The Health Resources and Services Administration approved eight drugmaker applications to test a 340B rebate pilot that replaces upfront drug discounts with post‑dispensed rebates. HRSA and participating manufacturers say the model aims to curb program abuse by validating patient eligibility during dispensing, but hospital groups warn the change will strain provider cash flow, increase administrative burdens, and risk access for vulnerable patients. Drugmakers approved include major firms that previously sued to pursue alternative 340B models; hospitals and provider associations signaled legal and political challenges ahead. The decision sets the stage for a contested pilot that could reshape reimbursement flows for safety‑net providers.