A new Senate bill would overhaul the 340B drug discount program, as the chair of the Senate health committee moves to rein in a scheme that has become highly lucrative for nonprofit hospitals. Sen. Bill Cassidy (R-La.) introduced the measure, which adopts many of the changes long sought by the pharmaceutical industry and is likely to trigger fierce lobbying on all sides.

What the 340B reform bill would change

The legislation targets both how hospitals capture 340B savings and whether those savings actually reach patients. Its core provisions would reshape a program that critics say has drifted far from its original purpose.

  • Allow drugmakers to give hospitals retroactive rebates instead of the upfront discounts hospitals prefer
  • Let hospitals demand discounts only if they pass the savings on to patients
  • Require hospitals to establish a sliding-fee scale for prescription drugs
  • Place new restrictions on the contract pharmacies hospitals use to administer the discounts

The 340B program lets eligible hospitals buy outpatient drugs at steeply reduced prices. Over time it has become a major revenue source for many nonprofit health systems, which is exactly why any proposed change draws intense pushback from hospitals on one side and drugmakers on the other. The shift from upfront discounts to rebates, in particular, would hand manufacturers far more control over the cash flow. For ongoing coverage of drug-pricing policy, see our business section.

A new name in the FDA commissioner race

Separately, Jeff Vacirca, a physician and leader of a prominent New York oncology group, is among the final candidates the Trump administration is considering to lead the FDA, according to Bloomberg News. The choice would put a practising cancer specialist atop the agency.

Vacirca holds a medical degree from St. George's University and has served as chief executive and chairman of New York Cancer & Blood Specialists since 2008. He co-founded and sits on the board of OneOncology, a network of independent cancer-care and urology practices, and is a board member of Caris Life Sciences. He supported Robert F. Kennedy Jr. for health secretary after President Trump was elected to a second term in 2024.

If selected, Vacirca would step into one of the most consequential health roles in Washington, overseeing the agency that approves drugs and regulates much of the pharmaceutical industry. His background running a large independent oncology practice and helping build OneOncology gives him both a clinician's and an operator's view of the cancer-care system the FDA touches every day.

Why these drug-policy moves matter

Both stories sit at the intersection of medicine, money and policy, and each could shape how drugs are priced and approved for years to come. A 340B overhaul would redirect billions of dollars between hospitals, drugmakers and patients, while the next FDA commissioner will set the tone for approvals, safety standards and how aggressively the agency polices the industry. Together they signal a period of significant change for how Americans access and pay for medicines. For more, follow our health news coverage.

340B and FDA news: key questions

What is the 340B program?

It is a federal program that lets eligible hospitals buy outpatient drugs at sharply reduced prices. It has become a large revenue source for many nonprofit health systems, which is why proposed changes are so contentious.

What would the Senate bill change?

Sen. Bill Cassidy's bill would let drugmakers offer retroactive rebates instead of upfront discounts, require hospitals to pass savings to patients and adopt a sliding-fee scale, and restrict the contract pharmacies hospitals use.