Democrats will spend 2026 blaming Republicans for every healthcare complaint coming out of rural America. What they will not mention is that the party actually working to dismantle the program keeping rural hospitals stocked with cancer and HIV drugs is not a party at all. It is the pharmaceutical industry.
New data from HRSA, released July 13, shows ten drugs accounted for 28.6 percent of the record $100 billion spent through the 340B program in 2025, itself a 23 percent jump over the year before. Four of those ten are oncology drugs. Two treat HIV. Merck’s Keytruda alone accounted for $8.9 billion in 340B purchases. Gilead’s Biktarvy, the HIV therapy, was not far behind. Darzalex Faspro, Opdivo, and Imfinzi round out the oncology group, with Descovy as the second HIV drug in the top ten.
The 340B program requires manufacturers who want access to Medicare and Medicaid dollars to sell outpatient drugs at a discount to safety-net hospitals and rural clinics. It costs taxpayers nothing. Hospitals use the savings to keep clinics open and treat patients who could not otherwise afford cancer therapy or HIV medication at all. That the ten drugs eating up nearly a third of the program’s spending are dominated by cancer and HIV treatment is not an accident. Those are the categories where list prices have climbed the fastest, and where rural patients have the least room to absorb the difference.
Every one of these manufacturers belongs to PhRMA, the industry’s chief lobbying arm and the same group pushing to gut 340B through rebate schemes and reporting mandates designed to shift costs onto hospitals instead of the companies setting the prices. It is a fair fight to have. Hospitals are not blameless in this program, and PhRMA’s argument that some large systems use 340B margins to pad revenue rather than serve patients deserves a hearing. But the industry’s preferred fix does not touch list prices. It touches what hospitals get to keep after paying them.
PhRMA’s membership roster is worth remembering here. Purdue Pharma, the OxyContin maker whose marketing practices helped ignite the opioid crisis, was a proud member for years, listing PhRMA’s ethics code in its own compliance materials. PhRMA never expelled the company. Purdue quietly resigned on its own in October 2019, two months after filing for bankruptcy, in a move a PhRMA spokesperson said had nothing to do with the opioid crisis. Rural hospitals now use 340B savings, in part, to fund addiction treatment and recovery programs in the same regions Purdue’s product devastated. The industry that let Purdue keep its seat for years is now lobbying to defund the program helping clean up that mess, while its remaining members raise prices on the cancer and HIV drugs those same rural patients need.
President Trump’s first administration finalized the 340B ceiling price rule specifically to let HHS penalize manufacturers for overcharging the hospitals that serve his voters, after HHS delayed it five times under industry pressure. That enforcement mechanism is still doing its job. Last year, HRSA sanctioned Rhodes Pharmaceuticals, a Purdue subsidiary, for overcharging 340B providers and ordered it to repay them. In January, Trump signed an executive order launching the Great American Recovery Initiative, a coordinated federal push on addiction treatment and prevention. His own family’s experience with addiction is not a talking point. It is part of why this issue lands differently for him than for a typical Washington policymaker weighing a rebate formula.
None of this happens in isolation. The same trade groups now fighting to gut 340B pushed back hard on the MAHA Commission’s report questioning the industry’s influence over childhood healthcare, and biotech’s own lobbying arm has spent heavily fighting Robert F. Kennedy Jr.’s vaccine policy overhaul. The pattern is consistent: an industry that treats safety-net spending as a cost to be engineered away, right up until the moment engineering it away starts costing them the argument.
Next time PhRMA or its member companies claim 340B is the problem, remember who benefits most from the program they are trying to kill, who they let sit at their table for years, and which drugs, the cancer treatments and HIV medications keeping rural Americans alive, they are angling to make more expensive.
Editor’s Note: The 2026 Midterms will determine the fate of President Trump’s America First agenda. Republicans must maintain control of both chambers of Congress.
Help RedState continue to report on the Democrats’ radicalism and inform voters as our nation faces a crossroads. Join RedState VIP and use promo code FIGHT to receive 60% off your membership.
Join the conversation as a VIP Member