340B对州雇员健康计划的成本

The Cost of 340B to StateEmployee Health Plans Stretching Federal Resources or State Budgets? CHUAN SUN, MS, MA,IQVIA Market Access Technology SolutionsHARISH KARNE, MS,IQVIA Market Access Technology SolutionsRORY MARTIN, PHD,IQVIA Market Access Technology Solutions Table of contents AbstractIntroductionTheTheState Abstract on self-administered drugs alone, with a weightedaverage markup of 162%. From Q3 of 2024 to Q2 2025(four quarters), state totals vary from $0.5 million inOklahoma to $89 million in New York. There is alsosignificant variation in the per-patient 340B spread,ranging from as low as $23 in New Jersey to as high as The 340B Drug Pricing Program (“340B program”) is afederal drug discount program in which drugmakersprovide heavily discounted drugs to participatinghospitals and clinics. These 340B providers thenprescribe the discounted drugs to patients and charge This study quantifies the fiscal impact of the 340Bprogram on state employee health plans across theUnited States, focusing on the “spread” betweendiscounted 340B prices paid by 340B providers and These excess pharmacy costs, taken in combination withthe fact that the 340B discount is rarely passed on topatients, have direct implications for state employees,taxpayers, and the sustainability of state-sponsoredhealth benefits. The burden is not limited to state health Our analysis shows that state employee health plansincurred about $1 billion in 340B upcharges annually Introduction The 340B program was forecast to exceed $170 billion insales at list price for 2025 [IQVIA preliminary estimate],and is poised to overtake Medicare Part D as the largest fees are up to 14% of the reimbursed amount of thedrug, or $65 per prescription if a flat fee is used.4The same report revealed that TPAs reported their fees are8-20% of the reimbursed amount of the drug. Contract Participating 340B hospitals and clinics generate 340Brevenue through the “spread” between the discountedacquisition cost of the drug and the reimbursementreceived from payers, and 340B providers assert they There is limited evidence of a direct benefit forvulnerable populations from the 340B program. Despite the program having grown by 98.5% from 2018 to 2022measured at list price,6340B hospital charity care ratios The size of 340B spread revenue,middlemen, and patient benefit The cost of the 340B program A recent report published by the North Carolina StateTreasurer estimated that 340B hospitals in that state 340B providers have asserted the program coststaxpayers nothing because it is solely funded by drug charged 5.4 times the amount they paid for 340B IVoncology drugs, collecting an 85% higher averageprice markup than non-340B hospitals.1Also, the large manufacturers.4,9However, this claim is not supported bydata-driven studies. For example, it has been estimated that the program costs self-insured employers and theirworkers over $5 billion a year because 340B discounts displace manufacturer rebates to employers.10A follow- Recent state and federal reports indicate that asubstantial amount of 340B revenue is being extractedas fees by for-profit middlemen such as nationalpharmacy chains, acting as contract pharmacies, and State employee plans by Third-Party Administrators (TPAs). For example, a When 340B hospitals and clinics acquire medicinesat substantial discounts but charge payers at orabove standard rates, the additional cost is borne Data and methods Data This study utilizes a combination of public and IQVIAproprietary data sources, including IQVIA’s LongitudinalAccess and Adjudication Dataset (LAAD) for pharmacy LAAD is a national sample of pharmacy claims thatincludes details about patient cost-sharing as wellas plan and payer information. While physician-administered drugs may qualify for the 340B program, State employee health plans across the countryare facing mounting financial strain. For instance, We also used public data for state employee health planenrollment to check for robustness and conduct analyses the Massachusetts Senate recently passed a bill for$240 million to cover a shortfall in the state health insurance fund.13In Florida, the state employee healthplan reported an operating loss of $296 million for Methods STEP 1: CLASSIFY PBM/PAYER/PLAN We identified plans funded by state or localgovernments, covering public employees and their STEP 2: APPLY TIMEFRAME CRITERIA Plans were selected based on prescription claim volumewithin the study period: July 1, 2023 – June 30, 2025. STEP 3: SEGMENT PLANS BY FUNDING SOURCE This study estimates the amount of 340B profit beinggenerated by 340B providers using state employee healthplans and patients. By accurately establishing the true costof the 340B program for state employee plans, we hope The study focused on primary state plans consisting ofstate employee plans only. Examples include CalPERS,Health Select of Texas (the plan for the EmployeesRetirement System of Texas),