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Defending the 340B Program from Every Direction

The 340B Drug Pricing Program has weathered attacks from different health care actors for years. Just months after the outbreak of the COVID-19 pandemic, manufacturers launched attacks by refusing to sell 340B-priced drugs to health centers that use contract pharmacies to increase patient access. This combination of manufacturer restrictions, alongside existing discriminatory contracting actions taken by drug middlemen, known as pharmacy benefit managers, has severely threatened the stability of the 340B program for health centers. NACHC surveyed health centers to better understand the impact of the recent attacks on health centers and highlight the importance of the 340B program.

Health center patients benefit from discounts and supportive services made possible by 340B

Congress created the 340B program to assist certain safety net health care providers, like health centers, who already operate on razor-thin margins to buy certain medications for a discount. Participation in the 340B program produces savings to support patient services that health centers otherwise would be unable to fund. The vast majority of health center patients are low-income, uninsured, and underinsured. These discounts promote greater access to lifesaving drugs and contribute to comprehensive primary care services to improve patients’ overall well-being and quality of life. For example, savings are used to meet the unique needs of health center communities with services such as dental care, behavioral health, specialty care, translation services, food pantries, housing support, and co-pay assistance programs.

NACHC activities highlight the 340B program’s value to health centers

In June, NACHC’s flurry of activities to elevate the importance of the 340B program included a survey, highlighting how the program helps health centers fill the gaps in providing care, primarily through contract pharmacies. Nearly 90% of health centers surveyed report utilizing contract pharmacies because they serve as an essential extension of the health center. These arrangements increase access to affordable medications, especially for patients with diabetes, heart disease, and behavioral health needs who reportedly rely on medications purchased through the 340B program more than any other patient population. The report also outlines NACHC policy asks to alleviate issues we face from pharmaceutical manufacturers and pharmacy benefit managers.

To highlight the report’s findings, NACHC hosted a press conference during which two health center leaders explained the detrimental effects on their patients if health center 340B savings went away.

Given the importance of the 340B program and how diabetes is one of the top conditions 340B savings are used to treat, NACHC sent a strong letter to Merck. Merck became the sixth company to refuse to ship discounted medications to health center contract pharmacies beginning May 31. The letter condemned Merck’s actions, given the integral role contract pharmacies play for patients. Most of the medications Merck has restricted help treat diabetes. Health centers are losing 340B savings that have historically helped support modes of care for these patients, such as offering nutrition classes, transportation assistance, and discounted over-the-counter medications.

Letter to HHS Secretary Becerra urging federal action

NACHC also sent a letter to the Secretary of Health and Human Services (HHS) Xavier Becerra, urging the Department to take enforcement action and impose fines on drug manufacturers before more manufacturers follow suit with restrictions. Administrative enforcement efforts would help relieve health centers of the financial burden because of the loss of 340B discounted medications.

Join NACHC in protecting the 340B program

NACHC needs every health center voice to make a difference in the fight to protect 340B. We hosted a live Twitter chat with health center advocates and will continue to need grassroots support in the future, whether on Capitol Hill, on Twitter, or at your own state’s capital. Please sign up for updates and alerts through our grassroots advocacy website, HCAdvocacy, and follow us on Twitter at @HCAdvocacy.

Elizabeth Linderbaum is the Deputy Director of Regulatory Affairs at NACHC.

Related: As Drug Makers Cut Off Discounts, Providers Fret for Low-Income Patients (Stateline)

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