A comparison of medication access services at 340B and non-340B hospitals

Rana, Isha; Oehsen, William von; Nabulsi, Nadia A.; Sharp, Lisa K.; Donnelly, Andrew J.; Shah, Sima Dinesh; Stubbings, JoAnn; Durley, Sandra F.

doi:10.1016/j.sapharm.2021.03.010

Cited by 9 publications

(17 citation statements)

References 17 publications

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“…One study found that 340B participation of disproportionate share hospitals was associated with a 29% increase in charity care spending, a 4% increase in discounted care, and a 19% increase in the income eligibility limit for discounted care, but was not associated with the offering of low-profit medical services . Another study found that 340B hospitals provided more medication access services and outpatient treatment services for drugs, alcohol, and HIV/AIDS compared with non-340B hospitals …”

Section: Resultsmentioning

confidence: 99%

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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Section: Resultsmentioning

confidence: 99%

Outcomes of the 340B Drug Pricing Program

Knox,

Wang,

Feldman

et al. 2023

JAMA Health Forum

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“…Although the mechanism was uncertain, prior work demonstrated that 340B hospitals more often invest in programs that improve the quality of care delivered, such as medication therapy management services. 11 These services encompass various components that seek to detect and prevent therapy-related problems (e.g., costs, complications) through the involvement of health care professionals, such as pharmacists, providing patients with the education F I G U R E 1 (A) Use of oral specialty drug. Hospital 340B participation (left) was not associated with use of an oral specialty drug, as use was similar between 340B participating and nonparticipating hospitals (22% vs. 23%; p = .63).…”

Section: Discussionmentioning

confidence: 99%

“…10 Some studies have demonstrated that participating hospitals invest in patient-centered activities, such as medication management services, and provide drug discounts to disadvantaged patients. 11,12 However, others have shown that program participation did not increase safety-net expansion. 13,14 Despite these mixed findings, the effects of the program on cancer care, which is expensive and commonly associated with financial toxicity, 15,16 is unclear.…”

Section: Introductionmentioning

confidence: 99%

The 340B Program and oral specialty drugs for advanced prostate cancer

Faraj,

Kaufman,

Oerline

et al. 2024

Cancer

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IntroductionExpensive oral specialty drugs for advanced prostate cancer can be associated with treatment disparities. The 340B program allows hospitals to purchase medications at discounts, generating savings that can improve care of the socioeconomically disadvantaged. This study assessed the effect of hospital 340B participation on advanced prostate cancer.MethodsThe authors performed a retrospective cohort study of Medicare beneficiaries with advanced prostate cancer from 2012 to 2019. The primary outcome was use of an oral specialty drug. Secondary outcomes included monthly out‐of‐pocket costs and treatment adherence. We evaluated the effects of 1) hospital 340B participation, 2) a regional measure vulnerability, the social vulnerability index (SVI), and 3) the interaction between hospital 340B participation and SVI on outcomes.ResultsThere were 2237 and 1100 men who received care at 340B and non‐340B hospitals. There was no difference in specialty drug use between 340B and non‐340B hospitals, whereas specialty drug use decreased with increased SVI (odds ratio, 0.95, p = .038). However, the interaction between hospital 340B participation and SVI on specialty drug use was not significant. Neither 340B participation, SVI, or their interaction were associated with out‐of‐pocket costs. Although hospital 340B participation and SVI were not associated with treatment adherence, their interaction was significant (p = .020). This demonstrated that 340B was associated with better adherence among socially vulnerable men.ConclusionsThe 340B program was not associated with specialty drug use in men with advanced prostate cancer. However, among those who were started on therapy, 340B was associated with increased treatment adherence in more socially vulnerable men.

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“…Most are part of a 340B covered entity, which helps to support the provision of medication access services such as prior authorization, free or discounted medications, and patient assistance programs. 6 Health-system specialty pharmacies dispense nonspecialty medications in addition to specialty medications. They employ an average of 13 pharmacists and 15 technicians, with a nearly 1:1 ratio of pharmacists to technicians.…”

Section: Discussionmentioning

confidence: 99%

“…(2) generally injectable and/or not selfadministered; (3) need for additional level of care in the chain of custody; (4) annual cost of therapy of $6,000 or more; (5) unique distribution; (6) need for extensive or in-depth monitoring and/or patient counseling; and (7) require reimbursement assistance. 3 In 2020, the United States spent $265.3 billion on specialty medications, representing 49.6% of total pharmaceutical expenditures.…”

mentioning

confidence: 99%

ASHP National Survey of Health-System Specialty Pharmacy Practice—2020

Stubbings¹,

Pedersen

Low

et al. 2021

American Journal of Health-System Pharmacy

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Purpose Results of the first ASHP National Survey of Health-System Specialty Pharmacy Practice are presented. Methods A sample of 230 leaders in health-system specialty pharmacies were contacted by email and invited to participate in a survey hosted using an online survey application. The survey sample was compiled from ASHP member lists, through review of data from other ASHP surveys indicating the presence of specialty pharmacies, and by outreach to ASHP member organizational leaders. Results The response rate was 53.0%. Most health-system specialty pharmacies dispense 30,000 or fewer specialty prescriptions per year, have an annual revenue of $100 million or less, are part of an entity eligible to participate in the 340B Drug Pricing Program, operate 1 specialty pharmacy location, have at least 1 specialty pharmacy accreditation, dispense nonspecialty medications in addition to specialty medications, and employ an average of 13 pharmacists and 15 technicians. More than two-thirds of health-system specialty pharmacies (68.8%) dispense no more than half of the prescriptions written by their providers due to payer network restrictions or limited distribution drugs. The health-system specialty pharmacy practice model includes access to the electronic health record (100% of respondents), pharmacists and technicians dedicated to specific clinics (64.9% and 57.7%, respectively), specialty pharmacist involvement in treatment decisions and drug therapy selection prior to the prescription being written (64.9%), and documenting recommendations and progress notes in patients’ electronic health record (93.4%). Most health-system specialty pharmacies (83.3%) offer experiential or formal education in specialty pharmacy. Top challenges that survey respondents expected to face in the next year included restricted access to payer networks and limited distribution drugs, 340B Drug Pricing Program changes, and shrinking reimbursement from payers. Conclusion The health-system specialty pharmacy represents an integrated advanced practice model that incorporates specialty medication-use management across the continuum of care.

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A comparison of medication access services at 340B and non-340B hospitals

Cited by 9 publications

References 17 publications

Outcomes of the 340B Drug Pricing Program

Outcomes of the 340B Drug Pricing Program

The 340B Program and oral specialty drugs for advanced prostate cancer

ASHP National Survey of Health-System Specialty Pharmacy Practice—2020

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