Health Capital Group, LLC, 300 Carnegie Center, Ste 150, Princeton, NJ 08540. Email:
Am J Manag Care. 2023 Jun 1;29(6):e184-e188. doi: 10.37765/ajmc.2023.89377.
To estimate neighborhood income differences between the locations of 340B-covered entities and their contract pharmacies (CPs) and examine whether these differences vary between hospitals and grantees.
Cross-sectional study.
Using Health Resources and Services Administration 340B Office of Pharmacy Affairs Information System and zip code tabulation area (ZCTA)-level US Census Bureau databases, we created a unique data set that contains covered entities' characteristics, CP use, and ZCTA-level median household income in 2019 for more than 90,000 pairs of covered entities and CPs. We computed income differences between each pair and for a subset of pairs in which the pharmacy is within 100 miles of the covered entity for both hospitals and federal grantees.
On average, median income in the pharmacy's ZCTA is about 35% higher than in the covered entity's ZCTA, with little difference between hospitals (36%) and grantees (33%). Roughly 72% of arrangements cover less than 100 miles; in that subset, income is about 27% higher for pharmacy ZCTAs, with little difference between hospitals (28%) and grantees (25%). In more than 50% of arrangements, the median income in the pharmacy's ZCTA is more than 20% higher than in the covered entity's ZCTA.
CPs serve at least 2 purposes: They can increase low-income patients' access to medicines directly when a CP is closer to where a covered entity's patients live, and they can increase profits for covered entities (some of which are potentially passed on to patients) and CPs. We find that in 2019, both hospitals and grantees used CPs to generate income but generally they do not appear to contract with pharmacies located in neighborhoods where low-income patients are likeliest to live. Prior research findings have suggested that hospitals and grantees behave differently from each other with respect to CP use, but results of our analysis suggest the opposite.
估计 340B 覆盖实体及其合同药房（CP）所在地的邻里收入差异，并研究这些差异在医院和受赠者之间是否有所不同。
横断面研究。
我们使用卫生资源和服务管理局 340B 药房事务办公室信息系统和邮政编码区（ZCTA）级美国人口普查局数据库，创建了一个独特的数据集，其中包含 2019 年超过 90,000 对覆盖实体和 CP 的特征、CP 使用情况以及 ZCTA 级家庭中位数收入。我们计算了每对之间以及在药房距离覆盖实体 100 英里以内的 CP 子集的收入差异，对于医院和联邦受赠者都是如此。
平均而言，药房所在 ZCTA 的中位数收入比覆盖实体所在 ZCTA 高约 35%，医院（36%）和受赠者（33%）之间差异不大。大约 72%的安排覆盖范围小于 100 英里；在该子集中，药房 ZCTA 的收入高约 27%，医院（28%）和受赠者（25%）之间差异不大。在超过 50%的安排中，药房所在 ZCTA 的中位数收入比覆盖实体所在 ZCTA 高 20%以上。
CP 至少有两个作用：当 CP 更接近覆盖实体患者居住的地方时，它们可以直接增加低收入患者获得药物的机会，并且可以增加覆盖实体（其中一些可能会传递给患者）和 CP 的利润。我们发现，2019 年，医院和受赠者都使用 CP 来创造收入，但他们通常似乎没有与最有可能居住在低收入患者附近的社区的药房签订合同。先前的研究结果表明，医院和受赠者在 CP 使用方面的行为彼此不同，但我们的分析结果表明情况恰恰相反。
