340B Purchase Data Highlights Continued Program Growth

Summary

HRSA 2023 340B purchase data demonstrates continued program growth and that sales for the top 10 340B drugs exceeded sales for those drugs in Medicare.

On October 18, the Health Resources & Services Administration (HRSA) released its annual update on 340B covered entity purchases for 2023. The agency highlighted that under the 340B program, drug purchases at discounted 340B prices reached a record of $66.3 billion in 2023, representing a 24% year-over-year increase. These data allow stakeholders to better understand the size of the 340B program and its use by different covered entity types.

Disproportionate share hospitals (DSHs) made approximately $51.9 billion in 340B purchases in 2023, accounting for approximately 78% of total 340B drug purchases. The next largest category of purchases was for health center programs, accounting for about $3.6 billion of total purchases (5.4%), followed by children’s hospitals, which made up roughly $2.1 billion of total purchases (3.2%). The data reported by HRSA is from the Prime Vendor Program (PVP), which captures most, but not all, 340B transactions.

Continued 340B Program Growth and Stakeholder Responses

Over the past decade, the 340B program has continued to grow significantly.

Figure 1. 340B Drug Sales from 2015-2023 (Billions)

Among government sponsored and funded programs, 340B drug spending is now second in size only to that of Medicare Part D’s. 340B purchases outpace net Medicaid spending on prescription drugs; KFF recently projected $51 billion in Medicaid net spending (spending post rebates) on prescription drugs in FY 2023. The 340B program growth trends have prompted manufacturers to impose contract pharmacy restrictions, increased stakeholders’ interest in potential rebate models, and have led policymakers to increase attention on the program and propose reforms.

A Closer Look at the Top 10 Drugs Based on 340B Sales

According to HRSA, the top-10 340B drugs accounted for roughly one-third of all 340B purchases in 2023. Avalere compared the 2023 340B purchases for these 10 drugs to the most recent year of data on Medicare Part B and Part D spending in the CMS Drug Spending Dashboards. While there is variation across individual drugs, 2023 340B purchases for these 10 drugs in total was about $3.5 billion higher than Part B and Part D spending on these 10 drugs in 2022 (see Table 1).

Table 1. 2023 340B Sales Compared to 2022 Medicare Spending for Top 10 340B Drugs


Brand Name	Primary Indication	2023 Total 340B Sales	2022 Total Medicare Part B + D Spending
Keytruda	Oncology	$6,905,377,755	$5,027,119,004
Biktarvy	HIV	$3,577,083,273	$2,703,581,195
Opdivo	Oncology	$1,953,824,181	$1,893,787,032
Darzalex Faspro	Oncology	$1,891,559,523	$1,618,324,049
Ocrevus	Oncology	$1,850,213,455	$816,698,392
Trikafta	Cystic Fibrosis	$1,817,226,143	$646,868,282
Humira (CF) Pen	Immunology	$998,809,804	$3,694,000,753
Descovy	HIV	$969,510,516	$574,036,753
Entyvio	Immunology	$949,744,300	$749,730,440
Durvalumab	Oncology	$889,594,527	$575,101,380
TOTAL		$21,802,943,477	$18,299,247,129

Source: Data from HRSA and CMS

Conclusion

Given the latest figures demonstrating continued 340B program growth, the conversation around reform is likely to continue in 2025 with bipartisan interest regardless of election outcomes in early November. In the 118th Congress, multiple bills (e.g., 340B SUSTAIN Act, 340B ACCESS Act) have been introduced, including proposals to ensure that patients benefit more directly from discounted prices, to improve program transparency, and to codify the role of contract pharmacies in the program.

Staying ahead of the latest trends and 340B policy developments will be critical for stakeholders looking to engage in a 340B reform conversation in early 2025. To learn more about how Avalere can support you on 340B policy and strategy, connect with us.