艾昆纬-返佣模式将如何影响340B药品定价计划中的现金流？（英）

White PaperHow Will a Rebate Model Impact Cash Flow in the 340B Drug Pricing Program?CHUAN SUN, MS, MA, IQVIA Market Access Technology SolutionsSHANYUE ZENG, MA, IQVIA Market Access Technology SolutionsWILLIAM SARRAILLE, JD, University of Maryland Francis King Carey School of LawRORY MARTIN, PHD, IQVIA Market Access Technology SolutionsTable of contentsAbstract 1Introduction 2Discount mechanisms in the 340B program 3340B rebate model pilot 4ADAPs and rebates 4The importance to patients of upfront discounts versus rebates 4The importance to manufacturers of upfront discounts versus rebates 4340B drug inventory and pricing models 4Study aims 7Data and methods 8Data 8Methods 9Limitations 9Findings 10Cash balance graphs 10Interest costs 12Interest costs for the 10 IPAY 2025 drugs 13Sensitivity analysis 14Interest rate, 340B discount, and WAC 14Rebate timeline 14Wholesaler payment timeline 14Discussion 17References 19Appendix A: Assumption matrix for 340B cash flow 22Appendix B: Descriptions of the eight 340B drug inventory and rebate models 23About the authors 25Acknowledgements 25Funding 25Conflicts of interest 25 iqvia.com | 1AbstractOn October 30, 2025, the Health Resources and Services Administration (HRSA) approved plans for eight manufacturers to participate in a rebate pilot for the 340B Drug Pricing Program (“340B Program”), signaling a shift from upfront discounts to retrospective rebates. Rebate critics assert that rebates will be a severe financial burden on providers due to interest costs associated with cash flow, while rebate advocates contend they will not impose any significant costs on providers.We developed data-driven cash flow models to estimate financing (interest) costs under eight drug inventory and rebate scenarios including physical inventory, physical replenishment (also known as virtual replenishment), credit-based replenishment, and two versions of a 340B rebate model. Scenarios spanned entity-owned pharmacies and contract pharmacies. Sensitivity analyses tested extended rebate payment timelines, higher interest rates, and shorter wholesaler payment terms.Across all eight scenarios, financing costs were small — less than half of one percent of the estimated reimbursement value of the 340B program — expressed as a percentage of wholesale acquisition cost (WAC). For entity-owned pharmacy purchases, interest costs for the rebate model (0.19%) were no larger than for the predominant drug inventory model used by those pharmacies, referred to as physical replenishment. For contract pharmacies, the rebate model had lower interest costs (0.03%) than both types of replenishment model — physical and credit-based replenishment. Even under unfavorable assumptions, rebate interest costs remained under 1.2%.Using 2023 data for the 10 drugs selected for both Medicare Part D price negotiation and the 340B rebate pilot in 2026, the estimated interest costs at entity-owned pharmacies are expected to total $11 million under the 340B rebate