340B Program Enrollment Led to More Oncology Services at Rural Hospitals

Rural hospitals that participated in the 340B Drug Pricing Program were more likely to introduce oncology services than facilities that did not enroll in the program, a study published in Health Affairs found.

Rural communities tend to have higher cancer mortality rates than metropolitan communities and suffer from limited availability of oncology services. Hospitals have cited high costs as barriers to providing oncology services and drugs.

Eligible hospitals participating in the 340B Drug Pricing Program receive a 35 percent discount on covered outpatient drugs, offering a potential way to increase the affordability of providing oncology services.

Researchers used American Hospital Association (AHA) Annual Survey data to determine if enrollment in the 340B program increased the likelihood of oncology service offerings at rural hospitals. They assessed oncology service offerings from 2011 to 2020 at rural hospitals that started participating in the 340B program between 2012 and 2018. They compared these offerings to those at hospitals that did not enroll in the program as of 2020.

The study sample included 563 rural general acute care hospitals in the United States, 426 of which newly participated in the 340B program during the study period and 137 that never participated.

Hospitals that began 340B program participation between 2012 and 2015 were categorized as early participants, while those that joined between 2016 and 2018 were referred to as late participants.

The sample was limited to hospitals that did not offer any oncology services in 2011. By 2015, around 8 percent of early participants had introduced oncology services, while 6 percent of late and never participants did. By 2020, almost 17 percent of early participants offered oncology services compared to 9 percent of late participants and 7 percent of never participants.

Before 340B participation, all hospitals had similar probabilities of offering oncology services. Among hospitals that newly enrolled in the 340B program, the likelihood of providing oncology services grew significantly, researchers found.

After participating in the 340B program for three years, rural hospitals increased their addition of oncology services by 8.4 percentage points more than those that didn’t enroll. This difference increased to 14.5 percentage points after hospitals had participated in the program for six years.

These findings indicate that the 340B program supports rural hospitals’ ability to offer oncology services, thus, improving access to cancer care for vulnerable communities.

Medicaid expansion was also associated with a higher probability of hospitals offering oncology services by 7.6 percentage points.

Among new 340B participants, hospitals that introduced oncology services were more likely to be nonprofit, located in a state that expanded Medicaid, and located in counties with lower uninsurance rates. They were less likely to be designated a critical access hospital.

Among hospitals that didn’t participate in the program, facilities that added oncology services were more likely to be in counties with higher median incomes and lower uninsurance rates.

“Although the 340B program may improve access to oncology services in some rural areas, these communities might not be as socioeconomically vulnerable as communities in which hospitals did not add oncology services,” researchers wrote.

“Together, our findings suggest that supportive policies and programs beyond the 340B program—to address other, concurrent barriers and disincentives—are necessary to ensure that geographically vulnerable areas have access to comprehensive health care resources such as oncology services.”

In addition, future research should focus on whether the 340B program helps reduce travel time to care, improves cancer care for rural populations, and if these outcomes help minimize rural-urban cancer mortality disparities.