Community Oncology Alliance asks Supreme Court to review 340B contract pharmacy law

The Community Oncology Alliance filed a Supreme Court amicus brief in support of review of Mississippi’s 340B contract pharmacy law, arguing that PBM-driven pharmacy restrictions can raise barriers for cancer patients and may not deliver the savings the program was meant to provide. The filing puts independent oncology practices at the center of a dispute over whether 340B is still serving vulnerable patients.

Why it matters: - The Community Oncology Alliance is pressing the Supreme Court to examine whether 340B contract pharmacy arrangements actually improve access and affordability for patients with cancer. - The filing argues that pharmacy benefit managers can profit from 340B without showing that those gains reach the vulnerable patients the program was designed to help. - The case could shape how cancer medications are dispensed, especially when PBMs steer patients to affiliated specialty or mail-order pharmacies.

What happened: - The Community Oncology Alliance filed an amicus curiae brief with the United States Supreme Court urging review of Mississippi’s 340B contract pharmacy law. - The brief was filed in support of the petition in Novartis Pharmaceuticals Corporation v. Fitch, case number 24-60342. - The brief was submitted on COA’s behalf by Frier Levitt, LLC. - A readout of the full brief is available as the company's announcement.

The details: - COA says independent community oncology practices are well positioned to describe how 340B affects patients because they both treat cancer and dispense oral cancer medications through in-office pharmacies or dispensing facilities. - Those practices work directly with PBMs to secure coverage and payment for oral cancer drugs. - COA says PBM network restrictions and prescription steering can complicate treatment start times, dose changes, refills and monitoring. - Ted Okon, COA’s executive director, said independent oncology practices see what happens when a PBM stands between a patient and a prescribed cancer drug. - Okon said protecting more contract pharmacy arrangements does not necessarily protect patients and may harm them. - Mississippi’s law bars manufacturers from limiting delivery of 340B drugs to contract pharmacies, including those affiliated with PBMs. - COA argues the law protects contract pharmacy arrangements without requiring proof that the arrangements lower patient costs or improve access.

Between the lines: - The filing widens the fight over 340B from a narrow legal dispute into a broader debate about who benefits from the program. - COA is using frontline oncology practices to argue that the program’s financial incentives may be drifting away from patient care. - The brief leans on research that questions whether 340B has expanded beyond its original safety-net purpose. - A study in The Milbank Quarterly found that Congress created 340B to preserve discounted medicines for core safety-net providers and concluded the program’s current scope has expanded beyond that intent. - An October 2026 ASPE report, Mission vs. Margin, said 340B’s financial incentives may favor revenue generation over patient needs and encourage consolidation that can hurt affordability. - COA says the research supports its updated 340B position statement calling for transparency, accountability and reforms.

What’s next: - The Supreme Court will decide whether to take up the Mississippi case. - COA says it will continue pressing its 340B arguments in court and in policy debates. - The organization has already filed related amicus briefs in the Tenth Circuit and in support of Arkansas’ law regulating PBM pharmacy ownership.

The bottom line: - COA wants the Supreme Court to decide whether 340B contract pharmacy rules are helping cancer patients or mainly protecting a financial model that benefits intermediaries.