Breaking Down the $80 Billion 340B Drug Program with William Sarraille | Only Healthcare Podcast #25

In this episode of Only Healthcare, host Randy Vogenberg welcomes William Sarraille, retired senior partner from Sidley Austin's healthcare practice and nationally recognized expert in US healthcare law. As both a legal authority and rare disease patient himself, Bill exposes how the 340B drug discount program has evolved from a modest safety net initiative into an $80 billion profit machine that enriches hospitals while burdening employers and devastating patients with medical debt.

With 30 years of experience representing all stakeholders in the 340B ecosystem, Bill reveals the shocking reality: what began as Congress fixing a "boo-boo" in Medicaid drug pricing has become the single largest driver of healthcare consolidation and price inflation, with hospitals charging employers 150-400% markups while providing charity care to only 2.15% of patients on average.

Key Topics Discussed:

• The $148 Billion Profit Explosion and Market Manipulation - New peer-reviewed IQVIA research reveals 80-100% of 340B's explosive growth from $6 billion in 2010 to $148 billion today stems from hospital utilization manipulation, not drug price increases, with hospitals charging employers 150-400% markups on discounted drugs while using profits to consolidate markets and eliminate competition
• Medical Debt Crisis Despite Massive Hospital Profits - 340B hospitals average only 2.15% charity care spending despite $80 billion in annual profits, with patients never informed about assistance programs, making 340B the largest contributor to medical bankruptcies in America while only 3-5% of contract pharmacy transactions provide patient assistance despite 32% of Americans being uninsured or underinsured
• The Employer Cost-Shift Trap and Transparency Failures - How self-interested brokers mislead employers with "50% discount" offers that represent markdowns from astronomically inflated charges, while 80% of 340B entities generating the most profits operate in complete opacity with no reporting requirements, feeding more dollars into hospital consolidation machines that raise prices on all healthcare services

The episode reveals how a program designed to help indigent patients has become a massive wealth extraction mechanism that enriches tax-exempt hospitals while bankrupting the very patients it claims to serve.

🎧 Listen now: onlyhealthcarepodcast.com

Hosted by: Randy Vogenberg, PhD

Guest: William Sarraille, Retired Senior Partne

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Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.

Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.