This white paper examines the evolution of the 340B Drug Pricing Program with a focus on contract pharmacy arrangements. It outlines how the expansion of contract pharmacies has altered manufacturer, covered entity, and pharmacy dynamics while increasing program complexity. The paper reviews recent policy actions, legal disputes, and manufacturer restrictions aimed at managing duplicate discounts and data transparency. It highlights operational challenges such as claims identification, data integrity, and compliance oversight, as well as the financial implications for stakeholders. The analysis concludes that sustainable program operation requires improved data sharing, clearer regulatory guidance, and balanced solutions that preserve patient access while ensuring program integrity.

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