Drug pricing program improved prostate cancer treatment adherence

Prostate cancer patients receiving care at hospitals that are part of a special drug pricing program were more likely to stick to their prescription drug therapy than patients at other hospitals, according to a study from researchers at the University of Michigan’s Rogel Cancer Center and Institute for Healthcare Policy and Innovation (IHPI).

The 340B Drug Pricing Program is a federal program that requires the pharmaceutical industry to provide a discount on the cost of drugs to participating hospitals and clinics who serve a disproportionate number of Medicare and Medicaid patients. The program was started to enable hospitals to stretch scarce resources, reach more patients and provide more comprehensive services. What the hospitals save on drug prices, they are expected to invest in services that help disadvantaged patients in their community.

“In the field of advanced prostate cancer, there’s been a paradigm shift to using newer targeted oral treatments. But these drugs are expensive, and cost can limit access to these drugs, particularly among those who are socioeconomically disadvantaged. We wanted to see if the 340B program could help mitigate this disparity,” said study first author Kassem Faraj, M.D., a urologic oncology fellow at Michigan Medicine.

The team looked back at a 20% sample of Medicare beneficiaries diagnosed with advanced prostate cancer who were treated with these targeted therapies at a hospital based program. They identified 2,237 men treated at 340B participating hospitals and 1,100 treated at non-participating hospitals.

They then looked at a social vulnerability index, a zip code based measure that characterizes socioeconomic, racial and household characteristics. They found that patients from areas with greater social vulnerability were less likely to use the oral drugs. There was no difference in use between 340B and non-340B hospitals.

However, patients receiving treatment at 340B hospitals were more likely to continue treatment. The researchers saw that in non-340B hospitals, as social vulnerability increased, adherence dropped. But in 340B hospitals, adherence remained flat regardless of social vulnerability. Results were published in Cancer.

“There are many reasons why adherence to these drugs can drop. We suspect that 340B hospitals potentially have some resources or mechanisms that are helping these vulnerable patients maintain adherence,” Faraj said. This could include medication management programs or financial help for out-of-pocket drug costs.

“While 340B participation didn’t increase the number of patients using this therapy, it was associated with better treatment adherence among socially vulnerable patients,” Faraj said.

Read the IHPI Policy Brief for more on the health policy and practice implications of Faraj and colleagues' findings.

Additional authors: Samuel R. Kaufman, Mary Oerline, Lindsey Herrel, Avinash Maganty, Megan E.V. Caram, Vahakn B. Shahinian, Brent K. Hollenbeck

Funding: National Cancer Institute grants T32 CA 180984, R01 CA275993, R01 CA 269367. 
The team received additional funding from the U-M Institute for Healthcare Policy and Innovation (IHPI), in partnership with Rogel Cancer Center, as part of its Policy Sprint initiative. 

Disclosure: Michigan Medicine participates in the 340B program. Learn more about how the hospital provides community support.

Citation: “The 340B Program and oral specialty drugs for advanced prostate cancer,”Cancer. DOI: 10.1002/cncr.35262