OPINION: Low-Income Kansans Rely on 340B Drug Pricing Program

The safety net of community health centers across the state, which includes Salina Family Healthcare Center, provide whole-body care to Kansans, regardless of insurance status or ability to pay. These 19 federally qualified health centers (FQHCs) and one look-alike health center provided medical, dental, mental health, and substance use disorder services to almost 275,000 individuals in 2019 alone.  This is one out of every 10 Kansans accessing care through these community health centers.

For many, arguably the most valuable service received is access to life-saving prescription medications at little to no cost.

Robert Kraft, MD, Chief Executive Officer and Chief Medical Officer for SFHC describes the impact of these cost-effective medications.  “Cost is a major barrier for many people to receive life- and health-saving medications.  The 340B pharmacy program at Salina Family and other safety net clinics across the country is a literal lifeline for many of our patients treating acute and chronic conditions.”

The 340B Drug Pricing Program, created by Congress during the 1990s, requires drug manufacturers to provide discounted pharmaceuticals to health centers and other covered entities – which makes the prescriptions affordable for all patients, including the uninsured. In addition, the savings retained by these entities allows them to serve even more patients and to increase comprehensive services at no cost to the taxpayer. By law, every penny of the savings is used on patients.

340B is a successful, accountable program that has strong bipartisan support in Washington to this day.

But it also is one that is under assault by the very pharmaceutical companies that manufacture the drugs.

At least five companies – Eli Lilly, Sanofi, AstraZeneca, Merck and Novartis – are attempting to unilaterally change the terms to which they’re legally obligated. In slightly different variations, the pharmaceutical giants are refusing to honor 340B pricing, refusing to ship to contract pharmacies utilized by health centers, imposing arbitrary reporting requirements, or a combination thereof. The companies claim they are attempting to rein in 340B discounts to ensure fiscal integrity of the program.

Health centers are not deserving of such retaliation, however. They are not the problem. Centers across the nation have proven to be excellent stewards of tax dollars and 340B savings. They are nonprofits, accountable by law and audit, and driven by mission – not money.

“We have talked with five of our state’s six members of Congress,” said Denise Cyzman, CEO of the Community Care Network of Kansas of which all 20 health centers are members, “and all of them, Republican and Democratic, are 100% confident health centers are implementing the program with the highest integrity and in accordance with the law.”

In fact, legislative health policy staff from more than one Kansas delegation member’s office have been attempting to stop big pharma’s attack on health centers and their patients in the midst of the COVID-19 public health emergency. Key supporters from Kansas and elsewhere are working with the National Association of Community Health Centers (NACHC) to find a solution.

One legislative piece was a letter to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar that, signed by more than half of all House members including Representative Sharice Davids, opened with this statement: “The 340B program plays an integral role in ensuring eligible health care organizations have access to vital lifesaving medications. As Members of Congress deeply committed to the important safety net mission of the 340B Drug Pricing Program, it is imperative that immediate action is taken to ensure covered entities continue to receive crucial 340B drug discounts.”  A similar letter, sent by the Senate, was signed by Senator Jerry Moran.

One of NACHC’s intended steps will be a lawsuit against HHS, demanding they simply enforce the regulations that clearly define how 340B works. HHS has expressed “significant initial concerns” with at least Eli Lilly’s tactics, adding in a letter to that company it will be watching for “over-charges to grantees and contractors.”

The NACHC lawsuit is expected to be filed this month.

The national association of HIV/AIDS clinics, whose members are affected by the same drug company actions, already has filed suit against HHS. Another legal challenge is expected from the American Hospital Association.

During the interim, community health centers and their patients will bear the brunt of the untimely and unfortunate moves by the pharmaceutical companies. Patients are being forced to switch medications if their usual one isn’t available. They may need to make the horrible decision between paying for suddenly high-cost medications or buying food.  Additionally, health centers also take a financial hit on any prescription that doesn’t come with the usual 340B price forcing them to use valuable resources to plan operational changes that will include reducing services to the patients who need it most.

The impact is frightening. Less patients served. Less services offered. Staff layoffs and increased unemployment. Devastating health outcomes.

Derek Pihl, PharmD, Executive Director of Pharmacy Services at SFHC notes, “340B at Salina Family provides access to medications directly for many of our low-income patients and also supports many valuable services for all of our patients like behavioral health and care coordination that are not covered by many insurances.”

All the while, health centers continue fighting on the front lines of the COVID-19 pandemic.

Whether it be HHS, the Health Resources and Services Administration, Congress, state attorneys general from across the country, or direct public pressure on the pharmaceutical manufacturers – swift action must be taken to stop the dismantling of the 340B Drug Savings Program. The health of Salina, Kansas and the nation are depending on it.

Salina Health Education Foundation, Inc. (SHEF) was founded in 1979 by Dr. Robert Brown as a community based, non-profit family medicine residency program. Salina Cares was founded in 1991 as a free clinic to serve the low income uninsured of Salina. Later, the two merged to form Salina Family Healthcare Center (SFHC), as a reflection of a long history of service to the community. SFHC offers comprehensive services for all, no exceptions. For more information on our medical, dental, behavioral health, and pharmacy services, please visit us online at salinahealth.org or call us at 785-825-7251. SFHC is a Federally Qualified Health Center (FQHC).

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Opinion piece from Salina Family Healthcare Center

Photo: Robert Kraft, MD Chief Executive Officer/Chief Medical Officer (left) and Derek Pihl, PharmD, Executive Director of Pharmacy Services (right)