艾昆纬-2024年340B计划的规模和增长（英）_13页_1mb

The Size and Growth of the 340B Program in 2024

Abstract

• The 340B Drug Pricing Program's purchases grew to $147.8B at list price in 2024, a 16.7% year-over-year increase, compared to a 4.9% increase for non-340B purchases.
• Since 2018, 340B purchases have surged by 174.6% (indexed to 2018), outpacing non-340B growth (53.3%).
• State bills mandating 340B pricing extension to contract pharmacies (retail and mail) contributed significantly to the incremental 340B growth (about 45.9% for retail and 55.0% for mail combined from Q1-Q4 2024).
• Factors driving growth include increased use of contract pharmacies, heightened hospital revenue maximization strategies, and the expansion of disproportionate share hospitals (DSH). Newly proposed 340B rebate models may slow future growth.
• Detailed analysis shows strong growth in targeted oncology and anti-virals, with diabetes and immunologic agents also showing significant increases. Manufacturer list price cuts (e.g., insulin) also affected 2024 purchases.

Introduction

• The 340B program provides substantial Medicaid-like discounts on outpatient drugs to eligible hospitals and clinics.
• Growth, especially due to increased use of contract pharmacies (third-party facilities), has been rapid, sparking debate about its drivers (hospital profit motives vs. manufacturer price increases) and its impact on healthcare costs.

Findings

Overall Growth

• Key Statistics: 2024 total 340B purchases: $147.8B (16.7% YoY growth); Non-340B purchases: $X≈51B-$66B (4.9% YoY growth).
• Long-term Trend (2018-2024): 340B purchases grew 174.6%, compared to 53.3% for non-340B purchases.

Channel Trends

• Purchases are split into hospital/clinic and retail/mail channels.
• Growth diverged starting 2021 due to contract pharmacy restrictions, with mail channels seeing increased 340B usage.

Impact of State Contract Pharmacy Bills

• States with Bills: Arkansas, Louisiana, Mississippi, Minnesota, Missouri, Kansas, West Virginia, Maryland.
• Manufacturer Response: Exemptions granted, allowing 340B pricing for drugs dispensed via contract pharmacies in these states.
• Growth Impact: State bill implementation caused a significant surge (up to approximately 46%) in 340B purchases via retail and mail pharmacies within these states during Q1-Q4 2024.

Disease Areas

• The five largest disease areas by 2024 340B purchases (oncology, anti-virals, immunologic agents, diabetes, anti-arthritics) accounted for 66.5% of total 340B purchases.
• Noteable growth: Anti-virals (128.8% indexed to 2018), Immunologic agents (446.3% indexed), Targeted Oncology (174.6% indexed), Diabetes (123.6% indexed).
• Immunologic agents and Anti-virals had the highest average 340B exposure (#38.2% and #33.4%) of all therapeutic areas in 2024, contributing significantly to their high purchase volume.

Limitations

• Data sample did not capture 100% of U.S. drug purchases.
• Lack of real-time channel data limited analysis of smaller distribution channels (<2% of 340B sales).
• State bill impact analysis could be skewed by manufacturers implementing benefits before Q1 2024.

Discussion and Future Outlook

• Future trajectory is uncertain due to potential reductions in Medicaid funding (impacting DSH hospital eligibility); possible federal legislation mandating unrestricted contract pharmacy use; and the introduction of 340B rebate models.
• Rebate models could slow down current rapid growth momentum.
• Increased volume in state-specific 340B usage drives higher drug costs in those states due to displaced manufacturer rebates.

Data Sources

• Data from IQVIA’s DDD Subnational Sales database (2018-2024).
• Covered entities used list pricing ($WAC) for calculations.
• Products and disease areas classified using the Uniform System of Classification (USC).

References

1. Sun C, Zeng S, Martin R. The cost of the 340B program part 1. IQVIA. March 2024.
2. Martin R, Sun C, Zeng S, Illich K. Unintended consequences: The ACA, DSH, and 340B. IQVIA. August 2024.
3. References related to insulin price cuts (Lilly, Novo Nordisk cited generally).
4. Mulligan K, et al. Strategic hospital behavior and the 340B program. BMC Research Notes. June 2021.
5. Other supporting reports from IQVIA.

Acknowledgements

• Thanks to Luke Greenwalt and Shiraz Hasan.

**Note:** Content specific to authors, contact details, the copyrighted disclaimer, and some specific drug classes (glutarimide derivatives, etc.) were omitted as per the summarization focus on key findings and analysis.