With the 340B program taking punches from the drug industry almost daily, a bipartisan group of 84 Members of the U.S. House of Representatives and 29 Members of the U.S. Senate have placed themselves right in the program’s corner. The letters were spearheaded by Sens. John Thune (R-S.D.) and Tammy Baldwin (D-Wis.) and Reps. Shelley Moore Capito (R-W.Va.) and Kathy Castor (D-Fla.). Click here for the House version of the letter and here for the Senate version.
In the Aug. 2 letters to House Speaker John Boehner (R-Ohio) and Minority Leader Nancy Pelosi (D-Calif.) and to Senate HELP Committee Chairman Tom Harkin (D-Iowa) and Ranking Member Lamar Alexander (R-Tenn.), Members of the House and Senate expressed their “bipartisan support” for 340B, which in their own words “helps to reduce pharmaceutical costs for hundreds of hospitals that serve many low-income residents of our states.” Elsewhere in their letters, the lawmakers say that “the program has reduced federal and state government spending on prescription drugs by billions of dollars and successfully increased access to drugs for low-income and other vulnerable patients served by 340B providers.” The letters also point out that the program enables hospitals to expand health care services to the community, increase the number of patients served, or offset losses from uncompensated care.
The large number of lawmakers who signed the letters is especially noteworthy, given that big PhRMA pushed back hard against the sign-on campaign. We’re proud to say that SNHPA worked very hard to encourage lawmakers to sign, and the results speak for themselves.
The letters’ description of the 340B program and its purpose contrasts sharply with the one being pushed by drug companies and their allies. They say that the discount program was intended to be limited to low-income uninsured patients only. While this patient population clearly benefits the most from the program, there would be little to no benefit from a program where providers had to pass over their entire savings to commercial insurers and Medicare.
Quoting now from the Senate version of the letter, Members of Congress said that “given the significant economic pressures on these safety net providers, any threat to these savings means that these community-based programs are at great risk.”
The House members closed their letter with these words: “On behalf of the millions of our neighbors who rely upon safety net providers, we urge you to resist and legislative efforts to change the law’s mission—to help safety net providers ‘stretch scarce Federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.'”
The sign-on letter campaign is the second big win for 340B on the Congressional front in less than a month. In the July 11 report accompanying its fiscal 2014 spending bill for the Departments of Labor, Health And Human Services, and Education, the Senate Appropriations Committee said 340B is “more than simply an individual discount program” and, in fact, “was designed to help safety net providers maintain, improve, and expand patient access to healthcare services generally.”
“In establishing the program in 1992, Congress explicitly stated that the 340B program was intended to ‘enable entities to stretch scarce Federal resources as far as possible,'” the committee said. “As [the Health Resources and Services Administration (HRSA) Office of Pharmacy Affairs (OPA)] continues to improve and enhance oversight of the 340B program, the Committee urges OPA to implement policies that maximize the healthcare safety net and expand patient access to healthcare.”
Health care providers enrolled in 340B have never had a way of checking whether they are being charged too much for the medicines they buy through the program. The Appropriations Committee would fix that that by:
- Authorizing a 0.1 percent user fee that providers would pay on their 340B drug purchases.
- Directing HRSA, as its first activity funded by the fee, to create a secure website that makes 340B ceiling prices available to hospitals, health centers, and clinics for the very first time.
The creation of the website was actually one of several steps to bolster 340B oversight and transparency that Congress and the White House included in the Affordable Care Act. Health care reform also requires HRSA to:
- Develop a system to verify the accuracy of drug manufacturers’ 340B prices.
- Audit manufacturers and perform spot checks of their 340B sales transactions.
- Establish procedures for manufacturers to issue refunds to providers when there is an overcharge.
- Impose civil monetary penalties for manufacturers that knowingly and intentionally overcharge providers.
- Create a formal dispute resolution process for providers and drug manufacturers.
The Appropriations Committee says HRSA should use the new user-fee collections to implement these long-overdue protections for 340B safety net providers.