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Two dozen states have waded into the heated dispute between the U.S. government and a growing number of pharmaceutical companies over a federal drug discount program, a complex, but significant battle with widespread implications for much of the American public.

In filings in two federal appeals courts, the states and the District of Columbia argued the companies have “flouted” their legal obligations to the 340B program, which requires drugmakers to offer discounts that are typically estimated to be 25% to 50% — but could be higher — on all outpatient drugs to hospitals and clinics that primarily serve lower-income patients.

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There are approximately 12,400 entities participating in the program, a number that has grown substantially in recent years. Since it began 30 years ago, the program has ballooned and fed into the national clash over the cost of medicines. In 2020, the last year for which data was available, 340B drug sales were $38 billion, a 7.2% rise from 2019, according to the U.S. government.

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