Virginia’s 340B, PBMs, and MFN Under the Spotlight: A BlackDoctor Policy Hub Lunch and Learn Recap

The BlackDoctor Policy Hub kicked off its new Lunch and Learn series with a timely conversation on some of the most misunderstood—and most impactful—policies in healthcare: the 340B Program, Pharmacy Benefit Managers (PBMs), and Most Favored Nation (MFN) policies. Moderated by BDO’s Executive Editor Jade Curtis, the discussion brought together industry and physician perspectives to uncover how these policies shape the cost of care, limit access to life-saving drugs, and affect communities across Virginia.

• John Newby, CEO of Virginia BIO, began by walking through the origins of the 340B program, which was designed in 1992 to help safety-net hospitals buy drugs at deep discounts and reinvest the savings into care for underserved patients. “When done right,” he explained, “it means lower drug prices and expanded services for those in need.” But he cautioned that misuse and lack of oversight often mean patients never see those savings.

Newby also addressed MFN policies, which tie U.S. drug prices to those in other wealthy countries. While the concept sounds fair, he warned that it could have the opposite effect: fewer new drugs, reduced innovation, and shrinking access to therapies. “If investors can’t see a return, innovation suffers—and patients lose,” he explained. On PBMs, Newby described them as “middlemen” who profit from higher list prices, incentivizing the use of more expensive drugs rather than cheaper alternatives.

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Dr. Harry Gewanter, a pediatric rheumatologist and President of the Virginia Society of Rheumatology, then revealed how the 340B program has drifted from its purpose. He pointed to troubling data: 67% of Virginia’s 340B hospitals provide below-average charity care, even while generating profits three times greater than what they reinvest in communities. “The program has been hijacked,” he said, explaining that contract pharmacies—including major chains like Walgreens and CVS—are often far removed from the underserved neighborhoods 340B was created to support.

Both panelists underscored the same theme: a lack of transparency and accountability is undermining trust. Patients rarely know when their prescriptions are tied to 340B discounts, and no system ensures the savings flow back to vulnerable populations. Dr. Gewanter urged reforms including clear eligibility standards, stronger oversight, and meaningful penalties for abuse: “We need standards, enforcement with teeth, and real consequences.”

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The conversation also highlighted the Protect 340B Act, a bipartisan bill meant to prevent discrimination against 340B providers by insurers and PBMs. While a positive step, both speakers agreed that the legislation must go further to truly protect patients and preserve safety nets.

In closing, the focus shifted to community action. Newby encouraged individuals to stay educated and engaged: “You are your best advocate. Don’t sit back and be passive.” Dr. Gewanter echoed the call: “If you want things to change, you have to be involved. Ask questions. Push your legislators. Demand accountability.”

This first Lunch and Learn session of the BlackDoctor Policy Hub made one thing clear: fixing the broken parts of our healthcare system will require persistence, policy reform, and people power. By shining light on complex policies like 340B, PBMs, and MFN, the Policy Hub is turning knowledge into action—and giving communities the tools to demand real change.