Among Medicare Patients With Chronic Asthma, 340B Not Eliminating Disparities

Health systems participating in the drug discount program did not have fewer disparities than hospitals not participating.

A new report is raising doubts about whether a program designed to ease access to prescription drugs for low-income, uninsured patients is adequately helping people with chronic asthma.

The so-called 340B program was established under Section 340B of the 1992 Public Health Service Act, and the intention was to provide discounts on outpatient drugs to qualifying safety-net providers. About 22% of acute care hospitals in the US participate in the program. However, as the program has grown, so too have questions over its value.

As seen in the new report in Health Services Insights, the authors decided to investigate whether the 340B program was helping to narrow health disparities among people on Medicare who have chronic asthma.

The authors retrieved data from Medicare fee-for-service claims for 2017 to 2019, focusing on people with moderate to severe chronic asthma who received their diagnosis while on Medicare. They then looked at 5 treatment measures and 5 adverse outcomes, comparing the results between patients treated at 340B health systems and those treated at health systems that met Section 340B’s criteria to qualify as a “disproportionate share” system but which did not participate in the program. Their analysis focused on potential disparities historically associated with a lack of access to quality health care.

They found 45,175 patients with chronic asthma at 1275 hospital systems participating in the 340B program and 2638 patients at 286 non-340B hospitals. There were disparities in drug treatment and health outcomes between patients in all 3 categories they examined: race/ethnicity, dual Medicare and Medicaid eligibility, and socioeconomic status (SES).

For instance, non-White, dual-eligible, and low-SES patients were less likely to receive maintenance drugs and novel therapies. Among the other findings, dual-eligible patients at 340B hospitals tended to start therapy about 9 days later than their Medicare-only counterparts, and non-White patients were more likely to have acute asthma events and emergency department visits at both types of hospitals.

The question for the authors was not so much whether disparities existed, but whether the 340B program affected the degree of such disparities. On that question, the authors said, the data showed differences in outcomes were more likely to occur at 340B hospital systems.

“Furthermore, for metrics in which there were disparities at both 340B and non-340B hospital systems, the magnitude of those disparities were larger at 340B hospital systems than non-340B hospital systems, on average,” they wrote.

On the other hand, disparities related to the quality of drug treatments or adverse outcomes were not statistically significant between the 2 groups.

Still, the authors said the data suggest the discounts offered to 340B hospital systems are failing to significantly curtail disparities between demographic groups.

“The drug discounts 340B hospital systems receive had no impact on reducing disparities in drug treatments for asthma or in the disparities of adverse outcomes related to asthma,” they said.

The investigators noted several limitations to their findings. Among them, the study did not include Medicare Part D claims data, so patients may have received prescriptions for asthma treatment or maintenance that are not included in the analysis. In addition, that the study focused on patients enrolled in Medicare fee-for-service programs and thus the findings do not capture patients in plans with other payment types.

Still, the authors said they believe their report raises significant questions about whether the 340B program is achieving its aims. They said policymakers are already working to try and strengthen the program and looking at a variety of options.

“The goals of these policy options are to ensure that vulnerable patients are the focal point of the program by considering guardrails in the use of 340B discounts,” they said.

They said a proper realignment of the program around those goals could lead to a program that succeeds in eliminating disparities.


Tripp AS, Marrufo G, Kornfield T, Morley M, Nichols D, Yeh A. The 340B program and health disparities among Medicare beneficiaries with chronic asthma. Health Serv Insights. Published online April 27, 2023. doi:10.1177/11786329231169257

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