This research, conducted in collaboration with Health Capital Group, investigated how two structural growth drivers of the 340B Program—the proliferation of child sites and contract pharmacy (CP) relationships—vary by hospital size and teaching status.
Using HRSA’s Office of Pharmacy Affairs Information System (OPAIS) data from 2017 to 2023 for continuously enrolled hospitals in 340B, the study groups hospitals by bed-size quartiles and teaching status and assesses changes in these two indicators of program expansion.
Results show that 340B growth across both dimensions is highly concentrated among the largest institutions. Although hospitals in the top bed‑size quartile account for just 33% of 340B hospitals, they generated 81% of child‑site growth and 60% of CP expansion over 2017–2023. On average, a 340B hospital added 4.2 child sites and 22.1 CP relationships, whereas the largest hospitals added >10 child sites and ~70 CP relationships each. Within the large‑hospital segment, teaching institutions (largely Academic Medical Centers, or AMCs) expanded at nearly twice the pace of similarly sized non‑teaching hospitals—averaging 49.6 vs. 25.4 child sites and 93.8 vs. 51.4 CP relationships—and the child‑site gap widened from 66% in 2017 to 95% in 2023. A similar trend emerged among 415 hospitals that joined between 2017 and 2023, where the largest hospitals (36.6% of new entrants) represented 71.9% of new child sites and 62.4% of new CP relationships, reinforcing the capture of 340B expansion by large systems.
Placed alongside prior work showing that child sites and CPs are predominantly located in higher-income, better-insured areas, these findings underscore a persistent tension: while 340B clearly benefits hospitals, how—and whether—those benefits translate to patients remains unclear. Without reform, 340B growth is likely to continue concentrating within the largest systems, with potential implications for healthcare consolidation and market dynamics that may disadvantage true safety-net providers. The paper discusses these issues central to ongoing policy debates about aligning 340B with its original intent.
This research was funded by Johnson & Johnson and conducted in collaboration with Dr. Neal Masia (Columbia University and Health Capital Group). For full details on the study design, methods and limitations, see: Masia, N. “Concentration of 340B Program Expansion Among Hospitals of Varying Size: A Retrospective Analysis, 2017–2023.” Health Capital Group. March 2026.
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