Prescription drug sales at 340B prices grew 12.2% year-on-year from 2021 to 2022, drug industry consulting and research firm IQVIA says in a new white paper. That is down 3.7 percentage points compared with 340B sales growth from 2020 to 2021 and down 5.9 percentage points from 2019 to 2020.
IQVIA reported last year that 340B sales grew 15.9% year-on-year from 2020 to 2021. Before that it reported 340B sales growth of 18.1% from 2019 to 2020 and 17.1% from 2018 to 2019. Drug manufacturers began restricting sales at 340B prices in mid 2020, a trend that accelerated through 2022 and kept growing this year.
“340B sales for retail and mail channels flattened in 2021 and 2022 as contract pharmacy restrictions took effect,” the new white paper said. “Conversely, 340B sales for hospitals and clinics accelerated in 2021 and 2022…. This behavior shows entities were partially successful protecting 340B volume, and suggests they did so by redirecting patients towards entity-owned pharmacies and allowable contract pharmacies, and by optimizing the choice of allowable contract pharmacies. In addition, some entities placed large orders of 340B drugs shortly before restrictions began…. Although restrictions remain in place, many covered entities have regained access to contract pharmacy pricing by submitting claims data.”
IQVIA said there was substantial variation in year-over-year 340B growth by disease area from 2021 to 2022. 340B sales shrank as low as -5.2% for gastrointestinal, hemostatic, and respiratory products. Diabetes, targeted oncology, and immunologic product 340B sales grew as high as 25%.
Looking ahead, IQVIA said “the notion that entities are responsible for all medical care for a patient and thus all drugs prescribed for the patient should be 340B-eligible,” while not widespread yet, “has the potential to substantially accelerate 340B growth. Ongoing studies in IQVIA are modeling continuum of care to quantify its potential impact.”
Over the past few months, several drug manufacturers have announced much more dramatic restrictions in the contract pharmacy setting and that data is not reflected in this study.
The paper is entitled “The 340B Drug Discount Program Exceeds $100B in 2022.” In this and preceding years’ analyses, IQVIA reported 340B sales not in real dollars, but instead as if those sales had been at wholesale acquisition cost and not at 340B ceiling prices (“dollarized using WAC pricing”).
If drugs sold at 340B prices in 2022 had been sold instead at WAC, total sales would have been $105.9 billion, IQVIA said. The white paper does not say what 340B total sales were in 2022 in real dollars.
In August 2022, the U.S. Health Resources and Services Administration reported on its website that 340B covered entities purchased $43.9 billion in covered outpatient drugs under the 340B program in 2021.
Normally in its annual budget request to Congress, typically released in early March, HRSA reports the most recently available data on annual 340B total sales and 340B sales as a percent of the total U.S. drug market. It did not do so in its fiscal year 2024 budget request released this March.