Trump’s Push for Healthcare Transparency, Starting With Hospital Prices, Can Go Even Further

The Trump administration is making hospital price transparency a centerpiece of its Make America Healthy Again agenda — and it has a chance to go even further toward achieving this goal.Earlier this month, federal regulators warned more than 500 hospitals that they could be violating federal requirements to disclose their prices. The message from the administration was simple. Patients deserve to know what healthcare costs.Yet transparency shouldn’t stop at hospital prices. If the administration is serious about exposing hidden financial arrangements in healthcare, it should turn its attention to the federal 340B drug-pricing program, which has allowed hospitals to retain billions of dollars in drug discounts intended to help vulnerable patients.The administration’s transparency push rests on a simple insight. Markets work better when consumers have information. Patients cannot comparison-shop when prices are hidden. Providers face less pressure to compete when consumers don’t know what care costs.Federal price transparency rules have been in place for years. Yet compliance remains spotty. According to PatientRightsAdvocate.org, fewer than one in four hospitals were fully compliant with the rules as of late 2024. Even fewer were posting actual dollars-and-cents prices that patients could readily use when shopping for care. Hospitals’ resistance to price transparency is not surprising. Opaque pricing protects them from competition.The same opacity plagues 340B. Congress created the program in 1992 to help hospitals and clinics serving large numbers of low-income patients, mostly in rural areas, stretch scarce resources. Drug manufacturers are required to provide eligible healthcare facilities substantial discounts on outpatient medicines. Hospitals can then mark those prices up and retain the difference.Over time, 340B has grown into one of the largest and least transparent financial arrangements in healthcare, with purchases exceeding $80 billion in 2024 — roughly four times their level in 2016.Yet policymakers still know remarkably little about how those savings are used. The law does not require hospitals to pass drug discounts directly to patients. Nor does it require them to account for how the revenue generated through 340B is spent.The limited available evidence suggests that hospitals are running far afield of 340B’s intent.One analysis found that nearly 70 percent of 340B disproportionate-share hospitals devote a smaller share of revenue to charity care than the national average. Other research has shown that many 340B hospitals have accumulated substantial reserves while providing relatively modest levels of uncompensated care.The Trump administration is finally insisting that hospitals open their books on 340B. Federal regulators have proposed a pilot program that would require hospitals seeking discounts to submit claims-level data demonstrating that prescriptions qualified for the program.Today, hospitals generally receive 340B discounts upfront. Under the pilot, manufacturers would instead provide rebates after hospitals submitted the required data.That may sound like a technical change. But it would create something 340B has long lacked: transparency. The claims data required to obtain rebates would offer a far clearer picture of who is benefiting from 340B discounts and whether the program is operating as intended.Some drug manufacturers have sought claims-level data to verify that 340B discounts are being applied appropriately. Yet many covered entities have refused to provide it. Last month, Lilly reported that roughly one-third of 340B providers had declined to share data needed to verify transactions.Their resistance is telling. Hospitals defend 340B as an indispensable tool for serving low-income patients. If that is true, then greater transparency should strengthen their case by showing that discounts are reaching eligible patients and program savings are being used as intended.Hospital price transparency and 340B reform should be pillars of the Make America Healthy Again agenda. Both seek to expose hidden financial arrangements and bring greater accountability to how our healthcare dollars are being spent.

Trump’s Push for Healthcare Transparency, Starting With Hospital Prices, Can Go Even Further

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