Expansion of the 340B Program’s Child Sites and Health Disparities Among Medicare Beneficiaries with Asthma

Abstract

Background: Under the 340B Drug Pricing Program, drug manufacturers are required to provide discounts to participating safety-net providers including hospitals serving a disproportionate share (DSH) of low-income patients. The program has experienced substantial growth in participating DSH providers due in part to growth in 340B DSH child sites, which are outpatient sites included on the DSH hospitals’ cost report. However, child sites are not required to be easily accessible to vulnerable patients. Objectives: The objective of this study was to determine whether the 340B program’s expansion of child sites was associated with fewer health disparities for asthma-related care. Research Design: We conducted a retrospective analysis of Medicare beneficiaries treated for moderate to severe asthma at 340B DSH hospitals with and without child sites. Measures: We evaluated five drug treatment measures and five adverse outcome measures related to asthma occurring within the first 12 months of the diagnosis date. Results: For Medicare beneficiaries treated for asthma at 340B hospitals with and without child sites, we identified risk-adjusted disparities in drug treatments and adverse health outcomes based on race/ethnicity, dual eligibility status, and socioeconomic status. Statistically significant disparities across the ten outcomes were more likely to occur within 340B hospitals with child sites than 340Bhospitals without child sites. Differences in the magnitudes of the disparities varied by vulnerable subgroup. Conclusions: Our findings suggest that the growth in 340B child sites have not universally expanded access to higher quality care for vulnerable patients, and as such policy changes may be needed.