4th Circuit Rules for Pharma: Maryland's 340B Contract Pharmacy Access Law Vacated — State-Level Protections Weakened

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. California FQHCs are protected by H.R. 7391 (340B FQHC Protection Act, 35 cosponsors) at the federal level, but this ruling signals pharma is winning in the courts against state-level protections nationally.