The proposed 2027 Hospital Outpatient Prospective Payment System (OPPS) rule contains one headline: a dramatic overhaul of 340B drug reimbursement. In place of the current standard of paying 340B drugs at a 6% mark-up from average sales prices, the Centers for Medicare & Medicaid Services proposes a sweeping 33.4% reduction from average sales price based on a 2026 acquisition cost survey. Because OPPS must remain budget neutral, those savings would be redistributed to non-drug outpatient services, producing an estimated 8.44% increase in total OPPS payments for non-drug care—including radiation oncology technical services. The effects are striking. Proposed relative payment increases include 26% for level 1 (77402), 17% for level 2 (77407), 14% for level 3 (77412), 11% for SBRT, 12% for proton therapy, and 14% for SRS. On the flip side, the proposal also accelerates CMS's recovery of the $7.8 billion redistributed following the Supreme Court's reversal of the original 340B cuts, increasing the OPPS conversion factor reduction from 0.5% to 3.0% annually beginning in 2027 through 2029. While the trajectory of changes has finally reversed course, we’re not sure where this ultimately leaves us relative to a couple of years ago. | ASTRO 2026
