Expanding 340B Won’t Fix a Broken System

Including community practices in the discount drug program would make a bad problem worse

Letter to The WSJ. 

"Regarding “Is the 340B Discount Drug Program Working?” (Letters, May 13): The American Society of Clinical Oncology’s proposal to expand 340B drug discount program eligibility to community practices will only worsen existing problems with the program.

What began in 1992 as a modest safety-net program intended to help vulnerable patients has evolved into a multibillion-dollar institutional revenue stream that too often benefits hospitals and health systems more than patients.

Expanding participation in a flawed program isn’t reform. It simply broadens access to the same distorted financial incentives that have fueled consolidation, higher costs and migration of cancer care into more expensive hospital settings.

The problem with 340B isn’t that too few institutions can profit from it. It’s that hospitals and covered entities can purchase drugs at steep discounts while receiving reimbursement from commercial payers, often without demonstrating that savings directly reduce costs for financially vulnerable patients.

Discounts should follow patients in need—not institutions. If a patient is uninsured, underinsured or financially vulnerable, the value of the discount should be directly tied to that patient’s care through lower out-of-pocket costs, financial assistance and improved access to treatment. That’s what Congress intended.

Ted Okon and Lucio Gordan, M.D.

Community Oncology Alliance and

Fla. Cancer Specialists & Research Inst."