Only 66 sites were added this quarter, about half the number in Q4 2011.
January 11, 2012—Hospital site enrollment in 340B through the drug discount program's expansion under health care reform has fallen off significantly, according to new figures from the Office of Pharmacy Affairs (OPA).
According to OPA, only 66 rural and children's hospital sites were added to 340B on Jan. 1, the beginning of the first quarter of 2012.
That was the smallest batch of so-called new covered entity types to join 340B since August 2010, when free-standing cancer centers, critical access hospitals, rural referral centers and sole community hospitals were first allowed to enroll under the terms of the Affordable Care Act (ACA). Although free-standing children's hospitals have been eligible for 340B discounts since September 2009, health care reform changed the legal basis for their eligibility and OPA counts them together with rural and cancer hospitals for purposes of tracking reform-driven program growth.
The relatively small Q1 2012 enrollment figure compares with 120 new covered entity type sites added in Q4 2011, 198 in Q3, 150 in Q2, and 287 in Q1. A total of 725 rural, cancer and children's hospitals sites came on board during all of 2010 and 2009, for a grand total of 1,561 sites to date due to health care reform. A small number of other ACA-entity sites were enrolled out of cycle during the past two years under OPA's 340B flexible enrollment policy following natural disasters.
The OPA data reflect the number of hospital clinics and satellites enrolled in 340B, not the number of parent hospitals. For example, the newest 66 sites belong to 50 larger institutions, as indicated by Medicare hospital identification numbers.
The 340B program has come under increased scrutiny in Congress since September, when the Government Accountability Office (GAO) reported that "with the program's expansion, program integrity issues may take on even greater significance unless effective mechanisms to monitor and address program violations, as well as more specific guidance, are put in place."
In response to pressure from an influential House Republican committee chairman and two senior GOP senators, OPA is beginning its first-ever audits of 340B providers for evidence of drug diversion and duplicate discounts.