In Episode 130 of DC EKG, Joe Grogan sits down with Ryan Long to unpack two policy stories that are driving real-world drug costs and healthcare spending: the 340B program and the fallout from Medicare Part D changes under the Inflation Reduction Act. Ryan explains why the current 340B structure can incentivize higher costs, hospital consolidation, and contract pharmacy expansion, while often directing the biggest windfalls toward larger, wealthier systems rather than truly resource-constrained hospitals. They cover contract pharmacies, exposure to diversion and fraud, Medicare Part B reimbursement dynamics, and why reforms need to address the incentives baked into the program. They then turn to Medicare Part D, the shift from copays to coinsurance, premium pressure, the accelerated move into “catastrophic” coverage, and what happens when Washington promises savings that do not materialize. The episode closes with a broader look at fraud, program integrity, and why durable reform requires Congress to act. In This Conversation Why does 340B incentivize higher costs and hospital consolidation  Contract pharmacies, diversion risk, and fraud exposure  Who really benefits from 340B and why rural hospitals can lose out  Medicare Part D premium pressure and the IRA tradeoffs  Copays vs coinsurance and what seniors experience at the pharmacy counter  Fraud, program integrity, and why limited resources should go to patients who need them Timestamps340B program, contract pharmacy, hospital consolidation, drug pricing, Medicare Part D, Medicaid rebate, Affordable Care Act, healthcare spending, healthcare costs, fraud exposure, policy impact, legislative reform, patient assistanceAbout Our GuestRyan Long is a Fellow at the Paragon Health Institute and a Scholar at the USC Schaeffer Center. He previously served as health policy lead for Speaker Kevin McCarthy and is a longtime Energy and Commerce veteran focused on drug pricing, Medicare, Medicaid, and healthcare spending reform. Podcast: DC EKG with Joe GroganEpisode: 130Guest: Ryan LongSponsor: Survivors for Solutions – https://survivorsforsolutions.orgExecutive Producer: John “CZ” Czwartacki, DC EKG PodcastProducer:  Stay on Course Studios – https://www.stayoncourse.studio