When Donald Trump promised to take on entrenched special interests in Washington, he wasn’t just talking about bureaucrats and lobbyists. He meant business—and that includes standing up to one of the most powerful industries in America: Big Pharma. 

Despite a coordinated pressure campaign, Trump’s administration continues to support the federal 340B Drug Pricing Program, a critical tool for hospitals that serve low-income and rural communities.

What Is the 340B Program—and Why Does It Matter?

Enacted in 1992, the 340B program requires pharmaceutical companies to provide discounted medications to qualifying hospitals and clinics. It’s not funded by taxpayers—drugmakers foot the bill. And for many rural hospitals across the country, those discounts are the difference between staying open or closing their doors.

Without the 340B program, smaller healthcare providers—many already operating on razor-thin budgets—wouldn’t be able to afford life-saving medications for their patients. And if those hospitals go under, families in the rural part of the country would be left with few, if any, local options. It’s not just about inconvenience. In emergency situations, travel delays can mean the difference between life and death.

Big Pharma’s Legal Assault—and a Win in the Supreme Court

Major drug companies like Novartis, Eli Lilly, and Bristol Myers Squibb have tried to gut 340B through the courts. Their argument? That these aren’t “discounts” required by law but rather voluntary “rebates” they can choose to deny. That’s a pretty slick way of trying to skirt the law and protect their bottom lines.

But states aren’t backing down. Arkansas passed legislation to protect the 340B program at the state level—and Big Pharma sued. That case made it all the way to the U.S. Supreme Court, where the justices declined to hear it, effectively upholding Arkansas’s right to enforce its law. That’s a huge win for rural healthcare providers across the country.

Trump and RFK Jr.: A Surprisingly Effective Team on Pharma Reform

The Trump administration’s continued support for 340B isn’t happening in a vacuum. His alignment with HHS Secretary Robert F. Kennedy Jr. may raise eyebrows, but when it comes to holding pharmaceutical giants accountable, the partnership is working. Both men have made clear they won’t be bought—and that’s something rural America desperately needs.

Together, they’ve taken a hard line against a powerful industry that’s used to getting its way. Trump’s base expected this kind of fight, and to his credit, he’s delivering. RFK Jr., long a skeptic of Big Pharma’s influence, is helping lead the charge from inside the administration.

A Rare Case Where the System Sided With the People

For once, the system worked in favor of ordinary Americans. The Supreme Court’s decision to let Arkansas’s 340B law stand signals that state-level protections can hold firm—even against billion-dollar corporations.

This fight is far from over. Big Pharma still has deep pockets and a long list of allies. But for now, thanks to strong leadership and some much-needed backbone in Washington, the patients and hospitals that depend on 340B live to fight another day.

And in deep red, rural places across the country, that means a lot more than politics—it means lives saved.