Presentation (CTI)

OBJECTIVES: To identify where 340B Program hospital expansion has been concentrated by analyzing growth in child sites and contract pharmacy relationships across hospitals of varying size and teaching status.
METHODS: A retrospective observational analysis was conducted using HRSA’s Office of Pharmacy Affairs Information System (OPAIS) as of Q4 2023. The cohort included hospitals continuously enrolled in 340B from 2017-2023 and new hospital entrants during the same period. Contract pharmacy relationships and 340B child sites—off-campus outpatient facilities registered under a hospital’s 340B identifier—were counted for each hospital. Entities were categorized into bed size quartiles (largest quartile = top 25% by bed count). Teaching status was derived from institutional sources. Growth metrics were compared across strata.
RESULTS: Hospitals in the largest quartile by bed size comprised 33% of all 340B hospitals yet accounted for 81% of child site growth and 60% of contract pharmacy expansion between 2017 and 2023. Among large hospitals, teaching institutions demonstrated disproportionate expansion, averaging nearly twice as many child sites (49.6 vs. 25.4) and contract pharmacy relationships (93.8 vs. 51.4) compared with similarly large nonteaching hospitals. Teaching hospitals had 66% more child sites than non‑teaching hospitals in 2017, a gap that widened to 95% by 2023. Of 415 hospitals entering 340B during the study period, the 36.6% in the largest quartile accounted for 71.9% of new child sites and 62.4% of new contract pharmacy relationships.
CONCLUSIONS: Driven by disproportionate expansion of child sites and contract pharmacies, 340B growth has concentrated in large hospitals, particularly large teaching hospitals, allowing these entities to capture a growing share of 340B benefits. This dominance raises questions about alignment with the Program’s original intent to support more affordable access for vulnerable patients being served by a narrow set of true safety-net providers.