In this episode of DC EKG, policy expert Ryan Long unpacks the tangled evolution of the 340B program—from its origins in the early 1990s to its explosive, unintended role in today’s healthcare market. Originally designed to help hospitals serving the uninsured access affordable drugs, 340B has morphed into a tool for profit, driving hospital consolidation, inflating costs, and straining the biotech innovation ecosystem. Ryan explains how vague eligibility rules, lack of oversight, and policy loopholes have turned a small support program into a massive $54 billion industry—with no requirement that savings actually reach the patients it's meant to help. This is a must-listen for anyone interested in how drug pricing policy, hospital behavior, and innovation incentives are shaping the future of medicine in America.