The closer we get to 2028, the more likely the US will settle for short-term solutions. These solutions will not change the health care system in a meaningful way. The 340B program was created by Congress in 1992. In August 2025, HRSA announced a voluntary pilot of the 340B Rebate Model, where manufacturers provide rebates in the form of refunds instead of upfront deductions. The pilot covers drugs selected for Medicare price negotiation under the Inflation Reduction Act of 2022 and began on January 1, 2026. The number of covered entity sites doubled between 2013 and 2023. States are increasing reporting requirements and transparency of the use of 340B savings.[1][2][3]