesaving care.
But somewhere along the way, the system broke. The savings are too often getting lost in a complex web of entities, and patients are being left behind.
The burden falls directly on patients. Recently, in Michigan, hospitals were exposed for charging up to 800% more for some prescriptions, and depending on the hospital, patients could be paying up to 18 times more for the same drug.
As a patient advocate who has lived this, I see the problem clearly. The issue is a system that allows profiteering to flourish, whether it’s through hospital systems, clinics, pharmacy benefit managers (PBMs) or contract pharmacy arrangements. The result is the same: The discounts on drugs, intended for patients, are being diverted to pad bottom lines.
The data is staggering. The Congressional Budget Office reported that in 2023, 340B spending on cancer drugs alone was $18.1 billion. When that much money is flowing through the system with little transparency, the incentive is to maximize revenue, not benefit patients. This can lead to the consolidation of care, the steering of patients toward higher-cost drugs instead of drugs that will work best for them and a focus on profits over people.
And it’s not just me. Nearly half of all cancer patients report having medical debt from their treatment. We are forced to make impossible choices between our financial survival and our physical survival.
That is the heart of the matter. Michigan needs 340B reform that ensures no entity — not hospitals, not PBMs, not contract pharmacies — can misuse a program meant for patients. We need transparency to follow the discounts and guarantee they are used to lower costs for vulnerable people.
Michigan lawmakers have a chance to be leaders in this fight. They must reject proposals like House Bill 4878 that lack real accountability and guardrails.
Here’s the problem with H.B. 4878: It sounds good on the surface, but it doesn’t go far enough to protect patients like me.
The bill asks hospitals to report data on how they use 340B savings, but the reporting is too broad and too vague. It would allow hospitals to lump all their numbers together in a way that hides what’s really happening. We would not be able to tell if an individual hospital is using the program as intended or if the savings are actually helping patients afford their care.
What patients need is real transparency — the kind that lets us follow the money and see for ourselves whether the discounts meant for us are actually lowering our costs. H.B. 4878 does not do that. It also does nothing to stop hospitals, PBMs or contract pharmacies from profiting off a program designed for vulnerable patients.
If we can’t see where the savings are going, and if we can’t stop middlemen from taking a cut, then how do we know patients are the ones benefiting? The honest answer is: we don’t. And that’s not good enough.
Michigan patients need policies that demand the savings from 340B are used as intended: to directly help patients afford their care. Surviving cancer should lead to a future filled with hope, not a lifetime of debt. It’s time to fix 340B and put patients back at the center of this program, where we belong.
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