患者是否在合同药房柜台获得340B药品折扣？

Table of contentsAbstractIntroduction340B drug discount cardsMethodsDataIdentification of 340B discount sharing mechanismsPercentage of claims using a 340B cardLimitationsFindingsDiscussionConclusionReferencesAbout the authorsAcknowledgements 12444456689101212 AbstractThe question of whether patients of hospitals andclinics participating in the 340B Drug Pricing Program(“340B program”) receive financial assistance whenfilling prescriptions has become central to 340B policydebates and litigation. Against a backdrop framed bythe rapid increase in 340B revenue generated usingcontract pharmacies, advocates and critics of theprogram offer sharply different perspectives on whether340B discounted prices are shared with patients fillingprescriptions at those pharmacies.To address that question, this study used a nationalsample of branded, self-administered drugs to examine340B patient discount sharing at contract pharmaciesbetween July 2020 and June 2024, completed as a follow-up to an earlier study performed by our group threeyears ago. We found that 340B drug discount cardscontinued to be the dominant mechanism used forsharing 340B discounts with patients, when assistancewas provided, and that 340B discount cards were usedin approximately 0.17% of all branded prescriptions atcontract pharmacies, whether 340B or not. iqvia.com | 1In Q3 2020, when the first manufacturer introduced acontract pharmacy policy designed to limit the use ofthose pharmacies, 340B cards were used on 3.0% ofall branded 340B prescriptions. In Q2 2024, by whichtime approximately three dozen manufacturers hadintroduced contract pharmacy policies, 340B cards wereused on 4.7% of branded 340B prescriptions filled atthose pharmacies. Despite 340B advocates’ assertionsto the contrary, these data do not support the notionthat manufacturer contract pharmacy policies reducedpatient assistance using 340B discount cards.Although 340B card usage was not adversely affectedby manufacturer contract pharmacy policies, patientassistance using 340B cards, both before and aftermanufacturer policies were implemented, was wellbelow the 32% of U.S. adults who were uninsured orunder-insured at the time of the study. Disproportionateshare hospitals — which receive the vast majority ofall revenue generated by the 340B program — weresubstantially less likely than health center grantees toprovide financial assistance to their patients. 2 | Do Patients Receive 340B Drug Discounts at the Contract Pharmacy Counter?model with separate pharmacies designed to leverage340B pricing for drugs that the covered entities do notdispense or administer. HRSA later explained that thisconcept of a contract pharmacy was developed by theagency and covered entities “as early as 1993”, following“program implementation”.7In a contract pharmacy arrangement, the 340B hospitalor clinic claims 340B pricing for a drug dispensed oradministered to a person at a pharmacy that is notowned or operated by the covered entity. The pharmacyonly has a contract with the covered entity to providedrugs to customers deemed to be the entity’s patients.Many contract pharmacy transactions involve eitherretail or specialty mail pharmacies affiliated with thelargest commercial payers, their pharmacy benefitmanagers, or their large, affiliated, national for-profitretail pharmacy chains.The scope of contract pharmacy transactions hasevolved over time. When HRSA first permitted contractpharmacies in 1995, it sought only to permit a singlecontract pharmacy for each 340B hospital or clinic.8However, in 2010, HRSA issued further guidance thatpurported to allow 340B hospitals and clinics to use anunlimited number of contract pharmacies, significantlyexpanding the ability of contract pharmacies to leverage340B pricing.9Between April 2010 and April 2020, thenumber of contract pharmacies grew, as a result, bymore than 4,000%.10 IntroductionThe 340B Drug Pricing Program (“340B program”) is afederal program in which manufacturers provide heavilydiscounted drugs to certain specified providers that aresupposed to deliver “direct care” to the uninsured andthe under-insured.1The program has evolved in waysthat have sparked controversy regarding its financialimpact and distribution of 340B drug discount revenue.A central question in the policy debates and litigationengulfing the program is the charge, made by 340Bcritics, that the evidence of 340B patients receivingfinancial assistance at the pharmacy counter is poor,while defenders of the program contend that many 340Bhospitals and clinics routinely provide that assistance.The debate has been particularly pointed in the litigationover manufacturer efforts to implement contractpharmacy policies2,3,4,5and was also a focus of discussionin the U.S. Senate HELP Committee Majority Staff’srecently released report on the 340B program.When it was first introduced in 1992, the programwas small, the number of allowable types of coveredentity was limited, and the program did not involve