340B Drug Discount Program
Understanding 340B exposure for plan design. Covered entities purchase outpatient drugs at significant discounts, creating spread opportunities between 340B acquisition cost and commercial plan reimbursement.
How 340B Affects Your Plan
The Spread Problem
340B entities acquire drugs at deep discounts (often 25-50% below NADAC) but may bill commercial plans at standard rates, capturing the spread. This inflates plan costs without benefiting patients.
Contract Pharmacy Growth
Contract pharmacy arrangements have expanded 340B's reach far beyond safety-net hospitals. Retail chains now dispense 340B drugs, making it harder for plans to identify 340B-eligible claims and manage spend.
What Plans Can Do
Identify high-340B-exposure drugs in your formulary. Negotiate 340B-specific reimbursement rates with your PBM. Use claims data to flag potential spread and redirect fills to non-340B pharmacies where possible.
Drugs with Largest Price Spreads
Drugs with the biggest gap between current NADAC and 12-month-ago pricing. Large spreads often indicate high 340B exposure potential, as entities purchasing at historical discount rates capture more margin on volatile-priced drugs.
| Drug | Class | Current NADAC | 12mo Ago | Spread | Mfrs |
|---|---|---|---|---|---|
| Teriparatide | Parathyroid Hormone Analog | $595.5376 | $846.0749 | $250.5373 | 3 |
| Tasimelteon | Melatonin Receptor Agonist | $400.1670 | $608.5590 | $208.3920 | 3 |
| Leuprolide | Gonadotropin Releasing Hormone Receptor Agonist | $220.1220 | $301.8717 | $81.7497 | 8 |
| Ganirelix | Gonadotropin Releasing Hormone Receptor Antagonist | $62.3467 | $91.6289 | $29.2822 | 7 |
| Liraglutide | GLP-1 Receptor Agonist | $39.4317 | $67.7356 | $28.3038 | 6 |
| Penciclovir | Herpesvirus Nucleoside Analog DNA Polymerase Inhibitor | $64.7348 | $89.6904 | $24.9556 | 4 |
| Tofacitinib | $73.8329 | $98.2506 | $24.4177 | 2 | |
| Insulin Degludec | Insulin Analog | $9.0250 | $32.5194 | $23.4944 | 0 |
| Insulin Aspart Injection | Insulin Analog | $6.9327 | $27.7661 | $20.8335 | 0 |
| Tolvaptan | Vasopressin V2 Receptor Antagonist | $21.2475 | $41.6075 | $20.3600 | 6 |
| Glucagon | Antihypoglycemic Agent | $197.6873 | $217.7587 | $20.0714 | 4 |
| Insulin Lispro-Aabc | Insulin Analog | $7.8912 | $26.3430 | $18.4518 | 0 |
| Nitazoxanide | Antiprotozoal | $87.9561 | $104.2482 | $16.2922 | 3 |
| Maraviroc | CCR5 Co-receptor Antagonist | $8.9631 | $19.6280 | $10.6649 | 4 |
| Linaclotide | Guanylate Cyclase-C Agonist | $9.0216 | $18.1549 | $9.1333 | 0 |
| Empagliflozin and Linagliptin | Sodium-Glucose Cotransporter 2 Inhibitor | $11.1925 | $20.1302 | $8.9378 | 0 |
| Empagliflozin | Sodium-Glucose Cotransporter 2 Inhibitor | $11.1962 | $20.1334 | $8.9371 | 0 |
| Ertapenem | Penem Antibacterial | $26.8334 | $35.4929 | $8.6595 | 5 |
| Fondaparinux | Factor Xa Inhibitor | $19.7584 | $28.1129 | $8.3544 | 4 |
| Levorphanol | Opioid Agonist | $10.6456 | $18.7757 | $8.1301 | 5 |
340B Program by the Numbers
Deep Dive: Ecosystem Resources
340B program statistics from HRSA OPAIS and published industry reports. Price spread data derived from CMS NADAC historical comparisons and is illustrative, not definitive. Plans should conduct independent 340B exposure analysis using claims data. Source: HRSA 340B OPAIS.