Browsing by Author "Wallack, Madeline Carpinelli"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    The 340B drug discount program: enrollment and participation among critical access hospitals
    (2013-06) Wallack, Madeline Carpinelli
    The 340B Program is a federal program that provides certain healthcare safety-net providers mandated price reductions on outpatient drugs. In 2010, critical access hospitals (CAHs)--small hospitals in isolated rural communities--became eligible for the program. This project set forth to understand the variables that are important to 340B program enrollment and purchasing through the 340B Prime Vendor Program (PVP), the government's contractor to represent the purchasing volume of all 340B entities. The CAHs with a higher number of total outpatient visits, more staff in the pharmacy department, full implementation of electronic health records, in relatively more urban counties, offer chemotherapy and provide outpatient surgery have higher odds of enrolling in the 340B Program. The CAHs that offer chemotherapy, have a contract pharmacy arrangement and have been enrolled in 340B essentially since program eligibility began are more likely to have made 340B purchases through the PVP. This project has also defined a typology to characterize the spectrum of 340B use by CAHs. The 340B typology is a systematic approach to understanding the differences in how the program may or may not be used and includes categories that range from CAHs never enrolling in the 340B Program to CAHs that are purchasing drugs using the PVP.
  • Thumbnail Image
    Item
    Excluding Orphan Drugs from the 340B Drug Discount Program: the Impact on 18 Critical Access Hospitals
    (University of Minnesota, College of Pharmacy, 2012) Wallack, Madeline Carpinelli; Sorensen, Todd
    Purpose: The 340B Drug Pricing Program is a federal program designed to reduce the amount that safety net providers spend on outpatient drugs. The Patient Protection and Affordable Health Care Act of 2010 extended eligibility for 340B to critical access hospitals (CAHs) for all drugs except those designated as “orphan.” Because this policy is unprecedented, this study quantifies the gross financial impact that this exemption has on a group of CAHs. Methods: Drug spending for 2010 from 18 CAHs in Minnesota and Wisconsin are reviewed to identify the prevalence of orphan drug purchases and to calculate the price differentials between the 340B price and the hospitals’ current cost. Results: The 18 CAHs’ purchases of orphan drugs comprise an average of 44% of the total annual drug budgets, but only 5% of units purchased, thus representing a very high proportion of their expenditures. In the aggregate, the 18 hospitals would have saved $3.1 million ($171,000 average per hospital) had purchases of drugs with orphan designations been made at the 340B price. Because CAH claims for Medicare are reimbursed on a cost-basis, the Federal government is losing an opportunity for savings. Conclusion: The high prevalence of orphan drug use and considerable potential for cost reduction through the 340B program demonstrate the loss of benefit to the hospitals, Federal government and the states.