HHS’ Health Resources and Services Administration unveiled details of a revised 340B rebate pilot that would allow some drug manufacturers to deny rebates for a small subset of drugs. The change targets how 340B program pricing rules apply to specific products rather than revising the program broadly. Under the 340B program, certain safety-net hospitals can purchase qualifying medicines at discounted prices tied to Medicaid-referenced rebate structures. The revised pilot adds conditional flexibility for manufacturers, increasing uncertainty around which product categories may carry rebates going forward. The industry response is expected to focus on contract complexity, reimbursement modeling, and continuity of supply for affected hospitals—factors that can influence patient access and pharmacy dynamics even when the intent is affordability.