New research has found the 340B program is slowing uptake of biosimilars by incentivizing use of more expensive biologics.
A version of this article was originally published on AJMC.com, the sister site of The Center for Biosimiars®. This version has been lightly edited.
The 340B program has driven provider variation in the uptake of biosimilars and may meaningfully reduce overall biosimilar use in the United States, according to research published in Health Affairs.1
The researchers investigated the 340B Drug Pricing Program’s impact on biosimilar uptake in hospital outpatient departments based on use of filgrastim (originator, Neupogen; biosimilars, filgrastim-sndz and filgrastim-aafi) and infliximab (originator, Remicade; biosimilars, infliximab-dyyb and infliximab-abda), which were the first 2 biologics with biosimilar launches via the Biologics Price Competition and Innovation Act. They studied 2017 to 2019.
Hospitals in the 340B program receive discounts on manufacturer’s average sales price, but Medicare reimburses them at the same rate as non-340B hospitals. The purpose is for hospitals in the program to use the savings for resources for their low-income populations. Eligibility for the program is based on disproportionate share hospital (DSH) percentage, which is a formula accounting for the share of the hospital’s low-income patients, urban and rural classification, and the number of beds. When DSH percentage exceeds 11.75%, hospitals become eligible for the 340B program.
“With 340B program discounts, reference products could be relatively more profitable than biosimilars,” the authors explained.
The 340B program has been controversial, with critics highlighting the lack of transparency around where those drug discounts go.2 The New York Times reported on how Bon Secours Mercy Health used the 340B program to turn a profit by opening satellite clinics in wealthy neighborhoods.3
The authors of the current study looked at 55,970 administrations for 6306 patients across 593 general acute hospitals.
The majority of hospitals were teaching hospitals (52.1%) and were in urban areas (94.9%). The majority of patients were White (83.7%). For patients taking filgrastim, the most common indication was nonmyeloid malignancy and chemotherapy (76.6%) followed by neutropenia (45.0%). For patients taking infliximab, the most common indication was rheumatoid arthritis (51.0%) followed by Crohn disease (29.2%).
Using a regression discontinuity design to examine the impact of the 340B program on biosimilar administration, the researchers found substantial discontinuities in biosimilar use among hospitals just above the threshold compared with those just below it.
“Relative to biosimilar use just below the threshold, the discontinuity estimate implies a 66 percent reduction in biosimilar use associated with 340B eligibility,” according to the authors.
They wrote that the study shows the 340B program may cause providers to favor drugs with higher Medicare reimbursement; however, they noted that other factors may have led to the estimated effects.
One proposal to incentivize use of biosimilars would be to consolidate billing codes to biosimilars are reimbursed at the same rate as the reference product, which would make the lowest-cost product (ie, the biosimilar) the most profitable to prescribe.
“Our results suggest that hospitals do respond to financial incentives and that this type of payment change may more effectively encourage the use of lower-price biosimilar medications,” they explained.
A 2022 white paper4 from the Community Oncology Alliance similarly found that 340B hospitals are slow to adopt lower-cost biosimilars, with a quarter (26%) of hospitals examined listing prices for only the reference product and not its biosimilars. In addition, only 10 hospitals evaluated carried all of the biosimilars studied.
References
1. Bond AM, Dean EB, Desai SM. The role of financial incentives in biosimilar uptake In Medicare: evidence from the 340B program. Health Aff (Millwood). 2023;42(5):632-641. doi:10.1377/hlthaff.2022.00812
2. Steinzor P. Nicolas Ferreyros: there is growing recognition the 340B program is “out of control.” The American Journal of Managed Care. March 22, 2023. Accessed June 1, 2023. https://www.ajmc.com/view/nicolas-ferreyros-there-is-growing-recognition-the-340b-program-is-out-of-control-shares-his-thoughts-on-the-340b-drug-pricing-program
3. Thomas K, Silver-Greenberg J. How a hospital chain used a poor neighborhood to turn huge profits. New York Times. September 24, 2022. Accessed June 1, 2023. https://www.nytimes.com/2022/09/24/health/bon-secours-mercy-health-profit-poor-neighborhood.html
4. Examining 340B hospital price transparency, drug profits, and incentives. Community Oncology Alliance. September 2022. Accessed June 1, 2023. https://communityoncology.org/wp-content/uploads/2022/09/COA_340B_hospital_transparency_report_2_final.pdf
Julie Reed: Why 2024 Is Important for Biosimilars
April 17th 2024Julie Reed, executive director of the Biosimilars Forum, showcases how the biosimilar industry is expected to develop throughout 2024, including major policy changes and hope for continued improvement in market share for adalimumab biosimilars.
Exploring the Biosimilar Horizon: Julie Reed's Predictions for 2024
February 18th 2024On this episode of Not So Different, Julie Reed, executive director of the Biosimilars Forum, returns to discuss her predictions for the biosimilar industry for 2024 and beyond as well as the impact that the Forum's 4 new members will have on the organization's mission.
BioRationality: Removing the Misconceptions Surrounding Interchangeability
April 15th 2024Sarfaraz K. Niazi, PhD, outlines the current state of interchangeable biosimilars in the US and policy changes needed to clear up misconceptions surrounding the meaning behind interchangeability designations.
A New Chapter: How 2023 Will Shape the US Biosimilar Space for 2024 and Beyond
December 31st 2023On this episode of Not So Different, Cencora's Brian Biehn and Corey Ford take a look back at major policy and regulatory advancements in 2023 and how these changes will alter the space going forward.
Biosimilars Council: PBM Rebate Schemes Cost Americans, Payers $6 Billion
April 10th 2024A report from the Biosimilars Council evaluating IQVIA data found that rebate schemes orchestrated by pharmacy benefit managers (PBMs) are costing US patients and payers billions of dollars by suppressing biosimilar adoption.
Rising Biosimilar Adoption for an Italian Payer Will Benefit National Health Care System, Patients
April 9th 2024Data from 2021 and 2022 indicates increasing biosimilar use in an Italian health care company, with potential for full adoption in the future, benefiting both the National Health System and citizens through efficient and sustainable health care policies.