April 17, 2026

The President’s Message is published in the MHA Weekly News Report, a member-only publication of the Montana Hospital Association. To subscribe, click here.

Next week, MHA members and staff will be in Washington, D.C. for the American Hospital Association (AHA) Annual Membership Meeting and hill visits with Montana’s Congressional delegation: Sen. Steve Daines, Sen. Tim Sheehy, Rep. Ryan Zinke and Rep. Troy Downing and their staffs. One of our top priorities is ensuring protection of the 340B Drug Pricing Program.

For more than three decades, the 340B program has allowed hospitals serving vulnerable populations to stretch scarce resources and reinvest savings directly into patient care. In Montana, 48 of our 63 hospitals rely on 340B to sustain essential services—everything from 24/7 emergency care to behavioral health programs, oncology services, transportation assistance, and free or reduced-cost medications for patients who need them most. These are not abstract benefits; they are the difference between maintaining and losing critical services in communities that already face significant access challenges.

We also recognize the importance of accountability and transparency. Hospitals across the country, including many in Montana, have affirmed the AHA’s 340B Good Stewardship Principles, a pledge to ensure that 340B savings are used as intended—to expand access, lower costs for patients, and strengthen services for vulnerable populations. This commitment underscores what we see every day: 340B is not a windfall, but a reinvestment tool that directly benefits patients and communities.

However, the program is under increasing pressure. Actions by pharmaceutical manufacturers to restrict access to 340B discounts—particularly through contract pharmacies—are already undermining the intent of the program and threatening the financial stability of hospitals that depend on it. Additional policy proposals risk compounding that harm.

We are particularly concerned about the proposed rebate-based pilot approach to 340B. While framed as a transparency effort, this model would fundamentally change how the program operates by requiring hospitals to purchase drugs at full price and then seek rebates after the fact. For Montana providers—especially rural and critical access hospitals operating on thin margins—this would create massive cash flow challenges, administrative burden, and uncertainty around rebate timing. In practice, it will likely result in reduced services, fewer outreach programs, and less access to care for communities.

Our message to Congress is clear: the 340B program is working as intended and provides critical resources for rural health patients and providers. We urge our federal delegation to protect the integrity of the program, reject policies that weaken its effectiveness—including the rebate pilot proposal—and ensure hospitals can continue delivering high-quality, accessible care across our state.