Abstract / Summary
Background The 340B Drug Pricing Program allows eligible safety-net hospitals and clinics to purchase outpatient drugs from manufacturers at discounted prices, creating revenue that can support care for low-income and uninsured patients. As the program has expanded, questions have emerged about whether participating hospitals reported financial assistance and patient-volume measures align with the programs intended objectives. Objectives We compared 340B and non-340B hospitals using reported measures related to care for uninsured and underserved patients, including charity care, charity care for uninsured patients, uncompensated care, and Medicaid admission days. Methods We conducted a cross-sectional analysis comparing unadjusted mean values across 340B and non-340B hospital categories 340B designation was derived by linking hospitals in RAND-transposed CMS HCRIS hospital cost report data to HRSA 340B covered-entity records. Hospitals identified as active 340B covered entities during the relevant reporting period were classified as 340B participants; all others were classified as non-340B. Key measures included charity care as a percentage of operating expenses, Medicaid admission days as a share of hospital days, unreimbursed or uncompensated care, and costs associated with uninsured patients approved for charity care. Welchs t-tests assessed statistically significant differences in unadjusted mean values. Results: Among 3999 hospitals, 340B hospitals reported lower charity care than non-340B hospitals (2.16% vs 2.82% of operating expenses, P<.05) and lower charity care for uninsured patients (1.60% vs 2.26%, P<.05). However, 340B hospitals reported higher Medicaid admission days (19.69% vs 17.76%, P<.05). Unreimbursed or uncompensated care was numerically lower among 340B hospitals, but the overall difference was not statistically significant. Conclusion These findings raise accountability questions about whether 340B participation consistently corresponds with greater reported direct financial assistance for uninsured and underserved patients. Greater transparency, standardized reporting, and clearer patient-assistance expectations may help ensure that 340B program benefits are better aligned with the needs of vulnerable populations.