Medicare Part D Claims Have Increased, But 340B Prescriptions Increased Faster

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The proportion of prescriptions by a 340B-affiliated physician increased from 9.4% in 2013 to 19.3% in 2020, but the prescriptions filled by 340B pharmacies increased from 18.4% to 49.9%.

Although the share of Medicare Part D claims from 340B-affiliated physicians increased between 2013 and 2020, the rate that 340B-eligible prescriptions were filled at 340B pharmacies increased faster during the same period, according to results of a study published in JAMA Health Forum. The study investigators aimed to describe the trends for the proportion of Medicare Part D claims that are prescribed and filled that are 340B-eligible.1

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In 1992, the 340B initiative was started, which had manufacturers offering more affordable drugs to 340B-affiliated entities such as hospitals. By meeting the criteria, including catering care to uninsured or underinsured patients, the hospital can qualify for lower-priced medications. In 2010, approximately 23.5% of hospitals participated in the program, according to an article published in Pharmacy Times.2

The study investigators used claims data from a 5% random sample of Medicare Part D beneficiaries from 2013 to 2020. They also selected 9-digit national drug codes to be used by at least 1000 beneficiaries in the sample, including 6292 drugs. The data were analyzed from November 2022 to April 2023, according to the study authors.1

The study authors said the proportion of prescriptions from 340B-affiliated physicians increased from 9.4% in 2013 to 19.3% in 2020. The prescriptions filled by 340B pharmacies increased from 18.4% to 49.9% during the same period, and the claims subjected to 340B discounts increased from 1.7% to 9.6%.1

Investigators found that the rates of prescribing and capture increased across therapeutic classes, which was a trend observed overall. The antiviral class of therapeutics consistently had the largest proportion of claims prescribed at 28.1%, filled prescriptions at 57.3%, and subject to discount claims at 16.1% in 2020. The second largest was targeted antineoplastics, according to the study authors.1

Furthermore, antiseptics and ophthalmic preparations had the lowest proportion of claims at a 340B discount in 2020 at 5.1% and 5.4%, respectively, according to the results.1

The top spend drug with more than 50% of claims prescribed was bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy; Gilead), and the second top spend drugs with the largest proportion of claims were imbrutinib (Imbruvica; Pharmacyclics, Janssen) and enzalutamide (Xtandi; Astellas, Pfizer).1

For other top spending drugs, investigators reported that rates of 340B prescribing increased according to the overall sample trend, from approximately 9% to 11% in 2013 to 18% to 23% in 2020. Excluding imbrutinib, rates of prescriptions for top spend drugs filled increased following the trends of the overall sample from between 18% and 20% in 2013 to between 46% and 62% in 2020.1

Investigators stated that bictegravir/emtricitabine/tenofovir alafenamide had the highest proportion of 340B claims subjected to discount at 31.4% in 2020, which they stated was a result of trends in prescribing and capture. Excluding bictegravir/emtricitabine/tenofovir alafenamide, imbrutinib, and enzalutamide, the rates of claims subjected to discounts increased from 1% to 2% in 2013 to 9% to 12% in 2020, according to the results.1

The study authors concluded that even though the prescriptions are being filled at a fast rate, “only half of 340B-eligible prescriptions are actually subject to the 340B discount." They urge policymakers to consider the effect of limiting 340B discounts on drug price growth.1

References

  1. Dickson S, Gabriel N, Hernandez I. Trends in Proportion of Medicare Part D Claims Subject to 340B Discounts, 2013-2020. JAMA Health Forum. 2023;4(11):e234091. doi:10.1001/jamahealthforum.2023.4091
  2. Alyasee L. What is 340B? Exploring pharmacist contributions, its important role in hospitals. Pharmacy Times. June 29, 2023. Accessed November 29, 2023. https://www.pharmacytimes.com/view/what-is-340b-exploring-pharmacist-contributions-its-important-role-in-hospitals
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