How does 340B affect my commercial plan spend?

Commercial plans can overpay when their members fill prescriptions at contract pharmacies that dispense 340B-priced product. The mechanism: a covered entity (typically a safety-net hospital) purchases the drug at the 340B price, dispenses it through a contract pharmacy, and bills the commercial plan at the standard PBM contract rate. The difference between the 340B acquisition cost and the commercial reimbursement is retained by the covered entity (and sometimes shared with the contract pharmacy and a third-party administrator).

For a $10,000/month specialty drug acquired at $3,000 under 340B, the commercial plan is still paying $10,000 even though the drug only cost $3,000 to acquire. The $7,000 spread funds the safety-net mission, but it represents pure overpayment from the commercial plan's perspective.

Per-plan 340B exposure is difficult to quantify from public data alone because HRSA OPAIS publishes the contract pharmacy network but not per-drug volume. RxFinder surfaces qualitative exposure scoring (high/medium/low risk per drug class) but precise dollar exposure requires claims-level analysis combined with covered entity / contract pharmacy NPI matching.