Julie Gill Shuffield, Executive Director for Patients Come First California, expressed concerns regarding the federal 340B program’s impact on rural healthcare access in California. She claimed that the program allows entities such as pharmacy benefit managers to exploit discounts intended for low-income patients.
“The 340B Program was created in 1992 with the intention to benefit the most vulnerable patients who can’t afford healthcare, but its lack of transparency has subjected it to being preyed on by large players in the healthcare system, like major hospital groups and big insurers,” said JULIETTA KATHERINE GILL SHUFFIELD. “If the 340B program was working correctly, the cost of the medicine would be lower for patients in underserved rural communities, but evidence suggests those savings are not reaching patients. there are bad actors that buy deeply discounted prescription drugs and then turn around and charge the patients and insurance companies higher prices and pocket the difference. Only 35% of 340B hospitals are located in the medically underserved area they are meant to serve. Yet, the discounts are flowing to the other 65%”
In an op-ed for the San Joaquin Valley Sun, Shuffield said that rural hospital closures in counties like Glenn and Kern are worsened by the 340B program’s lack of transparency and oversight. She explained that while the program is designed to provide drug discounts to underserved communities, it is being exploited by major hospital groups and insurers who do not pass savings on to patients. Shuffield called for congressional reforms to ensure that discounts reach those in need and prevent further deterioration of emergency care in rural areas.
A report from the PBM Accountability Project highlighted how pharmacy benefit managers exploit the opacity of 340B in California, diverting discounts away from patients and increasing drug costs. The report noted that nearly 60% of rural community hospitals operate at a loss, with 75% of critical access facilities affected, leaving communities without nearby emergency care. While SB 41 introduces reporting requirements and penalties, advocates argue that targeted reforms of the 340B program are still necessary.
According to a Senate report, hospitals and pharmacy benefit managers nationwide have abused the 340B program by marking up discounted drugs and retaining profits. Program purchases have increased from $9 billion in 2014 to $38 billion in 2020. This misuse has coincided with over 100 rural hospital closures since 2010, with 46% of remaining rural facilities operating at a loss as of 2025. Federal oversight remains inadequate, allowing entities to profit while vulnerable patients face barriers to affordable medications and care.
Shuffield leads Patients Come First California as its Executive Director, advocating for consumer and patient interests in healthcare policy. She also founded Power of 100 Sutter Buttes Basin, a charitable women’s group supporting community initiatives in her region. Shuffield was recognized as Woman of the Year by U.S. Representative John Garamendi for her contributions locally.
