The battle between pharma companies and hospitals over the federal drug discount program known as 340B is gaining steam as its size has tripled since 2018 and may even double again, according to a new IQVIA report.
The 340B program, which essentially cuts the prices of certain outpatient drugs by 55% for hospitals and clinics, saw 16.5% growth in 2023, up from 12% in 2022, the report said. By comparison, pharma sales outside of the 340B program grew more slowly, IQVIA notes.
“Several factors have the potential to accelerate the future growth of the 340B program, including state bills prohibiting the use of manufacturers’ contract pharmacy restriction policies, and the potential for eligibility expansion stemming from recent court findings,” the report says.
The pharmacy restrictions that pharma companies have deployed as 340B has ballooned in size have been consistently challenged at the federal and state levels, with mixed results. Courts have split on decisions for pharma companies and hospitals as a bipartisan group of senators look to revamp 340B to help with clarity.
In March, Arkansas won a case with the Eighth Circuit Court of Appeals, which found the state can block pharma companies from limiting the availability of these discounted drugs at certain pharmacies after the lobbying group PhRMA sued Arkansas’ Insurance Department Commissioner Alan McClain.
But the Third Circuit Court of Appeals sided with pharma companies in January 2023, ruling that they can’t be forced to provide 340B-discounted drugs purchased from an unlimited number of contract pharmacies.
Over the last four years, IQVIA notes that the majority of large pharma companies has restricted the number of contract pharmacies gaining access to 340B prices, including Teva, Bristol Myers Squibb, AbbVie, AstraZeneca and Pfizer.
At the federal level, a bipartisan group of senators is working on new legislation to set better boundaries around the program and establish user fees to manage the program more closely.
Even still, IQVIA says that if a South Carolina court’s interpretation of how to define a “patient” is implemented elsewhere, “the 340B program could expand dramatically, possibly doubling in size.”
That expansive growth has caught the eye of Sen. Bill Cassidy (R-LA), a ranking member on the Health, Education, Labor and Pensions Committee. He recently requested information from CVS Health and Walgreens about their roles as the largest pharmacy participants in 340B.