Wire
West Virginia’s 340B case goes back to the full Fourth Circuit
Judges voted to rehear the dispute en banc on May 28, putting off any final answer on how the drug-discount program works in practice for hospitals, pharmacies and manufacturers.
West Virginia’s 340B drug-discount fight is headed back to the full Fourth Circuit after judges voted on May 28, 2026, to rehear Pharmaceutical Research and Manufacturers of America v. John McCuskey en banc. For hospitals that rely on the program, pharmacies that fill the prescriptions and drugmakers that have been challenging the rules, the immediate effect is simple: the panel ruling is no longer the court’s last word.
The case names West Virginia Attorney General John B. McCuskey, several members of the state Board of Pharmacy and Insurance Commissioner Allan McVey as defendants-appellants. It also drew amicus support from 340B Health, the American Hospital Association, the West Virginia Hospital Association and the West Virginia Primary Care Association, while the American Society of Health-System Pharmacists backed rehearing on the other side.
The money question
The 340B program lets certain hospitals and clinics buy outpatient drugs at discounted prices so limited health-care dollars can stretch further. Battles over how states may steer pricing, payments or related business arrangements around that system can ripple well beyond one lawsuit, because they affect what covered providers pay and what pharmacies and manufacturers face in the market.
That is why this rehearing matters. It does not decide who wins, but it does wipe away any sense that the panel’s answer was the final appellate word. For now, the legal rules in West Virginia stay unsettled, and the broader 340B fight stays open.
A reset, not a ruling
An en banc rehearing means a larger slate of Fourth Circuit judges will reconsider the dispute instead of leaving it with the original panel. The result is delay, but also a fresh chance for both sides to argue over how far West Virginia can go in shaping the program’s economics.
For hospitals, the case is about keeping a discount structure that can determine how far scarce money goes. For drugmakers, it is about holding down rules they have been fighting in court. Either way, the rehearing keeps the pressure on a program that has become one of the sharper pressure points in health care finance.