CMS proposed changes to the 340B Drug Pricing Program payment rates for drugs beginning in calendar year 2027, while HRSA updated its 340B Rebate Model Pilot Program. Together, the moves signal an administration push toward greater reimbursement transparency and utilization management controls in the federal program. CMS cited survey evidence that hospitals pay less than ASP for 340B purchases, while Medicare payments have exceeded acquisition costs, and estimated $1.15 billion in potential drug cost savings. HRSA’s revised pilot adds a voluntary path for qualifying manufacturers to provide 340B ceiling-price rebates through claims-based mechanisms rather than upfront discounts, with transaction-level verification. The proposals and pilot revisions are designed to address duplicate discount risks and improve program sustainability, while keeping access for underserved communities in view.