Impact of 340B Exposure on Treatment Utilization and Cost for Medicare Patients With Cancer.

OBJECTIVE

To investigate how exposure to the 340B Drug Pricing Program influences care for patients with the two most common forms of cancer: lung and breast.

STUDY SETTING AND

DESIGN

Proponents of the 340B Program assert that it reduces care costs by supporting safety-net providers through outpatient drug discounts. There is a gap in understanding patient-level program impacts. We estimate the association between the 340B program and care utilization, treatment costs, and health outcomes by comparing patients exposed to the 340B program to patients not exposed using linear and logistic multivariate regression analyses with propensity score weighting. Costs are inflation-adjusted to U.S. 2020 dollars.

DATA SOURCES AND ANALYTIC SAMPLE: We use Medicare fee-for-service claims data for beneficiaries in the United States who are within one year of an initial lung (N = 35,334) or breast (N = 83,721) cancer diagnosis between 2013 and 2018.

PRINCIPAL FINDINGS: Exposure to the 340B program is associated with a significant increase in the probability of using Part B-covered cancer treatment drugs of 10.8 percentage points (pp) (95% CI, 9.2 pp. to 12.3 pp) for lung cancer and 14.8 pp. (95% CI, 13.9 pp. to 15.6 pp) for breast cancer. This is a relative increase of 19.6% and 43.1% for lung and breast cancer, respectively. Medicare spent $9592 (95% CI, $8498 to $10,686) more on lung cancer and $7598 (95% CI, $7215 to $7980) more on breast cancer patients exposed to the 340B program compared with patients not exposed, where the average cost of treatment was $36,256 and $15,626 for lung and breast cancer, respectively.

CONCLUSIONS

Findings are consistent with the financial incentives of the 340B program and highlight that the program has a broad impact on patient care and cost. Policymakers should consider ways to support safety net providers that are not tied to outpatient medications.