{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T16:37:11Z","timestamp":1772987831744,"version":"3.50.1"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100019329","name":"Emerson Collective","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019329","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["5P01\u2010AG005842\u201034"],"award-info":[{"award-number":["5P01\u2010AG005842\u201034"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000051","name":"National Human Genome Research Institute","doi-asserted-by":"publisher","award":["R01\u2010HG011792"],"award-info":[{"award-number":["R01\u2010HG011792"]}],"id":[{"id":"10.13039\/100000051","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate how exposure to the 340B Drug Pricing Program influences care for patients with the two most common forms of cancer: lung and breast.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>Proponents of the 340B Program assert that it reduces care costs by supporting safety\u2010net providers through outpatient drug discounts. There is a gap in understanding patient\u2010level program impacts. We estimate the association between the 340B program and care utilization, treatment costs, and health outcomes by comparing patients exposed to the 340B program to patients not exposed using linear and logistic multivariate regression analyses with propensity score weighting. Costs are inflation\u2010adjusted to U.S. 2020 dollars.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>\n                      We use Medicare fee\u2010for\u2010service claims data for beneficiaries in the United States who are within one year of an initial lung (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200935,334) or breast (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200983,721) cancer diagnosis between 2013 and 2018.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Exposure to the 340B program is associated with a significant increase in the probability of using Part B\u2010covered cancer treatment drugs of 10.8 percentage points (pp) (95% CI, 9.2\u2009pp. to 12.3\u2009pp) for lung cancer and 14.8\u2009pp. (95% CI, 13.9\u2009pp. to 15.6\u2009pp) for breast cancer. This is a relative increase of 19.6% and 43.1% for lung and breast cancer, respectively. Medicare spent $9592 (95% CI, $8498 to $10,686) more on lung cancer and $7598 (95% CI, $7215 to $7980) more on breast cancer patients exposed to the 340B program compared with patients not exposed, where the average cost of treatment was $36,256 and $15,626 for lung and breast cancer, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings are consistent with the financial incentives of the 340B program and highlight that the program has a broad impact on patient care and cost. Policymakers should consider ways to support safety net providers that are not tied to outpatient medications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70092","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T04:36:16Z","timestamp":1771216576000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of\n                    <scp>340B<\/scp>\n                    Exposure on Treatment Utilization and Cost for Medicare Patients With Cancer"],"prefix":"10.1111","volume":"61","author":[{"given":"Danea M.","family":"Horn","sequence":"first","affiliation":[{"name":"Center for Translational and Policy Research on Precision Medicine (TRANSPERS), Department of Clinical Pharmacy University of California  San Francisco California USA"},{"name":"Institute for Health Policy Studies University of California  San Francisco California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8926-5085","authenticated-orcid":false,"given":"Kevin","family":"Schulman","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine School of Medicine Stanford University  Stanford California USA"},{"name":"Operations, Information and Technology Graduate School of Business Stanford University  Stanford California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Drug Pricing Program: HHS Uses Multiple Mechanisms to Help Ensure Compliance With 340B Requirements","author":"GAO","year":"2020"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13281"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.0558"},{"key":"e_1_2_11_5_1","volume-title":"Report to the Congress: Overview of the 340B Drug Pricing Program","author":"MedPAC","year":"2015"},{"key":"e_1_2_11_6_1","volume-title":"Covered Entity Report","author":"OPAIS","year":"2023"},{"key":"e_1_2_11_7_1","volume-title":"Overview of the 340B Drug Pricing Program","author":"CRS","year":"2022"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.12823"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.1485"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa2306609"},{"key":"e_1_2_11_11_1","first-page":"442","volume-title":"Medicare Part B Drugs: Action Needed to Reduce Financial Incentives to Prescribe 340B Drugs at Participating Hospitals","author":"GAO","year":"2015"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2025.102971"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1706475"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13584"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.2015"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13278"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2016.11.001"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.4103\/0975\u20107406.62694"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.02810"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-018-0101-4"},{"key":"e_1_2_11_21_1","volume-title":"Medicare Physician & Other Practitioners \u2013 by Provider and Service","author":"CMS","year":"2023"},{"key":"e_1_2_11_22_1","volume-title":"27 CCW Chronic Conditions Algorithms: MBSF_CC_{YYYY} File","author":"CCW","year":"2023"},{"key":"e_1_2_11_23_1","volume-title":"CMS Chronic Conditions Data Warehouse (CCW): CCW Chronic Condition Reference List","author":"CCW","year":"2011"},{"key":"e_1_2_11_24_1","unstructured":"SEER Cancer Medications Enquiry Database (CanMED). Surveillance Research Program SEER Website Tool. Surveillance Epidemiology and End Results Program; National Cancer Institute National Institute of Health. (2023) https:\/\/seer.cancer.gov\/oncologytoolbox\/canmed\/."},{"key":"e_1_2_11_25_1","volume-title":"Treatment Choices for Non\u2010Small Cell Lung Cancer, by Stage","author":"ACS","year":"2025"},{"key":"e_1_2_11_26_1","volume-title":"Treatment of Breast Cancer by Stage","author":"ACS","year":"2019"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1200\/JOP.2013.000895"},{"key":"e_1_2_11_28_1","volume-title":"340B Eligibility","author":"HRSA","year":"2024"},{"key":"e_1_2_11_29_1","volume-title":"Prescription Drugs (outpatient)","author":"CMS","year":"2024"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jnma.2023.02.001"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2007.15.8253"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40425\u2010018\u20100442\u20107"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2212972"},{"key":"e_1_2_11_34_1","volume-title":"Fact Sheet: The 340B Drug Pricing Program","author":"AHA","year":"2023"},{"key":"e_1_2_11_35_1","volume-title":"340B Helps the Most Vulnerable Patients","author":"AAMC","year":"2019"},{"key":"e_1_2_11_36_1","volume-title":"Fact Sheet: Medicaid DSH Program","author":"AHA","year":"2025"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/amajethics.2022.1063"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.7249\/RR3033"},{"key":"e_1_2_11_39_1","volume-title":"The Prices That Commercial Health Insurers and Medicare Pay for Hospitals' and Physicians' Services","author":"CBO","year":"2022"}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70092","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1475-6773.70092","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70092","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T11:08:02Z","timestamp":1772968082000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.70092"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":38,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1111\/1475-6773.70092"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.70092","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"assertion":[{"value":"2025-11-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70092"}}