340B Thoughts from the Trenches

The 340B Front Line

How to use this page: In addition to the posts added to the main page of the site, we wanted to have a separate page to share personal insight and knowledge gained through our trials and tribulations with the 340B program. It is also an opportunity to share our thoughts on the legislative issues that seem to be constantly in the healthcare legislative news. Below are links to each individual topic as we discuss them. If you have experiences you would like to share or thoughts on the program, please feel free to comment on the page and we will add them into the body as an entry. Thank you.

Click on link below to go to that entry:
– Summer of 2012 340B Legislative Turmoil, Will 340B Survive

– Summer of 2012 340B Legislative Turmoil, Will 340B Survive: Over the last year the 340B program has experienced significant attention from our federal legislators. It feels like we are in a constant fight to keep the benefit of the 340B program alive. The constant onslaught from various lobby groups is enormous (eg, PhRMA), and it feels like we are fighting a battle we have already lost, and that we are too dumb to know we lost. In the next few paragraphs I will share some of the recent legislative news that has brought me to this pessimistic state; however, I do have hope. The hope lies in the fact that the 340B program is inherently a good thing. That as covered entities, we are providing massive good to our patients in need, and that in many cases we are able to do this in light of diminishing reimbursement for the care we provide. We as covered entities will continue to show and tell our stories of the patients that benefit from the 340B savings we qualify for. Whether we have lost the battle or not is irrelevant, because we have to try. We have to try for the one patient we cannot help with out the 340B dollars. The diabetic patient that cannot afford her insulin, but with 340b pricing, we can provide it at a price that will allow her to put food on the table and be compliant on her insulin dosing, which ultimately results in less chance of her progressing to a multiple disease state that would cost healthcare hundreds of thousands of dollars in the long run. Because we on the front line see it day in and day out, and we know how much the 340B savings means to some of our hospitals and how they cannot stay open without it. We must keep up the fight!

To our beloved senators and representatives: Thank you for serving our country. I get it. Things are not as easy as we would like to believe. From our perspective, we have a hard time understanding how it is possible that our colleagues in PhRMA wield so much influence that they can help craft so much opposition to a program that can do so much good. We do not understand how the inherent conflict of interest in their positions can carry so much weight. To the legislative staff who have come form PhRMA, I get it too. Your perspective is from PhRMA, and from your view you see the negatives and you have been told about the potential issues with the 340B program. It is what you know. I do believe many of us are all trying to do the best we can, and what we think is right or best.

I am afraid of: some recent legislative ideas brought up. The latest was this week. There is some thought of a legislative bill that would limit 340b pricing to only indigent care patients. I can understand how this thought could be considered valid. The goal of the 340B program is to expand and increase charity care. So let’s limit the benefit to charity care patients only. It is forgetting about the fact that how you qualify for the program is through the number of Medicaid and Medicare with SSI patients you serve. We already know that CMS (Medicare and Medicaid) payments often do not cover the full cost of healthcare. To me, this means that in 1992 when the legislation was drafted, they already knew that hospitals who have a disproportionate share of Medicaid patients often are struggling to remain profitable. So, now we are asking these hospitals to suck it up in light of the difficult reimbursement and if you happen to have a patient who is not Medicaid, then you can buy the drug at a lower cost. Although, you still need to cover the drug cost, administration cost, patient care cost, and all other costs associated with patient care with your negative reimbursement you make off of the covered Medicaid patients. Let’s add in one more factor, with the PPACA making it through the Supreme Court, the amount of Medicaid patients will increase and the amount of non-insured will decrease. This means that the 340B benefit is almost wiped out if this type of bill goes through. Is that the intent? Is this the newest tactic to get rid of the 340B program. We are on a roll, let’s keep going. Even though Medicaid reimbursement is not great, the states and federal government still have to cover the cost. Well, the covered entities who benefit the most from the 340B program are often our state run facilities. If these state run hospitals lose their 340B benefit, the states will end up having to shoulder the loss. I know my state hospital system would have a massive increase in cost if this type of legislation were to pass. It would be catastrophic for a state budget already trying to deal with Medicaid cost. So we are talking about state and not for profit hospitals potentially bankrupting with out bailouts compared to what? I don’t even know. I look at some of our pharmaceutical companies profit reports and think, is this so they can beat stock market analyst estimates, they look pretty good to me. I read headlines of the millions of dollars PhRMA puts into super PACs and lobbying, and I think, for more lobbyist dollars. We are talking about the difference between some hospitals keeping their doors open. We are also talking about hospitals like mine being able to create programs to help patients in financial need and to develop programs that increase the health of patients which will result in decreased cost for the whole system. I don’t like being cynical, but is it really about stock prices and lobbyist dollars versus patient care and improving the health of our population.

We started this blog to share our 340B journey. I never knew my education and training would take me to a world that is as convoluted and difficult to navigate as I have found. All I know now, and what I implore you to do is continue the fight. In addition, if you are a covered entity, keep doing what you are doing. We do not know the end and to stop because the future is not as bright as we would like it to be would ensure we could not provide additional benefit to our patients. For now, do the 340B program right and use it correctly and expand charity care services and help more people. I have faith in our legislatures, we have some who do get our perspective and are fighting for us (they seem to be a minority), and I thank you if you are one of them. If you have made it this far, thank you for reading. I hope this inspires you to join the fight to keep the 340B program around for our patients. Aloha, -Rob

4 Responses to “340B Thoughts from the Trenches”

  1. Pat O'Brien
    July 31st, 2012 at 10:16 am

    Hello, It seems likely the increase and formalization of the audit function is just one of the efforts to need to justify this benefit. Does anyone know if SNHPA has released its self-audit checklist yet?

    Pat O’Brien
    Maine Medical Center

  2. Rob, PharmD, MS
    August 1st, 2012 at 8:30 am

    Hi Pat, not that I have seen. They have their outline (http://www.snhpa.org/members/documents/pdfs/340B_Compliance_Outline_7-12.pdf) and it still says the checklist is “removed while being updated.” I have not heard of any updates. I am calling into to the SNHPA Advocacy call tomorrow and I just emailed Mike Hess to see when that is going to come back. I will let you know if I find anything new out.

  3. Rob, PharmD, MS
    August 1st, 2012 at 10:10 am

    Pat, I just heard back from SNHPA. Here is what they said about the checklist: “I’m not sure when the checklist will be completed, but I’m told that the checklist is basically a shortened version of the outline that is posted so everything on the checklist is also in the outline so you should be able to use that document in the same way.” So use the checklist web link on the previous comment and that is a good place to start.

  4. Pat O'Brien
    August 8th, 2012 at 11:33 am

    Excellent Rob. As usual, thanks for lift!

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