hospitals
Fourth Circuit reopens West Virginia 340B reimbursement fight
The Fourth Circuit agreed to rehear a dispute over how West Virginia's pharmacy rules affect the federal 340B drug discount program. That pauses a panel ruling and keeps the reimbursement fight open for hospitals, pharmacies and drugmakers.
West Virginia’s pharmacy-payment rules are headed back to the full Fourth Circuit. The rehearing order keeps the 340B dispute alive and delays a final answer on how the state handles reimbursements.
- The full Fourth Circuit will rehear the West Virginia 340B case.
- The dispute is about drug-payment rules and reimbursements.
- Hospital and pharmacy groups are among the groups backing the appeal.
- The June 2 order delays a final appellate answer.
- Patients, hospitals and pharmacies in West Virginia still do not have a final answer on how the state’s drug-payment rules will hold up
Patients, hospitals and pharmacies in West Virginia still do not have a final answer on how the state’s drug-payment rules will hold up. On June 2, 2026, the Fourth Circuit granted rehearing en banc in Pharmaceutical Research and Manufacturers of America’s case against West Virginia officials, putting the panel result back in play.
The order means the full court, not just a smaller panel, will take another look at the dispute over rules tied to 340B, the federal drug-pricing program that lets eligible providers buy outpatient medicines at a discount.
A wider fight than one lawsuit
The case names West Virginia Attorney General John B. McCuskey and members of the West Virginia Board of Pharmacy, along with the state insurance commissioner. On the other side is Pharmaceutical Research and Manufacturers of America, the drug industry group known as PhRMA.
The dispute has drawn hospital and pharmacy groups as amici, including 340B Health, the American Hospital Association, the West Virginia Hospital Association, the West Virginia Primary Care Association and the American Society of Health-System Pharmacists.
What stays unsettled
That roster shows how much is riding on the rules beyond the named parties. Hospitals, pharmacies and drugmakers are all watching the same question: how West Virginia’s payment rules work in practice, and how much they change reimbursements tied to 340B drugs.
For now, the rehearing delays a final appellate answer. The panel ruling no longer has the last word, and the state’s rules remain under review by the full Fourth Circuit.