340B Drug Pricing
🛡️ Public data only — no PHI permitted on this instance.
340B Drug Pricing Analyzer
Covered entities · ceiling price · contract pharmacy · HRSA audits · V28 & V24 · Medicaid carve-in/out — 1,425 corpus deals
Covered Entities
23
Annual Drug Spend
$1,045M
Ceiling Savings
$531M
Program Margin
$382M
Margin %
36.6%
Contract Pharmacy
91
Audit Risk (wtd)
51.6
Corpus Deals
1,425
Drug Category Savings Map
Covered Entity Inventory — DSH / FQHC / SCH / CAH / PED / Ryan White
| ID | Type | Name | Drug Spend ($M) | Ceiling Spread ($M) | CP Count | Child Sites | Margin ($M) | Audit Risk | Status |
|---|---|---|---|---|---|---|---|---|---|
| CE-001 | DSH | DSH Site 1 | $161.25 | $78.82 | 2 | 1 | $56.75 | 44 | monitoring |
| CE-002 | DSH | DSH Site 2 | $121.25 | $58.01 | 8 | 7 | $41.76 | 62 | clean |
| CE-003 | DSH | DSH Site 3 | $150.00 | $81.90 | 9 | 8 | $58.97 | 75 | clean |
| CE-004 | DSH | DSH Site 4 | $157.50 | $82.72 | 13 | 4 | $59.56 | 31 | clean |
| CE-005 | DSH | DSH Site 5 | $98.75 | $48.27 | 10 | 5 | $34.75 | 64 | monitoring |
| CE-006 | SCH | SCH Site 1 | $38.22 | $19.45 | 6 | 0 | $14.00 | 36 | clean |
| CE-007 | SCH | SCH Site 2 | $35.28 | $16.77 | 11 | 0 | $12.07 | 29 | monitoring |
| CE-008 | SCH | SCH Site 3 | $57.54 | $28.17 | 2 | 0 | $20.28 | 32 | clean |
| CE-009 | RRC | RRC Site 1 | $30.45 | $13.45 | 8 | 0 | $9.68 | 62 | clean |
| CE-010 | RRC | RRC Site 2 | $31.50 | $15.88 | 9 | 0 | $11.43 | 75 | clean |
| CE-011 | CAH | CAH Site 1 | $11.12 | $5.09 | 2 | 0 | $3.66 | 74 | monitoring |
| CE-012 | CAH | CAH Site 2 | $7.04 | $3.19 | 1 | 0 | $2.30 | 33 | minor finding |
| CE-013 | CAH | CAH Site 3 | $9.44 | $3.86 | 3 | 0 | $2.78 | 23 | minor finding |
| CE-014 | CAH | CAH Site 4 | $11.52 | $5.02 | 1 | 0 | $3.61 | 49 | monitoring |
| CE-015 | CAH | CAH Site 5 | $8.00 | $3.34 | 1 | 0 | $2.41 | 25 | clean |
| CE-016 | PED | PED Site 1 | $22.96 | $13.51 | 7 | 6 | $9.73 | 37 | clean |
| CE-017 | PED | PED Site 2 | $22.68 | $13.22 | 2 | 5 | $9.52 | 56 | clean |
| CE-018 | FQHC | FQHC Site 1 | $11.28 | $7.13 | 5 | 8 | $5.13 | 59 | monitoring |
| CE-019 | FQHC | FQHC Site 2 | $9.96 | $5.66 | 2 | 1 | $4.08 | 68 | minor finding |
| CE-020 | FQHC | FQHC Site 3 | $16.68 | $10.06 | 8 | 3 | $7.24 | 74 | monitoring |
| CE-021 | FQHC | FQHC Site 4 | $14.40 | $7.93 | 11 | 6 | $5.71 | 65 | clean |
| CE-022 | FQHC | FQHC Site 5 | $9.12 | $4.81 | 3 | 6 | $3.47 | 21 | clean |
| CE-023 | Ryan White | Ryan White Site 1 | $8.64 | $4.87 | 7 | 0 | $3.51 | 61 | clean |
Drug Category Economics — WAC vs 340B Ceiling Price
| Drug Category | Volume (units) | WAC $/unit | Ceiling $/unit | Discount | Annual Savings ($M) | Share of Spend |
|---|---|---|---|---|---|---|
| Oncology Biologics | 60,305 | $4,850.00 | $2,280.00 | 53.0% | $154.98 | 28.0% |
| Immunology / Biosimilars | 54,977 | $3,420.00 | $1,680.00 | 50.9% | $95.66 | 18.0% |
| Antivirals (HIV/Hepatitis) | 67,756 | $1,850.00 | $820.00 | 55.7% | $69.79 | 12.0% |
| Insulin & Diabetes | 172,301 | $485.00 | $220.00 | 54.6% | $45.66 | 8.0% |
| Respiratory / COPD | 228,501 | $320.00 | $148.00 | 53.8% | $39.30 | 7.0% |
| Ophthalmology Injectables | 44,767 | $2,100.00 | $980.00 | 53.3% | $50.14 | 9.0% |
| Vaccines | 237,404 | $220.00 | $105.00 | 52.3% | $27.30 | 5.0% |
| Rare Disease / Orphan | 6,685 | $12,500.00 | $5,850.00 | 53.2% | $44.46 | 8.0% |
| Blood Products | 16,939 | $1,850.00 | $860.00 | 53.5% | $16.77 | 3.0% |
| Chronic Mental Health | 49,741 | $420.00 | $195.00 | 53.6% | $11.19 | 2.0% |
Contract Pharmacy Network — Spread Capture by Type
| Pharmacy Type | Locations | Claims/mo | Spread/Claim | Monthly Margin ($k) | Annual ($M) | Integrity Risk |
|---|---|---|---|---|---|---|
| Chain (CVS/Walgreens) | 32 | 21,760 | $48.00 | $1,044.5 | $12.53 | low |
| Specialty Pharmacy | 18 | 5,760 | $185.00 | $1,065.6 | $12.79 | medium |
| Independent Community | 23 | 2,760 | $32.00 | $88.3 | $1.06 | low |
| Mail-Order | 7 | 3,360 | $62.00 | $208.3 | $2.50 | low |
| Oncology TPA-Directed | 11 | 935 | $245.00 | $229.1 | $2.75 | high |
Compliance Audit Inventory — HRSA Program Integrity
| Audit Area | Severity | Exposure ($M) | Remediation (days) | Last HRSA Visit | Status |
|---|---|---|---|---|---|
| OPA Registration Currency | clean | $0.000 | 0 | 2024-09-15 | current |
| Child Site Eligibility Docs | minor | $0.180 | 45 | 2024-09-15 | in remediation |
| Contract Pharmacy Self-Audit | moderate | $0.440 | 90 | 2023-11-02 | open |
| Medicaid Carve-Out Claims | minor | $0.125 | 30 | 2024-05-18 | closed |
| Duplicate Discount Prevention | clean | $0.000 | 0 | 2024-09-15 | current |
| GPO Prohibition (DSH) | moderate | $0.680 | 60 | 2024-02-08 | open |
| Diversion Risk (340B to Non-Eligible) | severe | $1.240 | 180 | 2023-06-22 | mediating |
| Manufacturer Dispute Filings | minor | $0.085 | 30 | 2024-07-14 | closed |
Manufacturer Restriction Exposure
| Manufacturer | Restricted Products | Restriction Type | Annual Impact ($M) | Workaround |
|---|---|---|---|---|
| Eli Lilly | 8 | contract pharmacy ship-to limit | $2.85 | AVAILABLE |
| Sanofi | 6 | claims-data certification required | $1.92 | AVAILABLE |
| Novartis | 5 | single contract pharmacy per CE | $2.20 | AVAILABLE |
| Merck | 4 | 340B ID verification | $1.35 | AVAILABLE |
| Bristol Myers Squibb | 7 | orphan drug exclusion | $3.40 | NONE |
| AstraZeneca | 3 | contract pharmacy limit | $1.08 | AVAILABLE |
| Boehringer Ingelheim | 2 | single CP, no specialty | $0.75 | AVAILABLE |
| AbbVie | 4 | contract pharmacy limit | $2.65 | AVAILABLE |
State Medicaid Interaction — Carve-In vs Carve-Out
| State | Carve Status | Avg MAC Rate | Duplicate Discount Risk | Gross Margin ($M) |
|---|---|---|---|---|
| California | carve-in (actual acquisition cost) | 28.0% | low | $4.85 |
| Texas | carve-out | 52.0% | low | $8.95 |
| New York | carve-in (FFP-only) | 35.0% | medium | $3.20 |
| Florida | carve-out | 48.0% | low | $7.45 |
| Illinois | carve-in | 32.0% | medium | $2.85 |
| Pennsylvania | carve-out | 46.0% | low | $5.20 |
| Ohio | carve-in | 30.0% | high | $1.95 |
| North Carolina | carve-out | 44.0% | low | $4.15 |
340B Thesis: 23 covered entities across Health System platform;
$1,045M WAC-equivalent drug spend produces $531M 340B ceiling-price savings
(51% of spend) and $382M net margin (36.6%).
Contract pharmacy network of 91 retail locations captures spread; weighted audit risk 51.6/100.
Manufacturer restrictions (Lilly, Sanofi, Novartis) erode ~$16.2M/yr; audit exposure $2.75M if findings sustained.
Diversion and duplicate-discount are material deal-breakers — ongoing compliance program required.