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Assessing the Impact of the 340B Drug Pricing Program: A Scoping Review of the Empirical, Peer‐Reviewed Literature.

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Title: Assessing the Impact of the 340B Drug Pricing Program: A Scoping Review of the Empirical, Peer‐Reviewed Literature.
Authors: LEVENGOOD, TIMOTHY W., CONTI, RENA M., CAHILL, SEAN, COLE, MEGAN B.
Source: Milbank Quarterly. Jun2024, Vol. 102 Issue 2, p429-462. 34p.
Subjects: Health care industry laws, Health literacy, Nonprofit organizations, Public hospitals, Medical information storage & retrieval systems, Safety-net health care providers, Human services programs, Health policy, Research evaluation, Decision making, Descriptive statistics, Motivation (Psychology), Systematic reviews, MEDLINE, Government programs, Research, Research methodology, Drugs, Health care industry, Online information services, Medical care costs
Geographic Terms: United States
Abstract: Policy PointsThe 340B Drug Pricing Program accounts for roughly 1 out of every 100 dollars spent in the $4.3 trillion US health care industry. Decisions affecting the program will have wide‐ranging consequences throughout the US safety net.Our scoping review provides a roadmap of the questions being asked about the 340B program and an initial synthesis of the answers. The highest‐quality evidence indicates that nonprofit, disproportionate share hospitals may be using the 340B program in margin‐motivated ways, with inconsistent evidence for increased safety net engagement; however, this finding is not consistent across other hospital types and public health clinics, which face different incentive structures and reporting requirements. Context: Despite remarkable growth and relevance of the 340B Drug Pricing Program to current health care practice and policy debate, academic literature examining 340B has lagged. The objectives of this scoping review were to summarize i) common research questions published about 340B, ii) what is empirically known about 340B and its implications, and iii) remaining knowledge gaps, all organized in a way that is informative to practitioners, researchers, and decision makers. Methods: We conducted a scoping review of the peer‐reviewed, empirical 340B literature (database inception to March 2023). We categorized studies by suitability of their design for internal validity, type of covered entity studied, and motivation‐by‐scope category. Findings: The final yield included 44 peer‐reviewed, empirical studies published between 2003 and 2023. We identified 15 frequently asked research questions in the literature, across 6 categories of inquiry—motivation (margin or mission) and scope (external, covered entity, and care delivery interface). Literature with greatest internal validity leaned toward evidence of margin‐motivated behavior at the external environment and covered entity levels, with inconsistent findings supporting mission‐motivated behavior at these levels; this was particularly the case among participating disproportionate share hospitals (DSHs). However, included case studies were unanimous in demonstrating positive effects of the 340B program for carrying out a provider's safety net mission. Conclusions: In our scoping review of the 340B program, the highest‐quality evidence indicates nonprofit, DSHs may be using the 340B program in margin‐motivated ways, with inconsistent evidence for increased safety net engagement; however, this finding is not consistent across other hospital types and public health clinics, which face different incentive structures and reporting requirements. Future studies should examine heterogeneity by covered entity types (i.e., hospitals vs. public health clinics), characteristics, and time period of 340B enrollment. Our findings provide additional context to current health policy discussion regarding the 340B program. [ABSTRACT FROM AUTHOR]
Copyright of Milbank Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Policy PointsThe 340B Drug Pricing Program accounts for roughly 1 out of every 100 dollars spent in the $4.3 trillion US health care industry. Decisions affecting the program will have wide‐ranging consequences throughout the US safety net.Our scoping review provides a roadmap of the questions being asked about the 340B program and an initial synthesis of the answers. The highest‐quality evidence indicates that nonprofit, disproportionate share hospitals may be using the 340B program in margin‐motivated ways, with inconsistent evidence for increased safety net engagement; however, this finding is not consistent across other hospital types and public health clinics, which face different incentive structures and reporting requirements. Context: Despite remarkable growth and relevance of the 340B Drug Pricing Program to current health care practice and policy debate, academic literature examining 340B has lagged. The objectives of this scoping review were to summarize i) common research questions published about 340B, ii) what is empirically known about 340B and its implications, and iii) remaining knowledge gaps, all organized in a way that is informative to practitioners, researchers, and decision makers. Methods: We conducted a scoping review of the peer‐reviewed, empirical 340B literature (database inception to March 2023). We categorized studies by suitability of their design for internal validity, type of covered entity studied, and motivation‐by‐scope category. Findings: The final yield included 44 peer‐reviewed, empirical studies published between 2003 and 2023. We identified 15 frequently asked research questions in the literature, across 6 categories of inquiry—motivation (margin or mission) and scope (external, covered entity, and care delivery interface). Literature with greatest internal validity leaned toward evidence of margin‐motivated behavior at the external environment and covered entity levels, with inconsistent findings supporting mission‐motivated behavior at these levels; this was particularly the case among participating disproportionate share hospitals (DSHs). However, included case studies were unanimous in demonstrating positive effects of the 340B program for carrying out a provider's safety net mission. Conclusions: In our scoping review of the 340B program, the highest‐quality evidence indicates nonprofit, DSHs may be using the 340B program in margin‐motivated ways, with inconsistent evidence for increased safety net engagement; however, this finding is not consistent across other hospital types and public health clinics, which face different incentive structures and reporting requirements. Future studies should examine heterogeneity by covered entity types (i.e., hospitals vs. public health clinics), characteristics, and time period of 340B enrollment. Our findings provide additional context to current health policy discussion regarding the 340B program. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Milbank Quarterly is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/1468-0009.12691
    Languages:
      – Code: eng
        Text: English
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        PageCount: 34
        StartPage: 429
    Subjects:
      – SubjectFull: Health care industry laws
        Type: general
      – SubjectFull: Health literacy
        Type: general
      – SubjectFull: Nonprofit organizations
        Type: general
      – SubjectFull: Public hospitals
        Type: general
      – SubjectFull: Medical information storage & retrieval systems
        Type: general
      – SubjectFull: Safety-net health care providers
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      – SubjectFull: Human services programs
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      – SubjectFull: Health policy
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      – SubjectFull: Research evaluation
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      – SubjectFull: Decision making
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Motivation (Psychology)
        Type: general
      – SubjectFull: Systematic reviews
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      – SubjectFull: MEDLINE
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      – SubjectFull: Health care industry
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      – SubjectFull: Online information services
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      – SubjectFull: Medical care costs
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      – SubjectFull: United States
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      – TitleFull: Assessing the Impact of the 340B Drug Pricing Program: A Scoping Review of the Empirical, Peer‐Reviewed Literature.
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              Text: Jun2024
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