4th Circuit Rules for Pharma: Maryland's 340B Contract Pharmacy Access Law Vacated, State-Level Protections Weakened
Issue
The U.S. Court of Appeals for the Fourth Circuit vacated the lower court ruling that had upheld Maryland's 340B contract pharmacy access law, siding with AbbVie, Novartis, and AstraZeneca. The ruling weakens the state-law backstop strategy — where states pass their own 340B protections when federal enforcement stalls.
A competing 5th Circuit ruling (upholding Mississippi's similar law) creates a circuit split that may push the issue to the Supreme Court. H.R. 7391 would shield FQHCs from the rebate pilot but has not left committee, and this ruling signals pharma is winning in the courts against state-level protections nationally.
Key points
- State-level 340B protection laws are losing in federal courts. Two federal bills, H.R. 7391 and S. 5244, would curb the 340B rebate pilot; neither has moved, and neither addresses state contract-pharmacy laws
- 4th/5th Circuit split may head to SCOTUS — major uncertainty for FQHCs without in-house pharmacies
Sources for this story
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Part of
- 340B drug pricing
State contract-pharmacy laws and the circuit split · Manufacturer restrictions and data demands
FQHC Talent. (2026, April 15). 4th Circuit Rules for Pharma: Maryland's 340B Contract Pharmacy Access Law Vacated, State-Level Protections Weakened. Source: 340B Report. Retrieved October 6, 2026, from https://www.fqhctalent.com/intel/340b-fourth-circuit-maryland-state-law-vacated
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