In case you missed it, an article in the latest issue of Managed Care Magazine explores the 340B drug discount program. Columnist Richard Kirkner calls 340B a “well-intended program [that] has become a textbook example of unintended consequences.”
Krikner points to the following issues contributing to the current state of the program:
- Lack of program oversight and accountability. “Congress has never given the agency that runs 340B the power to write clear guidelines on who exactly should get these drugs and what providers should do with the savings.”
- Broad expansion of program participation. “By 2011, the number of covered sites had nearly doubled over 10 years to 16,500. These sites were affiliated with 3,200 hospitals and other entities, meaning that each organization had about five facilities that participate in 340B.”
- Rapid growth of contract pharmacy arrangements. Adam Fein, Ph.D., a Philadelphia-based pharmaceutical consultant, notes once participating organizations were allowed to use multiple contract pharmacies to fill 340B prescriptions, “there was an explosion of very entrepreneurial, savvy individuals who figured out ways to profit from this system.”
The article points out that the managed care industry, including health plans and PBMs, should be paying attention to these issues given the potential for cost shifting. Krikner calls for a 340B program overhaul, so the program benefits patients without undermining the insurance systems.
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