Democrats will spend 2026 blaming Republicans for every healthcare complaint coming out of rural America. What they will not mention is that the party actually working to dismantle the program keeping rural hospitals stocked with cancer and HIV drugs is not a party at all. It is the pharmaceutical industry.
New data from HRSA, released July 13, shows ten drugs accounted for 28.6 percent of the record $100 billion spent through the 340B program in 2025, itself a 23 percent jump over the year before. Four of those ten are oncology drugs. Two treat HIV. Merck’s Keytruda alone accounted for $8.9 billion in 340B purchases. Gilead’s Biktarvy, the HIV therapy, was not far behind. Darzalex Faspro, Opdivo, and Imfinzi round out the oncology group, with Descovy as the second HIV drug in the top ten.
The 340B program requires manufacturers who want access to Medicare and Medicaid dollars to sell outpatient drugs at a discount to safety-net hospitals and rural clinics. It costs taxpayers nothing. Hospitals use the savings to keep clinics open and treat patients who could not otherwise afford cancer therapy or HIV medication at all. That the ten drugs eating up nearly a third of the program’s spending are dominated by cancer and HIV treatment is not an accident. Those are the categories where list prices have climbed the fastest, and where rural patients have the least room to absorb the difference.
Every one of these manufacturers belongs to PhRMA, the industry’s chief lobbying arm and the same group pushing to gut 340B through rebate schemes and reporting mandates designed to shift costs onto hospitals instead of the companies setting the prices. It is a fair fight to have. Hospitals are not blameless in this program, and PhRMA’s argument that some large systems use 340B margins to pad revenue rather than serve patients deserves a hearing. But the industry’s preferred fix does not touch list prices. It touches what hospitals get to keep after paying them.