The 340B drug discount program: enrollment and participation among critical access hospitals

Abstract

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.