The unintended consequences of the 340B safety‐net drug discount program

Thomas, Samuel

doi:10.1111/1475-6773.13281

Cited by 9 publications

(13 citation statements)

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“…Eleven (55%) included payer-specific pharmaceutical prices. Of the hospitals that released pharmaceutical data, 82% (and 85% of hospitals overall) were 340B entities, which entitled them to acquire drugs from manufacturers at prices below the ASP …”

Section: Resultsmentioning

confidence: 99%

“…Of the hospitals that released pharmaceutical data, 82% (and 85% of hospitals overall) were 340B entities, which entitled them to acquire drugs from manufacturers at prices below the ASP. 3 Prices varied between and within hospitals (Figure). Median negotiated prices for the 10 drugs in the study sample ranged from 169% (IQR, 137%-264%) of the Medicare payment limit at Rush University Medical Center to 344% (IQR, 307-368%) at the Mayo Clinic Hospital-Arizona, and median self-pay cash prices ranged from 149% (IQR, 124%-203%) of the Medicare payment limit at Rush to 306% at Brigham and Women's Hospital (IQR, 273%-327%) and Massachusetts General Hospital (IQR, 283%-327%; Table ).…”

Section: Payer-specific Negotiated Prices For Prescription Drugs At T...mentioning

confidence: 99%

“…Although prior research has focused on the role of clinical training in auscultation proficiency, 1,2 it remains unclear why even experienced practitioners achieve only 40% to 70% sensitivity in detecting VHD compared with echocardiography. [3][4][5] It is possible that in addition to auscultatory training, the quality of heart sounds also plays a role. Clinically undetectable or distant heart sounds have been anecdotally reported to occur in some settings.…”

Section: Clinically Undetectable Heart Sounds In Hospitalized Patient...mentioning

confidence: 99%

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Payer-Specific Negotiated Prices for Prescription Drugs at Top-Performing US Hospitals

et al. 2022

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Section: Resultsmentioning

confidence: 99%

Section: Payer-specific Negotiated Prices For Prescription Drugs At T...mentioning

confidence: 99%

Section: Clinically Undetectable Heart Sounds In Hospitalized Patient...mentioning

confidence: 99%

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Payer-Specific Negotiated Prices for Prescription Drugs at Top-Performing US Hospitals

et al. 2022

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“…The drug spending difference between 340B and non-340B hospitals found in previous studies suggests that drug discounts of the 340B program incentivize 340B hospitals to prescribe more or higher-priced medicines to their patients. 4 , 16 To remove the assumed financial incentives associated with the program and subsequently eliminate the drug spending difference between 340B and non-340B hospitals, the CMS adopted the 340B payment policy. 4 However, our study shows no association between higher drug spending and 340B status after adequately adjusting for beneficiary-level and hospital-level risk factors.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings have important implications for evaluating the 340B program and CMS 340B payment policy. The drug spending difference between 340B and non-340B hospitals found in previous studies suggests that drug discounts of the 340B program incentivize 340B hospitals to prescribe more or higher-priced medicines to their patients . To remove the assumed financial incentives associated with the program and subsequently eliminate the drug spending difference between 340B and non-340B hospitals, the CMS adopted the 340B payment policy .…”

Section: Discussionmentioning

confidence: 99%

Association of Beneficiary-Level Risk Factors and Hospital-Level Characteristics With Medicare Part B Drug Spending Differences Between 340B and Non-340B Hospitals

2022

JAMA Netw Open

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IMPORTANCECritics of the federal 340B Drug Pricing Program raised concerns that the program might provide financial incentives for participating hospitals to prescribe more and/or more expensive drugs because the revenue generated from Medicare reimbursement exceeds the purchase price by a substantial margin. Studies showing higher Medicare Part B drug spending at hospitals that are 340B hospitals, which can purchase outpatient drugs from manufacturers at discounted prices, compared with non-340B hospitals were used by the Centers for Medicare & Medicaid Services to justify their 340B payment policy that reduced Medicare payments for drugs in the 340B program in 2018 and thereafter. The Centers for Medicare & Medicaid Services attributed higher spending to the 340B benefit and believed that payment cuts would reduce the financial incentives associated with higher spending. However, the lack of sufficient risk adjustments is a significant concern of study validity. OBJECTIVE To examine whether per-beneficiary Medicare Part B drug spending is significantly different between 340B and non-340B hospitals while adequately controlling for patient-level and hospital-level risk factors. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study was conducted from October 1, 2020, to May 30, 2021, using 2017 administrative claims data from a random 5% sample of Medicare fee-for-service beneficiaries. Included beneficiaries had at least 1 separately payable non-pass-through drug claim in 2017, were fully enrolled in Part A and Part B through 2017, and did not die in 2017. MAIN OUTCOMES AND MEASURESThe outcome was separately payable Part B drug spending. RESULTS The sample included 35 364 beneficiaries (21 825 women [61.7%]; 29 996 White patients [84.8%]; mean [SD] age, 70.6 [12.0] years) and 2446 hospitals. A total of 918 hospitals (37.5%) were in the 340B program and 938 hospitals (38.3%) were teaching hospitals. There was a higher percentage of teaching hospitals among 340B hospitals (517 of 918 [56.3%]) than non-340B hospitals (421 of 1528 [27.6%]), and beneficiaries who went to 340B hospitals were more likely to be non-White than those who went to non-340B hospitals (3360 of 19 139 [17.6%] vs 1583 of 13 710

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Outcomes of the 340B Drug Pricing Program

Knox,

Wang,

Feldman

et al. 2023

JAMA Health Forum

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ImportanceThe 340B Drug Pricing Program requires manufacturers to offer discounted drug prices to support safety net hospitals and clinics (covered entities) providing care to low-income populations. Amid expansion, the program has received criticism and calls for reform.ObjectiveTo assess the literature on the foundations of and outcomes associated with the 340B program.Evidence ReviewThe databases searched in this scoping review included PubMed, Embase, EconLit, National Bureau of Economic Research (NBER), Westlaw, the Department of Health and Human Services Office of the Inspector General (HHS-OIG) website, the Government Accountability Office (GAO) website, and Google in February 2023 for peer-reviewed literature, legal publications, opinion pieces, and government agency and committee reports related to the 340B program.FindingsAmong a collected 900 documents, 289 met inclusion criteria: 83 articles from PubMed, 12 articles from Embase, 2 articles from EconLit, 1 article from NBER, 28 articles from Westlaw, 23 legislative history documents, 103 documents from Google, 11 GAO reports, and 26 HHS-OIG reports. Included literature pertained to 4 stakeholders in the 340B program: covered entities, pharmacies, pharmaceutical manufacturers, and patients. This literature showed that hospitals, clinics, and pharmacies generated revenue and manufacturers have forgone revenue from 340B discounted drugs. Audits of covered entities found low rates of compliance with 340B program requirements, whereas mixed evidence was uncovered on how covered entities used their 340B revenue, with some studies suggesting use to expand health care services for low-income populations and others to acquire physician practices and open sites in higher-income neighborhoods. These studies were hampered by a lack of transparency and reporting on the use of 340B revenue. Studies revealed patient benefits from access to expanded health care services, but there was mixed evidence on patient cost savings. Although the review identified considerable research on 340B hospitals, pharmacies, and patients, less research was found evaluating the 340B program’s effect on nonhospital covered entities, drug pricing, and racial and ethnic minority groups.Conclusions and RelevanceIn this scoping review of the 340B program, we found that the 340B program was associated with financial benefits for hospitals, clinics, and pharmacies; improved access to health care services for patients; and substantial costs to manufacturers. Increased transparency regarding the use of 340B program revenue and strengthened rulemaking and enforcement authority for the Health Resources and Services Administration would support compliance and help ensure the 340B program achieves its intended purposes.

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The unintended consequences of the 340B safety‐net drug discount program

Cited by 9 publications

References 11 publications

Payer-Specific Negotiated Prices for Prescription Drugs at Top-Performing US Hospitals

Payer-Specific Negotiated Prices for Prescription Drugs at Top-Performing US Hospitals

Association of Beneficiary-Level Risk Factors and Hospital-Level Characteristics With Medicare Part B Drug Spending Differences Between 340B and Non-340B Hospitals

Outcomes of the 340B Drug Pricing Program

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