340B
Loren Bonner
Are health care providers generally unfamiliar with which drugs are available at reduced prices in their health care system?
An article published in the November 2024 issue of the American Journal of Health-System Pharmacy American Journal of Health-System Pharmacy reports that providers in a federally qualified health center (FQHC) believed that the 340B program benefits patients and their organization. However, the findings suggested they lack a complete understanding of the program. In a nutshell, the federal 340B Drug Pricing Program allows qualifying hospitals and clinics that treat low-income and uninsured patients to buy outpatient prescription drugs at a discount of 25% to 50%. The program is intended to help safety-net health care providers, such as FQHCs.
“Only about half of respondents were able to correctly answer at least half of the knowledge-focused items,” said lead study author Adriane Irwin, PharmD, from Oregon State University College of Pharmacy. “Some of the knowledge gaps related to key elements of the 340B program, such as its underlying intent or how it generated savings for the organization.”
Irwin said she was initially shocked at the extent of the knowledge gaps.
Irwin and fellow researchers conducted a 27-item survey designed to assess prescriber knowledge and perspectives toward the 340B program. The survey was administered to a total of 198 health care providers with prescribing authority. Of those, 65 (32.8%) participated. The majority of respondents (66.2%) were female, 41.5% were 35 years old or younger, and 49.2% were physicians.
For the research, Irwin and the team partnered with a network of community health centers. However, all respondents were from the same organization, which may not be
generalizable to other 340B qualifying organizations, said Irwin.
“We also excluded pharmacists, so this project does not capture pharmacist knowledge or perceptions of the 340B program,” added Irwin.
Which drugs at which prices?
Irwin said the motivation for the research arose from a patient care perspective.
“It was noted that prescribers were sometimes gravitating toward older medications over guideline-directed therapies,” she said. “It was speculated that cost may be a driver and that prescribers were unaware that some newer medications could be affordable through the 340B Drug Pricing Program. This study aimed to explore this speculation by evaluating prescriber knowledge of the 340B program.”
The majority of survey respondents agreed that patients benefited from access to their organization’s 340B pharmacies (95.0%) and that 340B pricing is important to consider when prescribing medications (78.3%).
However, knowledge of the 340B program was limited, with only half of respondents (54.0%) able to correctly answer at least four of seven knowledge-focused items. Responses to a patient case suggested that some providers may be unfamiliar with which drugs are available at reduced prices.
Controversial program
Irwin said their findings may also help explain some of the “chaotic public dialogue” that surrounds the 340B program.
According to the Commonwealth Fund, the 340B program has grown significantly since its creation in 1992. Not only are more health care providers eligible to participate, but the volume of drugs purchased through the program has also increased. As a result, drugmakers, providers, and federal policymakers have been entangled in legal battles in more recent years.
“The 340B program is complex,” said Irwin. “If health care providers who practice in an FQHC have an incomplete understanding of the 340B program, then it is likely that many others have similar knowledge gaps.”
Irwin said she believes education about the program could help alleviate some of the controversy and scrutiny that surrounds 340B.
“There has been a lot of scrutiny on the 340B program. While some critiques of the 340B program are valid, many are not—and many are grounded in fundamental misunderstandings of the program and its intent,” said Irwin. ■