Impact of the 340B Drug Pricing Program on Cancer Care Site and Spending in Medicare
研究了340B药品折扣计划如何改变癌症药物在Medicare中的给药地点（从医生办公室转向医院门诊）并增加其他癌症护理支出，对政策制定者和医疗管理者有参考价值。
OBJECTIVE: To examine the impact of the 340B drug discount program on the site of cancer drug administration and cancer care spending in Medicare. DATA SOURCES/STUDY SETTING: 2010-2013 Medicare claims data for a random sample of Medicare Fee-for-Service beneficiaries with cancer. STUDY DESIGN: We identified the 340B effect using variation in the availability of 340B hospitals across markets. We considered beneficiaries from markets that newly gained a 340B hospital during the study period (new 340B markets) as the treatment group. Beneficiaries in markets with no 340B hospital were the control group. We used a difference-in-differences approach with market fixed effects. DATA COLLECTION: Secondary data analysis. PRINCIPAL FINDINGS: The probability of a patient receiving cancer drug administration in hospital outpatient departments (HOPDs) versus physician offices increased 7.8 percentage points more in new 340B markets than in markets with no 340B hospital. Per-patient spending on other cancer care increased $1,162 more in new 340B markets than in markets with no 340B hospital. CONCLUSIONS: The 340B program shifted the site of cancer drug administration to HOPDs and increased spending on other cancer care. As the program expands, continuing assessment of its impact on service utilization and spending would be needed.