New Data Show 340B Works Really Well ... When Patients Get the Discounts

I’m a sucker for new social networks, so -- yeah -- I’m on Threads. It’s brianbreid.

The fundamental dispute over the 340B program seems to be not whether improving access to medicine for low-income Americans is a good idea -- there is universal agreement there! -- but whether 340B actually delivers for those patients.

Most of the time, 340B operates on via a Rube Goldberg-inspired system in which cheap drugs are given to rich (or, at least, well-insured) patients, billed to insurance, and hospitals then (in theory!) use the profits on the spread to re-invest in the community.

Hospitals, not being particularly transparent institutions, have had a hard time proving that the 340B profits go back to charity care, elevating the question of who/how/when patients actually benefit.

Of course, there is a simpler way: hospitals could just pass the low 340B prices directly to their low-income patients rather than screw around with the follow-the-dollar insurance-company arbitrage.

Indeed, an IQVIA study from last year found that such a system, using a “340B discount card” reduced patient out-of-pocket costs by 93% … but that 340B discount cards were only used to 1.4% of 340B claims.

Anyway: a new study out by executives at a small Kansas hospital system assessed a program in which discounted 340B treatments for chronic obstructive pulmonary disease were given directly to patients, essentially turning $350 monthly burden for inhalers into a $15 payment.

The result was that patients ended up in the ER a lot less, they had much smaller medical bills overall, and a much smaller tab for their prescription drug use.

I don’t want to be so naive as to think that 340B can magically be fixed with some changes in the way that hospitals approach the program, but it sure looks like prioritizing patient benefit ought to be a guiding principle of any reform effort.

Big day for PhRMA today. CEO Steve Ubl has an op-ed out in STAT arguing that the administration’s drug-pricing approach is all wrong and “while the president promised a war on cancer, he declared a war on the cure instead.” Ubl points to three areas of concern: eroding IP protection, the IRA and monkeying with accelerated approval.

In addition, there was a great piece by a STAT intern that looked at the back-and-forth ad wars over PBMs. But rather than just list a bunch of campaigns and quote press releases about “seven-figure” ad buys, the article tried to do the math and figure out who was spending what, where. The upshot is that it looks like the anti-PBM side is massively outspending the pro-PBM side. Make of that what you will.

Elsewhere:

• Oh, since I’m in a 340B mood today, Astellas is also tightening up how it participates in the program. Xtandi will only be available to a single contract pharmacy going forward.

• It doesn’t talk about access specifically, but this STAT piece -- on the cardiovascular outcomes study for Wegovy -- should be a must-read, because once there is outcomes data on the obesity meds, the reimbursement conversation is going to get a lot more complicated, and quickly.

• Bernie Sanders is looking for any excuse to cap drug prices, anywhere, anyhow. This week, it’s trying to get international reference pricing attached to any med with technology that came from CDC or BARDA.

• I’m never sure how to handle breathless coverage of news that isn't really new. Just know that Reuters is all over Mark Cuban selling Humira biosimilars and Axios (among others) is out with a reminder that today is the day for FDA action on Leqembi.

• I don’t have full-text, so I can’t fully assess this study that looked at how a free, student-run clinic at Mount Sinai secured free medicine through prescription drug assistance programs, but the conclusion seems to be that those programs work, and work well.