Fourth Circuit reopens West Virginia hospital drug-discount case

In West Virginia, hospitals and pharmacies still do not have a settled rule for how the 340B drug-discount program works. The Fourth Circuit granted rehearing en banc, so the full court will take another look and the panel ruling is no longer the court’s final word.

The case, Pharmaceutical Research and Manufacturers of America v. John McCuskey, pits the drug industry group against West Virginia Attorney General John B. McCuskey and members of the state Board of Pharmacy.

The discount that keeps care moving

340B is a federal program that lets certain hospitals and clinics buy outpatient drugs at reduced prices. For safety-net providers, those discounts can help stretch tight budgets, and they also affect how pharmacies and drugmakers are paid.

That is why the rehearing matters beyond the courtroom. Until the full court speaks, the rules tying discounted drug purchases to the rest of the prescription supply chain remain unsettled.

Who is still waiting

The case has drawn hospital and industry groups on both sides. Amici supporting the state side include 340B Health, the American Hospital Association, the West Virginia Hospital Association and the West Virginia Primary Care Association. The American Society of Health-System Pharmacists filed separately in support of rehearing.

For patients served by 340B hospitals and clinics, the practical question is whether those savings keep flowing to care. For hospitals, pharmacies and drugmakers, the immediate reality is simpler: the money and the rules are still in limbo.