CMS proposed a second attempt to reduce Medicare outpatient reimbursement for drugs purchased through the 340B program, aiming to better align rates with what hospitals actually pay. The agency’s proposal would cut 340B reimbursement rates by more than a third and revisits the same reimbursement direction that was struck down by the U.S. Supreme Court in 2021, according to CMS descriptions. Provider groups are warning the rule could drive hospital outpatient drug economics into negative territory, particularly for institutions relying on 340B pricing support. The proposal also feeds into broader federal scrutiny of site-neutrality and Medicare payment structure, with uncertainty around timing, implementation, and potential legal challenges as stakeholders digest the draft rule.