“Hospitals already control the claims. Employers already pay full freight. And employers have no negotiating leverage once the claim hits the plan……SwyftScripts does not control prescribing. Hospitals do not control employer savings. And revenue is not driven by utilization expansion, but by reclaiming margin that already exists in the system.”
By Yasser Almuaala – Feb 4, 2026
A Measured Response To “Employers Beware”
Exciting to see SwyftScripts mentioned in this article published by National Alliance of Healthcare Purchaser Coalitions. But blaming 340B for high drug costs is like blaming the credit card processor for the price of a purchase. The real question is: who keeps the savings? Hint: it doesn’t have to be hospitals.
From someone who actually works inside the drug-cost problem let’s start with something we can all agree on: The 340B program has been abused.
Large hospital systems have learned how to use 340B not as a safety-net tool, but as a margin-expansion strategy, billing employers full commercial rates while quietly capturing discounts behind the scenes.
The article gets that part right. Where it goes wrong is what comes next.
The Core Error: Confusing the Abuser with the Tool
The article written by the National Alliance of Healthcare Purchaser Coalitions treats 340B as if it is inherently exploitative. It isn’t.
What employers are reacting to (and what they are desperate to fix) is not 340B itself, but this reality:
Hospitals already control the claims. Employers already pay full freight. And employers have no negotiating leverage once the claim hits the plan.
That is not a future risk. That is the status quo.
So when the article warns employers that “340B inflates costs,” it ignores the uncomfortable truth:
Those inflated costs already exist without employer participation, without transparency, and without savings being passed to patients or plans.
What SwyftScripts Does Differently (and Why That Matters)
The article assumes all employer 340B models look the same. They don’t.
Hospital-Driven 340B (What the Article Criticizes)
- Hospital captures the discount
- Employer pays full commercial price
- Patient sees no benefit
- Community providers see nothing
- Employer has zero leverage
SwyftScripts’ 340B Model (What the Article Ignores)
- The employer and patient are put back at the center
- Savings are passed through, not hoarded
- Patients benefit directly, often with reduced or eliminated cost-sharing
- Community health centers receive a share of the economics, enabling them to treat indigent and underinsured patients
- Employers see material, auditable reductions in specialty drug spend
This is not theoretical. It shows up in claims data, PMPM reductions, and avoided catastrophic spend.
Calling these two models the same is like calling a scalpel and a crowbar “surgical instruments” and pretending the outcomes are interchangeable.
Not to mention this article vaguely implies that this somehow raises costs, which is not true whatsoever.
On “Profiteering” and Incentives
The article warns that shared-savings models create incentives to overprescribe. That concern deserves scrutiny, but it only applies when:
- The party controlling prescribing is the party capturing margin
- Clinical governance is absent
- Savings are tied to volume, not value
SwyftScripts does not control prescribing. Hospitals do not control employer savings. And revenue is not driven by utilization expansion, but by reclaiming margin that already exists in the system.
If there were no excess margin in specialty drugs, there would be nothing to share.
The fact that employers save “a ton of money” is not evidence of distortion. It is evidence of how much waste already exists.
The Community Health Center Question (the Part Missing Entirely)
The article positions employer participation as undermining 340B’s safety-net mission.
That would be a serious charge – if it were true.
In practice, SwyftScripts’ model actively benefits community health centers, directing a portion of economics to organizations that:
- Treat indigent and uninsured patients
- Provide care hospitals increasingly avoid
- Actually reflect the spirit of the 340B statute
In other words, the safety net gets stronger, not weaker.
Ironically, that outcome is closer to Congress’s original intent than what most large hospital systems are doing today.
A Note on “Independence” and Conflicts
The article presents itself as a neutral warning to employers.
Yet it is worth noting (factually, not rhetorically) that the organization publishing it derives a substantial portion of its operating revenue from program services, including:
- Conferences
- Sponsorships
- Strategic partnerships
And those sponsorships frequently include pharmaceutical manufacturers – the very stakeholders most threatened when employers reduce net drug spend.
This does not invalidate the article. But it does warrant perspective.
When manufacturers lose leverage, they call it “market distortion.” When employers regain leverage, they call it “fiduciary responsibility.”
Both can’t be wrong, but they’re not equally disinterested.
The Real Question Employers Should Be Asking
Not: “Is 340B perfect?” But: “Who controls the economics today and who benefits from keeping it that way?”
Right now:
- Hospitals win
- Manufacturers win
- PBMs win
- Employers pay
- Patients hope
SwyftScripts doesn’t claim to fix the entire healthcare system. It does something more practical:
- It takes a mechanism already being used against employers
- Re-engineers it transparently
- Passes savings to plans and patients
- Supports community providers
- And produces real, measurable financial relief
That’s not exploitation. That’s correction.
Closing Thought
The article warns employers to “think twice.” That’s good advice. But thinking twice doesn’t mean walking away from 340B. It means refusing to let the same parties who created the problem define the solution.
If employers are already paying the bill, the least they deserve is a seat at the table – and the savings that come with it.
