Episode 248: The Truth About 340B With Anthony DiGiorgio

Returning guest Anthony DiGiorgio, DO, a practicing neurosurgeon at UCSF and noted health policy commentator, takes a deep dive into the 340B Drug Pricing Program—one of the most consequential yet misunderstood mechanisms in US healthcare. He traces the program’s origins in the early 1990s, designed to help safety net hospitals stretch scarce federal resources to better serve vulnerable patients. Dr. DiGiorgio examines how, over time, many institutions have leveraged 340B as an ancillary revenue stream rather than a patient-centered support system, detailing when and how these practices emerged, the financial incentives at play, and the consequences for both physicians and patients. He also discusses current policy debates and potential reforms aimed at restoring 340B to its original mission.

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This podcast oversimplifies 340B eligibility and overlooks the demand curve

It is not true that just one site must meet the DSH threshold and then the entire system is eligible.

An alternative cause of high cost drugs being used more frequently by 340B covered entities is their demand curve. With 340B the cost is lower so the quantity demanded is higher and better more expensive drugs are made more available to patients. The impact on anticoagulation practices is a useful place to study this phenomenon since with 340B, charity, care programs can afford to help patients obtain modern alternatives to warfarin.