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Giving Thanks to the 340B Drug Pricing Program Our Patients Rely On

Author: Sue Veer, MBA, president and CEO of Carolina Health Centers and NACHC Board Secretary.

Right before Thanksgiving, Community Health Centers across the country held a Zoom Rally and Twitter Storm using the hashtag #340BThankful. During Thanksgiving week, the #340BThankful hashtag was used 305 times and garnered a whopping 120,826 impressions! 

Twitter is perhaps the best social media platform for sending signals to our elected officials and policy makers — asking them to pay attention to issues that are important to us. I have talked with congressional staff who tell me that over 70% of their time is devoted to surveillance of social media with Twitter being the most used and their top priority. Given that, advocates fighting to protect 340B were elated that last week’s Twitter Storm amplified the message about how critical 340B is to our patients and the communities we serve.  

Let me take a minute for a quick refresher: 340B refers to a federal law that requires drug manufacturers who want their drugs to be used for Medicare and Medicaid to sell to safety net providers like a health center at a significant discount. That discount is passed on to low-income, uninsured, and underinsured patients often at prescriptions drug prices that are well below our cost to dispense the drug.

[View NACHC’s 340B page for details.]

If prescriptions are filled using 340B for patients who are insured and/or not eligible for an income based sliding fee, we are able to use any reimbursement above the cost of dispensing the drug to offset those losses on our low income, uninsured, underinsured patients. Reimbursement above what is necessary to offset our losses is retained as a contribution to our operating margin and used to support programs and patient care services that would otherwise be unfunded and unavailable for our most vulnerable patients.

The 340B Program is not federally funded. Consistent with the original intent of the law, prescriptions are affordable, and access is expanded to more comprehensive health care services without additional federal or state funding and that means without additional cost to taxpayers. It is a private/public partnership between drug manufacturers and safety net providers who care for the most vulnerable populations.  The manufacturers gain the benefit of promoting and distributing their drugs through the Medicare and Medicaid programs, and in return, enable organizations like health centers to stretch out scarce resources, providing more patients with access to more comprehensive services regardless of ability to pay. These programs and services are critical to achieving the outcomes we do, and they contribute to the cost effectiveness across the entire health care delivery system.   

That brings me to why I am 340BThankful.  Of course, I am thankful for all of the patients that have access to affordable prescription medication because of the 340B drug pricing program. Many years ago, our Chief Medical Officer, Dr. Locke Simons, focused my attention on the importance of 340B when he told me, “To be able to diagnose but not be able to treat a patient is always an exercise in futility, but for some patients it is a death sentence.” Because the 340B program enables us to make prescription medication affordable for even our most vulnerable patients, we are saving lives.   

I am also 340BThankful for the programs and services that we are able to provide to more patients because of the contribution 340B makes to our operating margin. Those programs and services include, but are not limited to: 

  • Delivery of medically necessary prescriptions to patients at our medical sites in rural and remote locations where access to a pharmacy may otherwise be unavailable.  
  • Integrated behavioral health counselors that treat patients who are uninsured, not eligible for, or have long waits to access the public mental health system.  
  • Expansion of comprehensive Early Childhood Development services integrated into our pediatric medical home model that enables us to reach more families and include families that don’t meet eligibility criteria for grant funded programs.  
  • A voucher program that subsidizes oral health care services provided by a network of private dentists for our low income, uninsured, and underinsured patients.    
  • Outreach and care coordination that brings vulnerable populations into a primary care medical home. 
  • The continued viability of primary care practice sites in communities with a disproportionate uninsured population. 

This morning, I thought about Carolina Health Centers’ mission and vision to ensure access to a comprehensive primary care medical home where everyone is treated with dignity, respect, and compassion. It would be difficult to fulfill our mission to the underfunded or otherwise unfunded programs and services mentioned above had it been reduced or even eliminated. In my mind’s eye, I saw a sea of individual patients drowning because of a lack of access to needed services:   

  • A confused and depressed young mother with no support system and no idea of where to turn for help;
  • A young man struggling with Substance Use Disorder dying of an overdose on the street because a health center didn’t have the behavioral health resources to support a more robust Medication Therapy Assisted program;
  • An uninsured patient suffering at home with the pain of an abscessed tooth, because they can’t afford even the most basic oral health care;
  • Entire families not knowing the importance of a health care home…not knowing where services are available…not knowing that they may be eligible for a sliding fee scale or even 3rd party insurance…all because of the lack of resources for outreach and patient education;
  • The many patients with uncontrolled or even undiagnosed (but manageable) diabetes, hypertension, or cardiovascular disease who might only use the emergency room for care if it weren’t for a community health center;
  • And so many more.

The 340B drug pricing program has come under attack over the past 2 ½ years, with some manufacturers wanting to limit access to 340B discounts. The details of this assault would require an entire separate message; suffice it to say that there is an army of advocates fighting to protect this program that is so very important to our patients. If you would like to have a voice in that battle, the most important message is a simple one: because of 340B we are able to provide our patients with affordable medication and access to comprehensive services that they might not have access to otherwise. As a result, the patients we serve live healthier, happier, and more productive lives.

Learn how you can take action to protect 340B as part of NACHC’s Health Advocacy Network.