By Amanda Krzepicki
Guest Columnist
For many patients across Michigan with chronic and debilitating conditions, access to life-saving treatment has become harder. This is especially true for people with autoimmune diseases such as celiac disease, lupus or psoriasis. I regularly hear from patients forced to spend hours fighting with insurers and pharmacy benefit managers just to get the medications they need.
Unfortunately, the Michigan Legislature is considering policies that could make things worse. House Bill 4878 and Senate Bill 94 would allow 340B hospitals to contract with unlimited pharmacy chains, expanding a system already being exploited by hospitals and major retail pharmacies. Instead of lowering costs for patients, they would funnel more money to institutions that put profits ahead of care.
The 340B Drug Pricing Program was created to help health centers provide care for vulnerable patients by allowing them to buy medicines at steep discounts. The intent was simple: use savings to expand access and services for those most in need. But today, hospitals and large pharmacy chains are manipulating the program for financial gain, while patients see little to no benefit.
The evidence is clear. A recent report found average profit margins on 340B drugs at contract pharmacies reached 72%, compared to 22% on non-340B drugs. Another study showed most patients receive no discount even when their medicines are purchased at reduced 340B prices. Meanwhile, 92% of Michigan hospitals in the program provide charity care at levels below the national average. Fewer than a third of contract pharmacies are even located in medically underserved areas.
In practice, this means the 340B program is fueling hospital profits while leaving low-income families behind. Hospitals have used 340B revenue for everything from Super Bowl ads to private planes. At the same time, 13% of Michigan residents live below the poverty line, forced to choose between paying rent or buying essential medications. For people with autoimmune and other complex conditions, these choices are devastating.
As someone who has worked in federally qualified community health centers, I know how powerful 340B could be when used responsibly. But right now, there is no requirement that hospitals pass along savings to patients—or even report how those funds are spent. That lack of accountability allows the program to be abused at the expense of those it was meant to serve.
House Bill 4878 and Senate Bill 94 do nothing to address these flaws. Instead of advancing reforms that would lower costs and protect patients, they expand the ability of bad actors to game the system. If passed, they would only widen the gap between the original mission of 340B and its current reality.
Michigan lawmakers should reject this misguided legislation and pursue comprehensive reforms. That means requiring transparency, ensuring savings go directly to patients and protecting those struggling most with out-of-pocket costs. For Michiganders living with autoimmune conditions and other serious diseases, the stakes are too high to let 340B become a profit machine for hospitals and pharmacy chains.
Amanda Krzepicki is policy director for the Autoimmune Association, headquartered in Clinton Twp.
