Comment on CMS-2026-2344-0001

As a Sole Community Hospital and like so many other entities covered under the successful 340b statute we urge CMS to abandon this mislead rule and quit trying to cater to drug manufactures increasing their profit at the expense of the American people. Dr Oz must not understand or is simply not communicating the devastating effect this would have on not for profit hospitals to the Trump administration regarding Hospitals that fall under EMTALA and provide care at reimbursements that are non existent or simply below the cost of providing ER and other services. The proposal neglects to acknowledge that paying a hospital that falls under EMTALA and an ASC the same rates on outpatient 340b drugs (or any other service) could only be due to one of two reasons. Either the crafters of the proposals simply don't understand that ASC operations are much less complex than Hospitals; ASC can more readily control costs by narrowly defining operating hours thereby not providing care 24/7, they can cherry pick patients by selecting patients with good payor sources and eliminate indigent and other patients without the ability to pay and simply refer indigent patients to the Government mandated ER of the very hospital this proposal aims to strip reimbursement from. All of this is in contrast to hospitals that are mandated by CMS to be open 24/7, see patients without regard to the ability to pay, staff Drs and other staff each and every hour even when patients aren't there. The only other explanation is that this is a way to get drug manufactures to line the pockets of politicians and other government bureaucrats. The proposed policy would be particularly harmful to hospitals serving rural, underserved, and economically disadvantaged communities. Many safety-net providers are already operating in an environment marked by workforce shortages, inflationary pressures, rising supply and pharmaceutical costs, and increasing levels of uncompensated care and unfunded Government mandates that other private equity institutions don't have. Additional reimbursement reductions threaten hospitals' ability to maintain local access to outpatient treatment services and could force difficult decisions regarding staffing, program expansion, capital investments, and service availability that are mandated by the very Government trying to strip reimbursement from them. Eligible healthcare providers stretch scarce resources and expand access to care for vulnerable patient populations. Hospitals have long relied on these savings to support services that are essential to their communities but often inadequately reimbursed just as the 340b program was designed to do. By significantly reducing reimbursement for 340B-acquired drugs, the proposal undermines hospitals' ability to leverage program savings to advance patient care, improve access, and address community health needs, all of which is what the 340b program is supposed to support. Furthermore, the impact of this proposal would be disproportionately felt by hospitals that care for a higher percentage of low-income and medically complex patients. Unlike many providers with larger commercially insured populations, safety-net hospitals have fewer opportunities to offset reductions in Medicare reimbursement. As a result, payment cuts of this nature place a greater financial burden on the very hospitals that are most critical to preserving access to care for vulnerable populations. At a time when healthcare providers are being asked to improve access, reduce disparities, and address growing community healthcare needs, CMS should avoid policies that weaken the financial foundation of safety-net hospitals. Preserving adequate reimbursement for 340B-acquired drugs is essential to maintaining access to high-quality outpatient care and ensuring that hospitals can continue serving as reliable healthcare resources within their communities. For these reasons, we respectfully urge CMS to withdraw the proposed reduction to ASP minus 33.4 percent and maintain reimbursement policies that recognize the critical role that 340B hospitals play in caring for underserved populations. Any modifications to reimbursement methodology should carefully consider the significant operational and patient-access consequences that would result from such substantial payment reductions. Another consideration to look at is what the 340b intended for. It was the Government understanding all the unfunded mandates it has placed on not-for- profit hospital and the government wanting to continue offering their constituents healthcare even if the constituent couldn't afford it. So, in and effort help these not-for-profits hospitals to be able to provide non profitable services the 340b program was created. There are two sides to it. Either fund the government mandates or remover the mandates so Hospitals can select patients just as the ASCs do, remove the staffing requirements, EMTALA and cost reporting mandates.