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Issue Brief: ESI Payments to 340B Hospitals are Multiples Higher than Their Estimated Acquisition Costs

Jessica Chang
October 30, 2025

The Health Care Cost Institute (HCCI) conducted an analysis on estimated acquisition costs and ESI reimbursement costs among 340B-participating hospitals in 2022. This issue brief analyzes the estimated ESI and Medicare fee-for-service price mark-up, relative to estimated acquisition costs, among 340B hospitals. Among the three physician-administered drugs of interests: daratumumab, pegfilgrastim, and infliximab, we found that 340B hospitals received a markup range between 3.9 and 10.6 times the estimated acquisition costs among ESI payers and markup range between 1.6 and 2.9 times the estimated acquisition cost among Medicare fee-for-service.

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