340B program linked to improved prostate cancer treatment adherence

Findings recently published in the journal Cancer show that although the 340B drug pricing program had no effect on specialty drug use for advanced prostate cancer, men in socially vulnerable areas who were started on therapy at a 340B hospital were more likely to continue treatment compared with those in non-340B hospitals.¹

The investigators noted a decrease in treatment adherence as SVI increased among patients in non-340B hospitals, vs flat rates of adherence among patients in 340B hospitals, irrespective of SVI.

The 340B Drug Pricing Program is a federal initiative which requires pharmaceutical manufacturers to provide medications at a discounted price to hospitals that serve a disproportionate number of patients receiving Medicare or Medicaid. These discounts generate savings that can help improve care among those who are socioeconomically disadvantaged.

“In the field of advanced prostate cancer, there’s been a paradigm shift to using newer targeted oral treatments. But these drugs are expensive, and cost can limit access to these drugs, particularly among those who are socioeconomically disadvantaged. We wanted to see if the 340B program could help mitigate this disparity,” said lead author Kassem S. Faraj, MD, in a news release on the findings.² Faraj is a urologic oncology fellow at the University of Michigan in Ann Arbor.

For the study, the investigators retrospectively compared treatment outcomes between 2237 Medicare beneficiaries who were treated at a 340B hospital and 1100 Medicare beneficiaries who were treated at a non-340B hospital. Patients included in the study were derived from a 20% sample of Medicare beneficiaries who received treatment with targeted therapies for advanced prostate cancer between 2012 to 2019.

The primary outcome measure for the study was use of an oral specialty drug for prostate cancer. Secondary outcome measures included treatment adherence and monthly out-of-pocket costs.

Overall, the investigators found no difference in the number of patients using specialty drugs in 340B hospitals vs non-participating hospitals. However, specialty drug use was associated with social vulnerability index (SVI), with drug use decreasing as SVI increased (odds ratio, 0.95; P = .038). The interaction between hospital 340B participation and SVI regarding specialty drug use did not reach significance.

Additionally, neither 340B participation, SVI, or their interaction were found to be associated with out-of-pocket costs.

Hospital 340B participation and SVI were also not found to be associated with treatment adherence. However, the interaction between the 2 regarding treatment adherence did reach significance (P = .020), indicating that 340B participation was associated with improved adherence among patients from socially vulnerable areas. In other words, the investigators noted a decrease in treatment adherence as SVI increased among patients in non-340B hospitals, vs flat rates of adherence among patients in 340B hospitals, irrespective of SVI.

“There are many reasons why adherence to these drugs can drop. We suspect that 340B hospitals potentially have some resources or mechanisms that are helping these vulnerable patients maintain adherence,” added Faraj in the news release.²

According to the release, these resources could include medication management programs or financial help for out-of-pocket costs.

References

1. Faraj KS, Kaufman SR, Oerline M, et al. The 340B Program and oral specialty drugs for advanced prostate cancer. Cancer. 2024. doi:10.1002/cncr.35262

2. Drug-pricing program improved prostate cancer treatment adherence. News release. Michigan Medicine – University of Michigan. March 20, 2024. Accessed March 21, 2024. https://www.newswise.com/articles/drug-pricing-program-improved-prostate-cancer-treatment-adherence