The Association of 340B Program Drug Margins with Covered Entity Characteristics

INQUIRY The Journal of Health Care Organization Provision and Financing, Journal Year: 2025, Volume and Issue: 62

Published: March 1, 2025

The 340B Drug Pricing Program aims to help facilities serving low-income and uninsured patients stretch scarce resources by allowing covered entities purchase outpatient drugs at federally mandated discounted rates while often receiving reimbursement for them higher commercial payers Medicare. Despite increasing focus on the expansion impact of program, profit margins under have not been fully explored. We aimed examine drug-, facility-, geographic-level factors that influence drug among entities. conducted a cross-sectional analysis predictors facility-level 5 classes in multivariable regression model using 2021 data linked across multiple proprietary public datasets. Regression results show drug, facility characteristics, geographic healthcare market-level characteristics program. Adjusted were hospital departments than free-standing offices (ie, hospital-affiliated physician independent, eligible clinics) more concentrated less competitive) markets. Covered entity market power, quantified measure non-340B indicating pricing area wealth both associated with margins. Margins stronger bargaining positions those wealthier areas. These findings add growing body literature expansions program into affluent communities, informing calls reforms ensure serves patients.

Language: Английский

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Anticoagulation Therapy for Venous Thromboembolism

Medical Clinics of North America, Journal Year: 2025, Volume and Issue: unknown

Published: April 1, 2025

Language: Английский

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Cost in the United States of FDA-approved small molecule protein kinase inhibitors used in the treatment of neoplastic and non-neoplastic diseases

Pharmacological Research, Journal Year: 2023, Volume and Issue: 199, P. 107036 - 107036

Published: Dec. 12, 2023

Because genetic alterations including mutations, overexpression, translocations, and dysregulation of protein kinases are involved in the pathogenesis many illnesses, this enzyme family is target drug discovery programs worldwide. The FDA has approved 80 small molecule kinase inhibitors with 77 drugs orally bioavailable. data indicate that 69 these medicinals for management neoplasms solid tumors such as breast lung cancer well non-solid leukemia. Moreover, remaining 11 non-neoplastic diseases psoriasis, rheumatoid arthritis, ulcerative colitis. cost was obtained from www.pharmacychecker.com using label to determine dosage number tablets required per day. This methodology excludes any private or governmental insurance coverage, which would cover entire more likely a fraction stated price. average monthly treatment neoplastic $17,900 price $44,000 futibatinib (used treat cholangiocarcinomas FGFR2 fusions) minimum $5100 binimetinib (melanoma). $6800 maximum $17,000 belumosudil (graft vs. host disease) $200 netarsudil eye drops (glaucoma). There negative correlation incidence targeted disease. Many agents were designated orphan meaning there fewer than 200,000 potential patients United States.

Language: Английский

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Considering Returns on Federal Investment in the Negotiated “Maximum Fair Price” of Drugs Under the Inflation Reduction Act: an Analysis

Published: Feb. 28, 2024

The Inflation Reduction Act (IRA) of 2022 contained landmark provisions authorizing government to negotiate a “maximum fair price” for selected Medicare Part D drugs considering the manufacturer’s research and development costs, federal support discovery development, extent which address unmet medical needs, other factors. This working paper describes investment in ten price negotiation first year IRA as well health value created through spending on these drugs. We identified $11.7 billion NIH funding basic or applied leading approval with median costs $895.4 million/drug. early public provided cost savings industry $1,485 million/drug, comparable reported levels by industry. From 2017-2021, spent $126.4 (median $10.7 billion) products before rebates. Excluding two diabetes, was $97.4 total 650,940 QALYs $67.7 (WTP/QALY=$104K) representing negative residual -$29.7 (before rebates). argue that negotiated should provide returns both private investments commensurate scale risk investments, principal return sector being (net price) accruing those using product. These empirical data basis negotiating rewards innovation provides social public.

Language: Английский

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Trends in Proportion of Medicare Part D Claims Subject to 340B Discounts, 2013-2020

JAMA Health Forum, Journal Year: 2023, Volume and Issue: 4(11), P. e234091 - e234091

Published: Nov. 17, 2023

Despite controversy surrounding the 340B program, no study has analyzed trends in proportion of Medicare Part D pharmacy claims eligible for discounts.To describe that are prescribed by 340B-affiliated clinicians and filled pharmacies.This longitudinal, retrospective cohort included 2013 to 2020 data from a 5% random sample beneficiaries Centers & Medicaid Services 6292 nine-digit national drug codes were used at least 1000 given year. Data analysis was completed November 2022 April 2023.For each year, there 3 outcomes: (1) total clinician; (2) clinician pharmacy; (3) under program (ie, pharmacy).The prescriptions written doubled 9.4% 19.3% 2020. The capture pharmacies, defined as increased 18.4% 49.9% As result, 1.7% 9.6% Rates prescribing consistently across therapeutic classes. In 2020, antiviral class with largest (16.1%), followed targeted antineoplastics (15.7%).This demonstrated share increased; however, rate which 340B-eligible pharmacies faster rate, driving overall increase claims. these trends, only half subject discount

Language: Английский

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Estimated Savings From Using Added Therapeutic Benefit and Therapeutic Reference Pricing in United States Medicare Drug Price Negotiations

Value in Health, Journal Year: 2023, Volume and Issue: 26(11), P. 1618 - 1624

Published: Sept. 7, 2023

This study describes and estimates savings from a specific approach Medicare could use to determine an initial offer price for drug negotiations.

Language: Английский

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Nonfederal average manufacturer price to estimate savings generated by minimum discounts under the Inflation Reduction Act

Journal of Managed Care & Specialty Pharmacy, Journal Year: 2023, Volume and Issue: 29(11), P. 1261 - 1263

Published: Oct. 27, 2023

DISCLOSURES: This work was funded by the West Health Policy Center. Dr Hernandez reports consulting fees from Pfizer and BMS, outside of submitted work. Following submission original manuscript, Dickson became an employee AHIP. AHIP has had no role in reviewing this letter. The statements, findings, conclusions, views, opinions contained expressed herein are not necessarily those IQVIA Inc. or any its affiliated subsidiary entities.

Language: Английский

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Medicare drug price negotiation: The complexities of selecting therapeutic alternatives for estimating comparative effectiveness

Journal of Managed Care & Specialty Pharmacy, Journal Year: 2023, Volume and Issue: 30(3), P. 218 - 225

Published: Dec. 13, 2023

Under the 2022 Inflation Reduction Act, Centers for Medicare and Medicaid Services (CMS) are able to negotiate prices topselling drugs in Part B D programs. In determining initial price offers, CMS will compare clinical benefits of subject negotiation therapeutic alternatives. Despite central role that selection alternatives play negotiations, available guidance published by provides few details about how organization undertake this process, which be particularly complex approved more than one indication. To better inform we identified all US Food Drug Administration-approved indications first 10 negotiation. Using 2020-2021 claims data, beneficiaries using each drugs. We extracted medical with diagnosis codes report relative treated prevalence use indication drug. reviewed guidelines identify relevant indications. integrated evidence on propose describe challenges may face selecting

Language: Английский

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Market Transparency in Medicine Pricing: Pathways to Fair Pricing

PharmacoEconomics, Journal Year: 2024, Volume and Issue: 42(6), P. 611 - 614

Published: May 9, 2024

Language: Английский

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Concentration of spending and share of specialty drug spending in Medicare Part D over a 10-year period

Journal of Managed Care & Specialty Pharmacy, Journal Year: 2024, Volume and Issue: 30(12), P. 1355 - 1363

Published: Nov. 29, 2024

In 2021, Medicare Part D gross prescription drug spending amounted to $216 billion, a number that has more than doubled over the last 10 years. Spending in is concentrated on small of drugs, and specialty drugs increased recent However, extent which concentration changed time drivers this change have not been described.

Language: Английский

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