A new wave of scrutiny is building around the US 340B drug discount program, with Sen. Bill Cassidy preparing legislative action and advocates calling for patient-focused reforms and greater transparency. At BIO 2026, stakeholders argued the program has expanded beyond its original safety-net intent and is increasingly duplicating discounts. Advocates cited growth in 340B participation, noting the program has expanded from a small number of nonprofit hospitals decades ago to a much larger footprint today. Criticism centers on whether the discounts are translating into lower costs for patients rather than subsidizing broader hospital spending. Separately, analysis presented at BIO 2026 highlighted large estimates of program impact, including the role of “duplicate discounts,” which can distort incentives across entities. Cassidy’s bill is positioned as a mechanism to rein in the program while hospitals face other cost-pressure proposals such as site-neutral payments.