The US federal government advanced a two-track update to 340B drug pricing oversight, targeting how covered entities handle and report reimbursement flows. CMS proposed changes to payment rates under the 340B Drug Pricing Program beginning in 2027, citing gaps between hospital acquisition costs and Medicare payments, and projecting $1.15 billion in savings. Separately, HRSA revised its 340B Rebate Model Pilot Program through a claims-based rebate pathway. The pilot would allow manufacturers to provide the 340B ceiling price via rebates rather than upfront discounts for a limited set of covered outpatient drugs, with a focus on transparency, transaction verification, and duplicate-discount prevention. Together, the CMS proposal and HRSA pilot revisions point to tighter operational controls and more direct reconciliation mechanisms across the 340B ecosystem.