Evaluating Cost Savings and Patient Benefit from the 340B Drug Pricing Program through Expansion of Pediatric Outpatient Pharmacy Services

PURPOSE: The 340B Drug Pricing Program was established in 1992 for covered entities to stretch Federal resources and provide eligible patients with comprehensive services. Pediatric hospitals were recognized as eligible for the 340B program in 2006. There are limited reports on expanding access to pharmacy services and the value of cost savings and patient benefit. Addressing all three measures of the IHI Triple Aim, the primary objective of this study was to develop, operationalize, and implement the acceptance of commercial payers for pharmacy services in a pediatric outpatient same-day surgery (SDS) unit through bedside delivery and counseling services, and to evaluate the related cost savings from the 340B Program.

METHODS: This retrospective, descriptive study is approved by the Institutional Review Board. Patients receiving care within the outpatient same-day surgery unit that were discharged with prescriptions were eligible for inclusion. Reports for all outpatient prescriptions written from same-day surgery and for all outpatient units were collected for a period of 3 months before and after implementation. Reports included prescribed medications, dose, quantity, mode of transmission, and prescription count for those captured by the pharmacy. Data was aggregated to determine prescription capture rate and pharmacy workload. For same-day surgery prescriptions captured by the pharmacy, 340B product pricing was compared to Wholesale Acquisition Cost (WAC) pricing in order to determine the primary outcome of overall cost savings from insurance expansion. Reimbursement data from adjudicated prescriptions was averaged and applied in determining margin for each drug purchased. For secondary outcomes, patient benefit was assessed by administration of a pre-/post- questionnaire to caregivers during their visit. Drug pricing for captured prescriptions was compared to contract pricing using the same data set for a non-340B covered entity within the organization to appraise the value of cost savings through field comparison.

RESULTS: The monthly prescription capture rate in SDS increased from 1% to 64% (p<0.001), and patients reached increased from 15 to 1008 (p<0.001). The monthly SDS prescription workload for the outpatient pharmacy increased from 0.003% to 24%, and SDS prescriptions comprised 2% of all discharge orders written monthly across the hospital. Total cost savings utilizing 340B pricing increased from $289 to $29,089, compared to WAC ($189 and $(2,031)) and contract pricing ($203 and $1,834). Patient satisfaction increased dramatically, and the most valued features of the service noted were convenience (87%) timeliness (73%), and education by the pharmacist (64%) (n=122). All 125 respondents indicated they would use the service on a future patient visit.

CONCLUSION: Pharmacy service expansion was financially supported through participation in the 340B Program, successfully addressed measures of the IHI Triple Aim, and improved patient experience and prescription access.