Outpatient chemotherapy drug costs and expensive chemotherapy drug use in 340B and Non-340B hospitals - an observational study

Sep 23, 2026

This observational study evaluates whether patient and cancer characteristics and whether hospitals are affiliated with NCI-designated cancer centers explain differences in Part B drug costs and the use of expensive chemotherapy drugs between 340B and non-340B hospitals. Using SEER-Medicare and 340B entity data, it includes fee-for-service beneficiaries diagnosed from 2013 to 2015 and applies multivariate stepwise generalized estimating equation modeling to test independent associations.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusions

Hu and Nerenz BMC Health Services Research (2025) 25:157 BMC Health Services Research [https://doi.org/10.1186/s12913-024-12188-1](https://doi.org/10.1186/s12913-024-12188-1) RESEARCH Open Access Outpatient chemotherapy drug costs and expensive chemotherapy drug use in 340Band Non-340B hospitals: an observational study Jianhui Hu 1* and David R. Nerenz 1 Abstract Background The 340B Drug Pricing Program has been controversial since its inception in 1992, a major criticism being that 340B hospitals use more outpatient drugs, and more expensive drugs, because of financial incentives to “make money” through the program. The goal of this study was to determine whether characteristics of patients treated at 340B hospitals, and affiliation of hospitals with NCI-designated cancer centers, would explain higher Part B drug costs and use of more expensive chemotherapy drugs. Methods This is an observational study using data from SEER-Medicare and 340B entity database. Fee-for-service Medicare beneficiaries who were first diagnosed with cancer between 1/1/2013 and 12/31/2015 were included. Hospital, patient, and cancer/clinical characteristics were used as predictors of both overall Part B drug costs and use of expensive chemotherapy drugs. Patient characteristics and cancer conditions were compared between those who were treated at 340B and non-340B hospitals, and between those who used and who did not use any expensive chemotherapy treatment. Independent relationships between overall Part B drug costs and patients’ 340B status, and between patients’ use of expensive chemotherapy drug and patients’ 340B status were evaluated in multivariate analyses, using a “stepwise” generalized estimating equation modeling approach. Results We found that patients at 340B hospitals had a somewhat higher chance of using one of the ten expensive chemotherapy drugs, and somewhat higher overall drug costs, but these relationships became non-significant when patient, cancer/clinical factors, and cancer center status were considered. Compared to the reference patients, patients who were treated in an NCI-designated cancer center or a hospital affiliated with such center, who had certain types of cancers (e. g., B-cell), or had advanced-stage disease had a higher chance to use expensive chemotherapy treatment; patients who were older, survived the first 12 months upon diagnosis, had advanced-stage disease, or had more drug claims had higher drug costs. Conclusions Hospital 340B status was not significantly associated with use of more expensive cancer drugs or drug costs once other relevant factors (e. g., cancer center status, advanced-stage disease) were taken into account. Keywords 340B, Cancer centers, Expensive chemotherapy, Part B drug costs *Correspondence: Jianhui Hu [jhu1@hfhs.org](jhu1@hfhs.org) 1 Center for Health Policy & Health Services Research, Henry Ford Health, 1 Ford Place, Suite 5E, Detroit, MI 48202, USA Background The 340B Drug Pricing Program (340B) was established in 1992 with the intent of enabling participating entities to “stretch scarce federal resources” as far as possible to provide more comprehensive services to underserved populations [1]. The program allows qualifying hospitals to purchase outpatient drugs at a significantly reduced © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated

FAQs

What question does the study investigate about 340B and chemotherapy costs?

It tests whether patient treated at 340B hospitals, along with cancer characteristics and affiliation with NCI-designated cancer centers, account for higher Part B drug costs and greater use of expensive chemotherapy drugs.

What data and patient selection were used?

The study uses SEER-Medicare and the 340B entity database, including fee-for-service Medicare beneficiaries first diagnosed with cancer between 1/1/2013 and 12/31/2015.

What is the main conclusion about 340B status and expensive chemotherapy use?

Hospital 340B status was not significantly associated with use of more expensive cancer drugs or higher drug costs after adjusting for other factors such as cancer center status and advanced-stage disease.

Sep 23, 2026

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