Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan, USA.
Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Cancer. 2024 Sep 15;130(18):3077-3081. doi: 10.1002/cncr.35379. Epub 2024 May 28.
Cancer treatment has become increasingly expensive, partially due to the use of specialty drugs. The costs of these drugs are often passed down to patients, who may face the consequences of paying for more than they can afford, leading to financial toxicity. The 340B drug pricing program is a health care policy that may provide an opportunity to mitigate the financial consequences of cancer care. The 340B program requires manufacturers to sell outpatient drugs at a discount to hospitals caring for a significant number of socioeconomically disadvantaged individuals. The program intended for hospitals to use savings from discounted purchases to expand their safety net to vulnerable patients. Some studies have shown that participating hospitals do this by offering more charity and discounted care, whereas others have demonstrated that hospitals fail to sufficiently expand their safety net. A potential flaw of the program is the lack of guidance from governing bodies on how hospitals should use savings from discounted purchases. There has been growing discussion among stakeholders to reform the 340B program given the mixed findings of its effectiveness. With the rising costs of specialty drugs and associated prevalence of financial toxicity in patients with cancer, there is an opportunity to address these issues through reform that improves the program. Directing hospitals to offer specific safety net opportunities, such as passing along discounted drug prices to vulnerable populations, could help the growing number of patients who are financially burdened by medications at the core of the 340B program.
癌症治疗的费用变得越来越高，部分原因是使用了专科药物。这些药物的成本通常转嫁给了患者，他们可能面临支付超出承受能力的后果，导致财务毒性。340B 药品定价计划是一项医疗保健政策，可能为减轻癌症治疗的财务后果提供机会。340B 计划要求制造商以折扣价向为大量社会经济弱势群体提供服务的医院出售门诊药品。该计划旨在让医院利用折扣采购节省下来的资金扩大对弱势患者的安全网。一些研究表明，参与医院通过提供更多的慈善和折扣护理来实现这一目标，而另一些研究则表明，医院未能充分扩大其安全网。该计划的一个潜在缺陷是，没有管理机构就医院应如何利用折扣采购节省下来的资金提供指导。鉴于该计划有效性的研究结果喜忧参半，利益相关者一直在讨论对该计划进行改革。鉴于专科药物成本不断上升，以及癌症患者中存在与财务毒性相关的普遍问题，有机会通过改革来解决这些问题，从而改善该计划。指导医院提供特定的安全网机会，例如将折扣药价转嫁给弱势群体，可能有助于越来越多的患者减轻药物负担，这些药物是 340B 计划的核心。
