Researcher on 340B: Physicians 'select patients who require more intensive pharmaceutical treatments after joining the 340B program'

Danea Horn, a researcher at the University of California, has indicated that physicians or their employer organizations might select patients requiring intensive pharmaceutical treatments to benefit from financial incentives under the 340B program. This statement was made in a publication.

"Physicians (or their covered entity employer) may strategically select patients who require more intensive pharmaceutical treatments after joining the 340B program in alignment with program-profit incentives, essentially the opposite of a practice known as cream skimming," said Horn.

The 340B Drug Pricing Program, established by Congress in 1992, aims to assist covered healthcare entities in stretching federal resources and providing more comprehensive services. Over time, the program has seen significant expansion, including an increase in the number of covered entities and contract pharmacies. Policymakers have expressed concerns regarding transparency and whether the program's benefits are reaching the intended low-income patient populations.

A study published in 2023 in Health Services Research and Managerial Epidemiology found no statistically significant improvements in mortality rates for low-income patients participating in the 340B program. The analysis examined outcomes across multiple health systems and questioned the program's effectiveness in achieving its public health goals. The study concluded that financial incentives alone might not suffice to improve health outcomes.

According to a 2024 report from the House Oversight Committee, pharmacy benefit managers (PBMs) employ complex pricing practices that can distort market competition and inflate costs for patients. The report detailed how PBMs profit from spread pricing, rebate arrangements, and steering prescriptions to their affiliated pharmacies. These practices have led to reduced access for small and independent pharmacies.

Horn is a researcher at the Center for Translational and Policy Research on Precision Medicine (TRANSPERS) at the University of California, San Francisco. She earned her Ph.D. from the University of California, Davis, and was a postdoctoral scholar at Stanford University with a focus on health policy and innovation. In 2013, she authored "Chronic Resilience," which explored patient experiences with the healthcare system.