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. 2023 Jun 2;4(6):e231485.
doi: 10.1001/jamahealthforum.2023.1485.

Association Between New 340B Program Participation and Commercial Insurance Spending on Outpatient Biologic Oncology Drugs

Jessica Chang  1 , Pinar Karaca-Mandic  2 , Sayeh Nikpay  1 , Molly Moore Jeffery  3
Affiliations

Association Between New 340B Program Participation and Commercial Insurance Spending on Outpatient Biologic Oncology Drugs

Jessica Chang et al. JAMA Health Forum. .

Abstract

Importance: Previous studies have found that hospitals participating in the 340B Drug Pricing Program have higher Medicare Part B spending and expansion into affluent neighborhoods. Less is known about the association of 340B participation with spending by commercial insurance, where reimbursements are higher than Medicare.

Objective: To use the Affordable Care Act expansion of eligibility for the 340B Drug Pricing Program to study the association between participation and spending on outpatient-administered oncological drugs for commercially insured patients.

Design, setting, and participants: This cohort study included a balanced panel hospital cohort containing new and never 340B program participants between 2007 and 2019; more recent data were not included to avoid the effect of disruptions in care due to the COVID-19 pandemic. Descriptive analyses documented spending trends for patients receiving common outpatient-administered biologics used in cancer treatments (bevacizumab, filgrastim, pegfilgrastim, rituximab, and trastuzumab) at 340B (treated) and non-340B (control) hospitals. A difference-in-differences model assessed changes in episode drug spending. Analyses were conducted between December 2021 and June 2022.

Exposure: New 340B program participation between 2010 and 2016.

Main outcome and measures: Total drug episode spending, with control variables including total billed units, drug, calendar-year fixed effects, and hospital fixed effects.

Results: Of 95 127 included episodes (56 917 [59.8%] episodes in female patients) across 478 hospitals, patients seen in 340B and non-340B hospitals were similar in sex and drug used, and 340B hospital patients were older than non-340B patients (median [IQR] age for all patients, 61 [51-71] years). New 340B participating hospitals were more likely to be small (<50 beds) and more likely to be in rural settings. In the difference-in-differences analysis, total episode drug spending increased by $4074.69 (95% CI, $1592.84-$6556.70; P = .001) in the year following start of 340B program participation relative to nonparticipants. Heterogeneous group time effects were seen, with earlier participants less likely to have increased episode spending.

Conclusions and relevance: In this cohort study, new 340B participation was associated with statistically significant higher oncological drug episode spending compared with nonparticipants after changes in 340B inclusion rules in 2010. These findings raise questions about unintended consequences of the 340B program on drug spending from the commercially insured population.

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Conflict of interest statement

Conflict of Interest Disclosures: Ms Chang is an employee at the Health Care Cost Institute for work unrelated to this article and a doctoral candidate at the Division of Health Policy and Management at the University of Minnesota School of Public Health. Dr Karaca-Mandic reported grants from the Agency for Healthcare Research and Quality, the National Institute for Health Care Management, the National Institute on Drug Abuse, the Robert Wood Johnson Foundation, and the United Health Foundation; personal fees from the Mayo Clinic, Koya Medical, Sempre Health, and XanthosHealth; and serving in an executive position and holding equity in XanthosHealth outside the submitted work. Dr Nikpay reported grants from the National Heart, Lung, and Blood Institute and the Agency for Healthcare Research and Quality outside the submitted work. Dr Jeffery reported grants from the Agency for Healthcare Research and Quality; the National Heart, Lung, and Blood Institute; the National Institute on Drug Abuse; the Centers for Disease Control and Prevention; the National Center for Advancing Translational Sciences; and the US Food and Drug Administration outside the submitted work.

Figures

Figure 1.
Figure 1.. Trends in Outpatient Drug Utilization and Unadjusted Average Episode Spend Before and After 340B Drug Pricing Program Participation
Utilization was defined as the number of patient episodes, and 0 represents the year of 340B program participation. For non-340B hospitals, a pseudo-340B start year was randomly assigned. Error bars indicate 95% CIs.
Figure 2.
Figure 2.. Event-Study Difference-in-Differences on Total Episode Spending Between 340B and Non-340B Hospitals, Pooled Sample
Model included calendar year, event time, episode drug, hospital fixed effects, and patient characteristics (age group, insurance type, state of residence, and sex). Error bars indicate 95% CIs, and 0 represents the year of 340B Drug Pricing Program participation. Full model specification is included in the eMethods in Supplement 1.
Figure 3.
Figure 3.. Event-Study Difference-in-Differences on Total Episode Spending Between 340B and Non-340B Hospitals by Insurer Segment
Model included calendar year, event time, episode drug, hospital fixed effects, and patient characteristics (age group, state of residence, and sex). Error bars indicate 95% CIs, and 0 represents the year of 340B Drug Pricing Program participation. Full model specification is included in the eMethods in Supplement 1.
See this image and copyright information in PMC

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