Op-Ed: Health Equity Requires More Than Good Intentions: Why 340B Needs Transparency Before Expansion – Black women and families in underserved communities face some of the highest stakes when healthcare systems fall short. In Illinois, Black women are significantly more likely to experience serious health challenges, including being nearly three times more likely to die from pregnancy-related causes than white women. They are also more likely to live with chronic illness and face financial strain tied to medical care. That reality should shape how Illinois evaluates policies intended to support underserved patients.
As Illinois considers expanding participation in the federal 340B Drug Pricing Program, a program designed to support safety net providers in delivering medications to uninsured and low-income patients, it is essential to pause and ask a fundamental question: are patients, particularly Black women and families in underserved communities, truly benefiting from the program as it exists today?
The connection between 340B savings and patient benefit is often unclear. Across our communities, we hear from Black women and families who struggle to afford prescriptions, delay care because of the cost, or navigate confusing billing systems that offer little transparency. These barriers persist even as the 340B program has grown significantly over the past decade, raising important questions about whether the program is working as Congress intended.
Under current rules, hospitals can purchase drugs at discounted 340B prices and can be reimbursed at full market rates, without any requirement to show how those savings are used or whether patients are seeing lower out‑of‑pocket costs. Patients are rarely told whether a drug was purchased through 340B, and policymakers lack consistent data on who benefits most from the program or how revenues are reinvested into the communities they are meant to serve.
For many communities, especially Black underserved communities, this lack of accountability is not a technical issue. It is a health equity issue.
Across Chicago’s South and West Sides and in other areas with fewer healthcare options, patients continue to report difficulty affording medications and navigating complex billing systems. These challenges are most acute in communities already facing higher rates of chronic illness and economic instability.
Meanwhile, health systems continue to grow while patients are confronted by the choice to ration medications or forgo treatment altogether due to costs. This gap between system growth and patient experience undermines trust in healthcare. Communities are asked to believe that savings are being used to improve care, yet they are given little visibility into whether this is happening in practice. Equity‑focused policy requires more than assurances. It requires evidence.
None of this means the 340B program lacks value. Safety‑net providers play a critical role in caring for vulnerable populations, and many use program resources responsibly to expand services and support patient care. But as programs expand, accountability must expand with them to ensure that benefits flow to patients.
Clear reporting on how 340B savings are generated and reinvested would allow communities to see whether the program is delivering on its promise and help ensure equity is not just a stated goal, but a measurable outcome.
llinois has an opportunity to lead by insisting on accountability and transparency. Rather than treating 340B expansion as an end in itself, policymakers should ask whether existing structures are producing results for patients. Do savings lower costs at the pharmacy counter? Do they expand access to care in communities with the greatest need? Do they improve health outcomes for Black women and families?
Health equity is built on evidence, accountability, and trust. If the 340B program is to fulfill its mission in Illinois, transparency and patient‑centered safeguards must come first. Expansion should follow evidence that patients are benefiting, not precede it.
Op-Ed: Health Equity Requires More Than Good Intentions: Why 340B Needs Transparency Before Expansion
