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At Grady Memorial Hospital, where Atlanta’s poor and uninsured are welcomed, the pharmacy charges most patients $5 or less for outpatient medications that treat everything from diabetes to cancer.

To say the American healthcare system is complex is certainly an understatement. When even one healthcare program is not working, it affects us all. Seniors and lawmakers understand the importance of Medicare and work tirelessly to defend it, but we must also work to ensure that waste, fraud, and abuse have no place in the broader healthcare market. The 340B program is a prime example of a program that is being abused to the detriment of America’s seniors. And while the intentions of the program are good, the need for substantial reform is clear.

A Here we are in March 2017 and no one is sure where things stand with the 340B Drug Discount Program. HRSA and its oversight of the 340B program are subject to the recent Executive Orders restricting issuance of federal regulations and the promised repeal of the Affordable Care Act (ACA) has the potential to impact 340B operations. In fact, the only thing that appears certain for the 340B program is that nothing is certain. So let’s review several recent 340B developments, and potential developments to come.

Defenders of the 340B Drug Discount Program say it is vital to safety net hospitals and the patients they serve. On that, we agree wholeheartedly. The program was originally intended by Congress to provide assistance to those treating uninsured or underinsured patients so that this vulnerable population had access to medical treatment. However, inadequate oversight has distorted the noble intent of 340B, transforming it into a perverse profit generator for many of America’s tax-exempt hospitals, few of which provide any meaningful level of charity care.

President Donald Trump took an important step in the right direction when he recently met with pharmaceutical executives and expressed grave concern about high drug prices. Escalating prices, especially for life-saving cancer therapies, are a serious problem for patients that must be addressed.

The 340B Drug Pricing Program, designed to provide support for out-patient drug purchases, severely lacks federal oversight, said BRG Healthcare, the business advisory group, in a report sponsored by the Alliance for Integrity and Reform of 340B (AIR340B).

WASHINGTON, D.C. (December 6, 2016) – A new study released today by the Alliance for Integrity and Reform of 340B (AIR 340B) projects the 340B Drug Pricing Program will continue to expand at an unprecedented rate through 2021, by which time it is expected to exceed $23 billion in total purchases at the 340B price. This rapid expansion would see 340B purchases surpass current Medicare Part B drug reimbursement purchases over the next five years.

Given its name, you’d expect the federal 340B Drug Discount Program to save money for the American health system. When it comes to cancer, though, it’s actually a major driver increasing costs, according to a report from the Community Oncology Alliance.