However, in recent years lawmakers, pharmaceutical companies and others have questioned whether the savings and revenue generated by the 340B program are being used to improve care for those patient populations. Participating providers are not required to directly pass along the discounts to patients. A spokesman for the Health Resources and Services Administration said the law does not require the agency to direct how providers use 340B savings.
The authors of the study, published Monday in the journal Health Affairs, are Rena Conti, assistant professor of health policy and economics at the University of Chicago, and Dr. Peter Bach, director of Memorial Sloan Kettering Cancer Center's Center for Health Policy and Outcomes. Both have been critical of the 340B program – matched data for 960 DSH hospitals and 3,694 affiliated clinics participating in the 340B program in 2012 against socioeconomic data about communities from the US Census Bureau.
Newer participants—those providers that joined 340B in or after 2004—serve communities with lower poverty rates and higher income levels than the providers that began participating in 340B before 2004, Conti and Bach found. They also concluded that affiliated clinics that hospitals registered in 2004 or later are in communities with lower rates of uninsurance than the locations of their parent institutions. “These results suggest that the expansions among 340B DSH hospitals run counter to the program's original intention,” they wrote.
The scrutiny over how providers use the 340B savings and revenue along with the program's expansion under the Affordable Care Act has led to calls to reevaluate the program, mainly from the drugmakers that are required to provide discounted drugs to a rapidly growing number of 340B providers. The number of 340B providers nearly doubled from 2001 to 2011.
Bach and Conti pressed for more data to understand how the 340B program is benefiting patients in the communities where 340B providers operate. “Few data are available to systematically assess the impact that the expansion of 340B-qualified hospitals may be having on medical care spending, access and quality,” they wrote.
The Safety Net Hospitals for Pharmaceutical Access, a trade group for 340B hospitals, criticized the analysis. “The fact remains that 340B DSH hospitals support heavy caseloads of Medicaid and low-income Medicare patients—regardless of where their outpatient clinics are located,” the association said in a statement. “Savings from the program are essential in helpings all safety-net hospitals treat vulnerable populations.”
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