hospitals
Fourth Circuit orders new review of West Virginia 340B dispute
The en banc rehearing means the panel ruling is no longer the court’s final word on how the federal drug-discount program works for hospitals, pharmacies and drugmakers.
West Virginia’s 340B dispute is headed back to the full Fourth Circuit after judges voted to rehear the case en banc on May 28. The move leaves the earlier panel decision unsettled for now, keeping hospitals, pharmacies and drugmakers in limbo.
- The Fourth Circuit agreed to rehear the West Virginia 340B case.
- The earlier panel ruling is no longer the court’s final word.
- Hospitals, pharmacies and drugmakers still do not have a settled answer.
- 340B affects how safety-net providers buy discounted medicines.
- West Virginia hospitals, pharmacies and drugmakers will keep living with uncertainty after the Fourth Circuit voted May 28 to rehear a 340B case en banc
West Virginia hospitals, pharmacies and drugmakers will keep living with uncertainty after the Fourth Circuit voted May 28 to rehear a 340B case en banc. That means the panel ruling in Pharmaceutical Research and Manufacturers of America v. John McCuskey is no longer the court’s final word.
340B is the federal drug-discount program that lets certain safety-net providers buy medicines at reduced prices. When the rules around it are unsettled, the effects show up in hospital purchasing, pharmacy arrangements and the way manufacturers account for those discounts.
The discount at the center
The dispute reaches the people and institutions that feel 340B most directly. West Virginia Attorney General John B. McCuskey, several members of the state Board of Pharmacy and Insurance Commissioner Allan McVey are on one side of the case.
On the other side is Pharmaceutical Research and Manufacturers of America, better known as PhRMA, the industry group for drugmakers. The fight has drawn in health-system and hospital groups because the program’s reach shapes how discounted drugs move through the supply chain and how far the savings go once they do.
Who is caught in the pause
The rehearing does not settle which side will prevail. It simply pushes the case back before the full court and leaves the earlier outcome unresolved for now.
That delay matters because 340B is not an abstract pricing dispute. For providers that rely on discounted medicines, and for drugmakers that have to manage those discounts, the practical question is how the program will work in everyday use. For the moment, the answer is still waiting on the court.