JAMA Publishes Letters Disputing Opinion Piece on 340B

by Admin | October 17, 2013 4:00 pm

Last May, the Journal of the American Medical Association (JAMA) published an article[1] in its Viewpoint section by two academics (one of whom receives speaking fees from Genentech) stating that the 340B program raises costs for patients, particularly those with cancer. We’re pleased to report that JAMA‘s Oct. 16 edition includes a letter to the editor from SNHPA[2] pointing out that the essay’s authors made unsupported assertions about 340B while neglecting significant evidence of the program’s benefits.

Here’s an extended excerpt from the letter, which was co-written by SNHPA President and Chief Executive Officer Ted Slafsky and SNHPA Associate Counsel Jeff Davis:

The authors suggested that the 340B program increases patient costs. They did not provide evidence of this occurring, and did not mention that hospitals participating in the program pass their savings on to their vulnerable patients in many ways, including reducing drug prices, serving more patients, and increasing access to vital services. Multiple reports authored by the US Government Accountability Office and federal research analysts demonstrate that hospitals use savings from the 340B program to benefit vulnerable patients.

The authors claimed manufacturers will increase drug prices to compensate for increased 340B sales. Yet, according to the US Department of Health and Human Services, the 340B program accounts for only 2% of the total US drug market. [The authors] noted that 340B hospital enrollment has doubled since 2009, but they did not mention that much of this growth is because Congress expanded the 340B program to rural hospitals in 2010. According to the US Department of Health and Human Services, these hospitals account for only 10% of the 340B purchasing volume.

The authors are also incorrect that 340B hospitals cannot use discounted drugs for Medicaid patients. Many hospitals and other 340B entities have been purchasing discounted drugs for their Medicaid patients since the program’s inception. They pass these savings on to states, which reduces Medicaid spending.

The [article] recommended limiting the use of the 340B program to patients who are poor and uninsured or requiring hospitals to bill all payers at lower rates. This would eliminate much of the program’s benefit and lead to increased costs to patients and reduced services. As the Health Resources and Services Administration has said, if 340B entities could not access savings by billing insurance companies, “their programs would receive no assistance from the enactment of section 340B and there would be no incentive for them to become covered entities.”

JAMA also published a letter co-written by the president of the American Society of Clinical Oncology (ASCO) and the chair of ASCO’s 340B work group stating that the May 2013 opinion article “lacked a balanced perspective and perpetuated several misperceptions” about 340B.

“The assertions made by the authors, particularly that physicians are altering prescribing behaviors to profit from 340B, have no factual underpinning,” the two physicians wrote.

As we’ve said many times before, we stand ready to work with critics of 340B to make the program more effective. Collaboration is hard, however, when critics portray hospitals’ accrual of 340B savings as abuse and suggest that hospitals and other caregivers put profits above patients.

Source URL: https://340binformed.org/2013/10/jama-publishes-letters-disputing-opinion-piece-on-340b/

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