Research Seminar with Rachel Sachs, JD, MPH

The already-fragile American health care safety net is being supported by a program that was never intended to bear its weight. At its establishment in 1992, the federal 340B prescription drug discount program was modestly created to enable safety net health care entities to purchase prescription drugs for their patients at discounted prices, stretching their scarce resources further. But the 340B program has now grown to become one of the biggest programs in health law.

In 2025, 340B covered entities purchased $100 billion in drugs under the program, a number which is only expected to grow. The 340B program is not directly financed by the government but is instead indirectly financed through its legal structure, enabling covered entities to retain the difference between the low acquisition price of their drugs and higher rates at which they are reimbursed by insurers for providing those drugs. The program’s indirect financing structure creates both positive and concerning incentives for the program’s interactions with health law issues including prescription drug pricing, hospital and health system consolidation, rural health sustainability, the provision of uncompensated care, and more.

Importantly, the legal and institutional structures of the program create a fundamental instability in its operations: Congressional gridlock, the executive branch’s lack of substantive rulemaking authority over the program, and partial federal preemption have left key questions of program administration unresolved or in the hands of regulated parties. Ongoing legal developments including in Medicare rulemaking and litigation brought by pharmaceutical companies have the potential to limit the availability of 340B discounts, potentially addressing some of the program’s concerning incentives but potentially also leading to closures of health care safety net entities. In identifying this set of emerging issues, this talk lays out a research and policy engagement agenda for academics and policymakers moving forward and invites future work in this area.

Co-sponsored with the Department of Medical Ethics and Health Policy (MEHP).

Please note: Registration is required. In-person attendance is strongly encouraged, although virtual access will be provided for all registrants.

Speaker

Rachel Sachs, JD, MPH

Wiley B. Rutledge Professor of Law, Washington University in St. Louis

Rachel Sachs, JD, MPH, is the Wiley B. Rutledge Professor of Law at Washington University in St. Louis, a secondary faculty member at the Washington University Bursky School of Public Health, and a Faculty Co-Director of Washington University’s Cordell Institute for Policy in Medicine and Law. Her research analyzes problems of innovation and access to health care technologies, exploring the intersection of health law, food and drug law, and patent law. Professor Sachs served in the Biden Administration as a Senior Advisor at the Department of Health and Human Services Office of the General Counsel, Centers for Medicare and Medicaid Services Division. She serves as a Non-Resident Fellow at the Brookings Institution. She clerked for Judge Richard A. Posner of the United States Court of Appeals for the Seventh Circuit. She received her JD magna cum laude from Harvard Law School and Master of Public Health from the Harvard School of Public Health.