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TOPLINE:

Participation in the 340B drug discount program does not affect the use of oral specialty drugs for advanced prostate cancer, but it may boost adherence to medication once initiated in more vulnerable patients, new research showed.

METHODOLOGY:

• The high cost of oral specialty drugs for advanced prostate cancer can fuel treatment disparities. The 340B program allows hospitals to buy medications at discounts, generating savings that can improve care of the socioeconomically disadvantaged.
• Researchers analyzed Medicare claims data for 3337 men with advanced prostate cancer diagnosed from 2012 to 2019.
• They compared the use of oral specialty drugs, out-of-pocket costs, and medication adherence between men treated at 340B-participating hospitals (2237, 67%) and those treated at nonparticipating hospitals (1110, 33%), and evaluated the effect of social vulnerability on these outcomes.

TAKEAWAY:

• Patients treated at 340B and non-340B hospitals were just as likely to receive an oral specialty drug (23% at non-340B vs 22% at 340B; P = .63).
• However, each 0.10 unit increase in the social vulnerability index (odds ratio [OR], 0.95; P = .038) corresponded to a decrease in use of an oral specialty drug; use was 26% in the least vulnerable men vs 19% in the most vulnerable men.
• Monthly out-of-pocket costs were also similar for men treated at 340B vs non-340B hospitals ($772 vs $848, P = .23). However, among men without low‐income subsidies, these out-of-pocket costs decreased with increasing social vulnerability ($940 in the least vulnerable group to $660 in the most vulnerable), though the difference was not significant (P = .1).
• Neither 340B participation nor social vulnerability index was independently associated with adherence to medication. However, for each 0.10 increase in social vulnerability index, adherence to specialty drugs among patients treated at non-340B hospitals decreased (OR, 0.84), but remained relatively stable in those who were managed at 340B hospitals (OR, 1.03).

IN PRACTICE:

The results suggest that the 340B program is associated with the "important patient outcome" of better adherence to medication in more socially vulnerable men with advanced prostate cancer, which could translate to improved clinical effectiveness, the authors said.

SOURCE:

Kassem S. Faraj, MD, MS, with the University of Michigan, Ann Arbor, Michigan, led the study, published online on February 23, 2024, in Cancer.

LIMITATIONS:

The study used Medicare claims data and was unable to account for disease severity, which limits the ability to determine the ideal number of men who should be started on an agent in this population. There may have been differences in how 340B hospitals operate that would not be captured using claims data.

DISCLOSURES:

The study was supported by grants from the National Cancer Institute. The authors had no relevant conflicts of interest.