艾昆纬-2024年340B计划的规模和增长（英）

White PaperThe Size and Growth of the 340B Program in 2024 RORY MARTIN, PHD, IQVIA Market Access Technology Solutions HARISH KARNE, MS, IQVIA Market Access Technology SolutionsTable of contentsAbstract 1Introduction 1Findings 2Channel trends 3Impact of state contract pharmacy bills 5Disease areas 6Limitations 7Discussion and future outlook 7Data sources 8References 9Acknowledgements 10About the authors 10 iqvia.com | 1This study is part of an ongoing series by IQVIA that examines the size and growth of the 340B Drug Pricing Program (“340B program”). In 2024, 340B purchases reached $147.8B at list price, growing 16.7% year-over-year, driven in part by state bills mandating the use of contract pharmacies. Indexed to 2018, 340B purchases at list price in 2024 grew by 174.6%, compared to only 53.3% growth for non-340B purchases.We studied the effect of state bills mandating the extension of 340B pricing to drugs dispensed using contract pharmacies. As of the end of 2024, eight states had passed such bills. The incremental 340B growth in retail and mail contract pharmacies due to state bills was 45.9% from Q1 2024 to Q4 2024, a 9-month period. This growth will lower manufacturer rebate payments, increasing healthcare costs for state and local government employers and for commercial employers.Potential policy shifts, including state and federal legislation and possible cuts in Medicaid funding, raise questions about future program growth and healthcare costs.IntroductionThe 340B Drug Pricing program is a federal initiative in which manufacturers provide substantial, Medicaid-like discounts on qualifying outpatient drugs to participating hospitals and clinics. The program has grown rapidly in recent years, driven by the expanded use of contract pharmacies — third-party pharmacies that are contracted with 340B hospitals and clinics to help dispense 340B drugs to their patients. There is ongoing debate about the reason for the program’s growth. Program critics argue it is driven by hospital profit maximization strategies, while program advocates suggest it is caused by manufacturer drug price increases. Increased usage of 340B drugs has been shown to increase healthcare costs.1Beginning in late 2020, multiple manufacturers implemented integrity programs limiting contract pharmacy participation. By the end of December 2024, more than three dozen manufacturers had introduced restrictions, and eight states responded by passing bills mandating unrestricted use of contract pharmacies, setting up potential conflicts and altering 340B growth dynamics. Understanding the impact of these state bills and their accompanying manufacturer exemptions is important for several reasons. First, 340B is a federal program, but state mandates are asserting control over how it operates within their borders, and there is ongoing litigation between manufacturers and states over whether these laws are preempted by federal law or not. Second, employers are concerned that 340B e