Outpatient drug purchases under the 340B Drug Pricing Program crossed the $100 billion mark across 2025, a roughly 23% increase over the $81.4 billion of 2024, the Health Resources & Services Administration (HRSA) reported this week.
The tally is another escalation in scale for the controversial subsidy program, which critics say is being exploited by large nonprofit health systems to pad bottom lines. Purchases in the program, intended by Congress to support safety-net providers, had totaled $43.9 billion in 2021 and $16.2 billion in 2016, for reference.
In 2024, the purchases represented more than 16% of the country’s total drug spending. HRSA noted that the $100 billion for 2025 lands alongside a reported $901 billion in net payer spending on prescription drugs, a roughly 9% year-over-year increase.
HRSA’s new numbers reflect purchasing data provided by the contractor-managed 340B Prime Vendor Program, which “captures the vast majority but not all 340B transactions” and may be corrected and adjusted.
Within its $100 billion topline, HRSA noted that $79.2 billion of the 2025 purchasing was fueled by disproportionate share hospitals, with much smaller sums coming from children’s hospitals ($2.5 billion), critical access hospitals ($1.5 billion) and sole community hospitals ($632 million).
Other noteworthy participants included health center programs ($5.9 billion), rural referral centers ($2.5 billion) and various Ryan White HIV entities across multiple programs ($3.1 billion).
HRSA, when discussing what it viewed as driving spending growth, pointed to the macro-level shift in care delivery from inpatient to outpatient settings.
“For example, oncology drugs, biologics and other infusion therapies administered in hospital outpatient departments represent the fastest-growing segment of purchases in the 340B Program,” HRSA wrote while also highlighting increased drug utilization, newly introduced therapies and general price increases.
Specialty drugs also continue to claim a large portion of the program’s total purchases “in alignment with the national trend,” HRSA added. These high-cost drugs accounted for 61.9% of the total reported purchasing amounts while representing just 38.1% of purchased unit volume.
Ten drugs alone reflected 28.6% of the program’s total 2025 spending, with Merck’s Ketruda ($8.9 billion) and Gilead’s Biktarvy ($4.8 billion) leading the way. However, HRSA noted that obesity/diabetes drugs are joining oncology and immunology products as major cost growth drivers, with Eli Lilly’s Mounjaro ($1.8 billion) jumping up the ranks as 340B’s sixth-highest product in regard to total spend.
HRSA’s tallies are likely to become the new Exhibit A for drugmakers and policy leaders pursuing changes to the program.
Drugmakers have said health systems have relied on loopholes and statutory ambiguities to improperly draw more revenue, and over the years have sought to impose requirements and restrictions they argue will increase accountability. One such move by Eli Lilly has recently escalated into discount pricing rescindments for some hospitals and health systems that wouldn’t comply with its data reporting policy, opening up a new legal front for affected providers.
Hospitals staring down sweeping federal funding cuts have said that the discounts, granted years ago by Congress to subsidize care for low-income or uninsured patients, are more necessary for their financial stability than ever. The sector has worked to beat back, at least temporarily, a pilot program from HRSA that would swap upfront discounts for after-the-fact rebates in a bid to head off improper cross-program discounts, and is already making noise about the Centers for Medicare and Medicaid Services’ proposal to cut federal reimbursement for 340B drugs by more than 30%.
Bolstered by program growth, healthcare cost debates and limited data suggesting large systems are major beneficiaries of the program, lawmakers have increasingly waded into the discussion on 340B reform. Outgoing Senate Health, Education, Labor and Pensions Committee Chairman Bill Cassidy, R-Louisiana, unveiled last month a legislative discussion draft that includes flexibility on rebate structures, limits on hospitals’ contract pharmacies and increased transparency on how systems are using the savings secured through 340B. Bipartisan lawmakers in the House also introduced their own bill earlier this month with several similar goals.