February 2, 2018—A team of independent health policy experts have questioned the major findings in a recent New England Journal of Medicine (NEJM) study critical of the 340B drug pricing program.
In its Jan. 24 issue, the journal published a study authored by Sunita Desai, Ph.D., and J. Michael McWilliams, M.D., Ph.D., that raised questions about whether 340B hospitals are driving acquisition of medical practices, whether 340B hospitals used program savings to care for low-income patients, and said eligibility for the 340B program is not associated with lower mortality rates among cancer patients.
The Advisory Board, a respected research firm that works to “improve the performance of health care organizations,” published an analysis of the NEJM study that identifies three “major caveats” with the findings.
The report questions the notion that the 340B program is driving doctor-hospital consolidation and notes the trend toward such consolidations is “industry wide” and crosses a variety of physician specialists. The Advisory Board said such actions are also motivated by reimbursement cuts and physicians’ personal retirement plans.
The Advisory Board also caveats the NEJM study’s suggestion that 340B hospitals don’t use the savings from drug price discounts consistent with the program’s goals. Its report notes that the NEJM study doesn’t cite evidence to support that point.
Finally, the Advisory Board raises a concern with the study’s attempt to establish a correlation between spending on cancer care and patient outcomes, namely mortality rates. “The truth is that we know very little about what factors consistently extend survival across patients with different cancer diagnoses,” the analysis says.
The Advisory Board also cites the criticism of the NEJM study by 340B Health. In a public statement, we noted the study’s authors excluded disproportionate share (DSH) hospitals with an adjustment percentage above 21.75 percent, excluding nearly one-third of all DSH hospitals in the 340B program, and said the NEJM study “is based on a flawed understanding of the 340B drug pricing program’s purpose and intent.”