Can someone correct me if I’m wrong. State Medicaid has to pay full RETAIL price for scripts filled under 340B , but the contracted pharmacy makes a significant premium and the prescribing 340b Covered Entity (the hospital typically) gets to keep all the profit they didn’t go to the pharmacy they contracted with and often own Yes ? No ? I ask because State Medicaid Programs are getting crushed.

For what it's worth, states recover millions and millions through 340B rebates to ADAPs. Basically, a state ADAP can buy health insurance for a patient. When the state pays the premium+deductible/copay for the patient, by federal policy the state ADAP becomes entitled to the 340B rebate from the full cost of the drug even though the insurance company paid for it. So if the ADAP pays $200/month for insurance and gets a rebate of $1000/month on Biktarvy, they net a ton.