You would never pay a restaurant bill without an itemized check. And if that bill charged you twice for the same steak, you would dispute it on the spot. 

Unfortunately, federal programs don’t always operate using this kind of common sense. In fact, the 340B drug discount program, which moves more than $100 billion a year, has never worked that way. 

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So it is refreshing that the Trump administration is proposing to change that by asking participating hospitals to itemize their invoices before discounts are paid.

Paying a 340B claim without claims-level data is like settling that tab sight unseen, right down to the risk of being charged twice for the same steak, which in 340B is the same drug getting discounted under two programs at once. The principle is the same either way: show your work before the money moves. 

Some nonprofit hospitals mark up steeply discounted drugs by hundreds of percent while patients pay full cost-sharing on those same drugs. Under current rules, almost no one can see which hospitals are doing........

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