In rural Iowa, access to health care isn’t a political talking point — it’s a lifeline. When a hospital cuts services or a clinic closes, it doesn’t just inconvenience families. It can mean longer drives in emergencies, delayed care, and real consequences for our communities.

That’s why Congress must protect the federal 340B drug pricing program which is one of the few tools that helps rural providers stretch limited resources without costing taxpayers a dime.

The 340B program was created with a simple, bipartisan idea: in exchange for access to lucrative Medicare and Medicaid markets, pharmaceutical manufacturers agree to provide discounted medications to hospitals and clinics that serve a high number of low-income and rural patients. Those savings allow providers to reinvest in patient care, expanding services, keeping clinics open, and reaching more people who might otherwise fall through the cracks.

Here in lowa, those savings make a real difference. Rural hospitals operate on razor-thin margins. Many are already struggling with workforce shortages, rising costs, and declining reimbursement rates. The 340B program helps bridge that gap by giving Providers flexibility to meet the needs of their communities, whether that’s offering behavioral health services, keeping a local pharmacy running, or simply keeping the doors open.

Importantly, 340B is not a government spending program. It does not rely on taxpayer funding. Instead, it’s a market based arrangement that has worked for more than three decades delivering value for patients, providers, and the health care system as a whole.

But today, that balance is being threatened.

Large pharmaceutical companies are increasingly attempting to rewrite the rules of the program. Through new rebate schemes and restrictions on contract pharmacies, they are effectively shrinking the reach of 340B and limiting how providers can use these critical savings. In doing so, they are bypassing the federal agency, the Health Resources and Services Administration (HRSA), that Congress designated to oversee the program.

The result is fewer resources for patient care, especially in rural areas like ours.

If these efforts succeed, the consequences will be felt quickly. Services will be cut. Clinics will close. And struggling hospitals will be pushed closer to the brink. At that point, the burden doesn’t disappear, it shifts to taxpayers, who may ultimately be asked to step in to stabilize a failing system.

That’s not a path we should accept.

States across the country, red and blue alike, are recognizing what’s at stake. More than 20 states have already taken action to protect the integrity of the 340B program and ensure that providers can continue to use it as intended. That kind of broad, bipartisan support should send a clear message to Washington.

This isn’t about politics. It’s about preserving access to care and maintaining a system that works.

Congress should act to reaffirm HRSA’s authority, push back against efforts to undermine the program, and ensure that 340B continues to serve the patients and communities it was designed to help.

In lowa, we pride ourselves on practical solutions and responsible stewardship. The 340B program embodies both. It allows providers to do more with less, strengthens rural health care, and does so without adding to the federal deficit.

That’s something worth protecting.

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Mike Pike is a Republican member of the Iowa State Senate Representing District 20. He assumed office in 2025.