340B Participation and Safety Net Engagement Among Federally Qualified Health Centers

Area of Science:

• Health Services Research
• Health Economics
• Public Health Policy

Background:

• The 340B program offers drug discounts to safety net providers, but its impact on care provision varies.
• While studied in hospitals, less is known about how Federally Qualified Health Centers (FQHCs) utilize 340B revenue for safety net care.
• FQHCs are a significant group of 340B covered entities, serving vulnerable populations.

Purpose of the Study:

• To determine if 340B program participation is associated with increased safety net care provision in FQHCs.
• To assess the relationship between a proxy for 340B revenue and the delivery of services to underserved patient groups.
• To investigate the use of 340B funds for preventive and enabling services within FQHCs.

Main Methods:

• A descriptive, retrospective cohort study analyzing data from 1468 FQHCs from 2005-2022.
• Utilized the Health Resources and Services Administration Uniform Data System and the 340B Outpatient Pharmacy Affairs Database.
• Employed FQHC and year-level fixed effects, controlling for Medicaid expansion, with data analyzed between March and December 2023.

Main Results:

• An increase in 340B registered locations correlated with higher patient volumes, particularly for uninsured and low-income individuals.
• Associated with increased delivery of key preventive services, including HIV testing, lead screening, influenza shots, Pap smears, and tobacco cessation counseling.
• Average annual increase in 340B locations was 1.5 over the study period.

Conclusions:

• Findings suggest FQHCs may leverage 340B revenues to expand safety net care, similar to public hospitals.
• Statistically significant increases in preventive services for vulnerable populations were observed.
• Results support nuanced policy discussions regarding differential 340B program reforms for hospital and non-hospital entities.