340B Program Essential, Hospitals Say at Capitol Hill Briefing

by Admin | November 16, 2016 3:43 pm

November 16, 2016—Hospitals from across America came to Capitol Hill today to urge the incoming Trump administration and GOP-led Congress to do no harm to the 340B drug discount program[1].

[2]Hospital representatives from New York, Wisconsin, Texas, and California explained at a standing-room-only congressional staff briefing that they depend heavily on 340B savings to care for low-income and otherwise vulnerable patients. They cited research[3] showing that hospitals in the drug discount program provide care to more poor patients, more uncompensated care, and more money-losing services.

340B Health, which represents nearly 1,300 hospitals that participate in 340B, organized the briefing and sponsored the research.

The highly profitable drug industry is waging a fierce public relations campaign to smear the 340B program as overgrown and under-regulated. During the race for president, President-elect Trump slammed drug companies for profiteering and indicated he favored letting Medicare negotiate drug prices. However, with respect to prescription drugs, the presidential transition website’s statement on healthcare[4] says only that the Trump administration will act to “reform the Food and Drug Administration, to put greater focus on the need of patients for new and innovative medical products.” He and congressional Republicans are focused now on repealing and replacing the Affordable Care Act. If the law is completely erased, about 1,000 small rural hospitals would see their 340B savings wiped out permanently. Drug discounts would shrink back to their pre-ACA levels and program improvements to ensure that hospitals aren’t being overcharged would be lost. Millions of Americans could potentially experience a disruption their insurance or Medicaid coverage, straining safety-net hospital budgets to the breaking point.

Hospitals, meanwhile, are deeply concerned about pending 340B program guidance that would limit the program severely, such as eliminating discounts on discharge prescriptions, on infusion orders written outside the hospital, and on emergency room drugs. Close to one third of hospitals would consider dropping out of 340B if the so-called 340B mega-guidance is not altered.

“340B is one of the sole sources of drug cost savings available to us today given the significant increases we are seeing,” said Ryan Stice, Executive Pharmacy Director at Sutter Health – Valley Region in Sacramento, Calif. “If the proposed guidance went through as written, we would have to dis-enroll almost all of our sites from the program.”

Nearly 60 percent of the patients at Sutter Medical Center, a 532-bed hospital in Sacramento, are low-income Medicare or Medicaid beneficiaries. The hospital saves about $21 million on medicines through 340B. Even with those savings, it loses about $56 million annually. Stice said examples of how the hospital uses its 340B savings include:

• an Interim Care respite program for homeless patients who are discharged from the hospital
• Street Nurse and Community Navigator programs that connect the underserved with medical and social resources
• case-management services for underserved patients who access the emergency department for non-urgent needs.

“340B for us is the primary vehicle where we can provide access to services in rural and underserved areas who otherwise would not be able to access that kind of care,” added Peter Robinson, Chief Operating Officer and Vice President of Government and Community Relations at University of Rochester Medical Center in Rochester, N.Y.

“As the region’s safety-net provider, we provide care to Medicaid recipients and all other patients who walk through our doors, regardless of their ability to pay for the treatment they need,” Robinson said. The medical center’s Strong Memorial and Highland hospitals provide $64 million in uncompensated care annually. “The discounts and savings that Strong and Highland receive by participating in the 340B program have a direct impact on our ability to meet the healthcare needs” of uninsured and underinsured patients, Robinson said, including $4.5 million last year in free medications to patients who could not otherwise afford to pay.

Robinson told of a patient with aggressive cancer whose insurance didn’t cover the $7,400 monthly cost of her oral chemotherapy medication. “She did not have the ability to pay for this drug on her own, and thanks to 340B, we were able to provide it to her at no cost so that she could receive the treatment she needed,” he said.

Without 340B, his uninsured and underinsured patients would have to pay full price for their medications, the medical center would have to scale back or terminate services and reduce staff, cancer patients in rural areas would have to drive an hour or more for chemotherapy rather than at facilities close to home, and patients would be discharged without medications, leading to readmissions.

Nick Gnadt, Manager of Ambulatory Pharmacy Services Unity Point Health – Meriter in Madison, Wis., said “despite any questions about the program, 340B is accomplishing its goals and impacting patients’ lives and allowing us to do things we would otherwise be unable to do.”

Gnadt told the story of a woman working at a Madison-area convention center who was rushed to the emergency room. “She was exposed to a unknown cleaning agent that resulted in an anaphylactic reaction,” he recalls. After doctors got her reaction under control, she was given a prescription for an EpiPen which she went to fill at the hospital’s onsite outpatient pharmacy in the lobby.

She was uninsured and would have had to cover the entire cost herself, Gnadt says. She was ready to walk away without it. “I was able to provide the product to her at no charge, thanks to 340B, and get her a potentially lifesaving medication as she headed back to work.”

“People say, ‘Yeah, sure, EpiPen, it’s all over the news,'” Gnadt said. “But I’m telling you, there are hundreds of stories like these.”

Shewan Aziz, Network Director of Pharmacy for Seton Family of Hospitals, a member of Ascension Health in Austin, Texas, said if there is just one message he hopes the congressional staff in attendance would take away, it is “maintaining and keeping the 340B program so we can continue providing services to the poor and vulnerable.”

Five of Seton’s 11 hospitals participate in 340B. They provide about $357 million in uncompensated care annually. Their combined 340B savings are about $7 million, Aziz said. About 30 percent of patients at Seton’s University Medical Center Brackenridge are Hispanic and about 20 percent are African American. Around 45 percent of patients are low-income.

“We are really using the 340B program to serve the poor and vulnerable in the community,” Aziz said. 340B savings help the health system fund primary and specialty care clinics, financial assistance to patients who cannot afford their medications, and outreach programs such as mobile primary care units, school clinics, and weekend medical missions. “We need the 340B program now more than ever,” he said.

Source URL: https://340binformed.org/2016/11/340b-program-essential-hospitals-say-at-capitol-hill-briefing/

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