Community Health Clinics of Wichita Fight to Keep 340B Drug Pricing Program Essential to Low-Income Kansans.

Drug Companies Threatening to Increase Drug Pricing for Low-Income Kansans

The safety net of community health centers across the state, which includes GraceMed Health Clinic, HealthCore Clinic, and Hunter Health, provides whole-body care to Kansans, regardless of insurance status or ability to pay. These clinics provide medical, dental, behavioral health, and substance use disorder services to almost hundreds of thousands of individuals across the state. These predominantly low-income patients also receive enabling services such as transportation and case management.

For many, arguably the most valuable service received is access to life-saving prescription medications at little to no cost. “Everything we do at Hunter Health is to improve the health and well-being of patients, including providing access to discounted medications. We need to be able to stock our pharmaceutical inventory for the underinsured and uninsured patients we serve, and we rely on the 340B program and the contracting pharmacies to be able to do so. If we are going to make the healthcare system better for everyone, we need to eliminate barriers like high priced medications for those who need them,” said Amy Feimer, Hunter Health CEO

“The 340B program helps reduce the disparities in care provided for our uninsured patients.  For example, the newer diabetic medications are shown to significantly reduce the risk of heart attack and death in diabetic patients.  However, without the 340B discount, they are too expensive for the majority of our uninsured patients.  Another example is inhalers for patients with asthma or COPD.  Both rescue inhalers and daily maintenance inhalers are usually needed and are ridiculously expensive without the 340B discount program.  Please help us care for our patients, regardless of their insurance status.” Said Penny Jeffery, M.D., HealthCore Clinic Chief Clinical Officer.

The so-called 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 the patient. 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.

The attack on contracting pharmacies will have a severe impact on health centers serving patients throughout a larger metro area.  “Contracting pharmacies are an essential part of the success of the 340B program,” Venus Lee, GraceMed Health Clinic CEO, noted. “Community health centers can’t afford to operate pharmacies in all the neighborhoods we serve. And we certainly don’t have the capacity to stock enough inventory to fill prescriptions for all the patients we serve. So, we work with a network of these contracting pharmacies to give our patients better access to the medications. It’s vitally important, especially when you consider that many of our patients deal with transportation issues that others do not.”    

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, 20 health centers are members. “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, singed by more than half of all House members including Representative Sharice Davids, to U.S. Department of Health and Human Services (HHS) Secretary Alex Azar that, 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 obtain their medication from a pharmacy miles away, instead of at their community pharmacy down the road.  They may need to make the horrible decision between paying for suddenly high-cost medications or buying food.  Additionally, health centers also take the financial hit on any prescription that doesn’t come with the usual 340B price. The health centers are using 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.

“The outcomes we can achieve with the thousands of uninsured patients we see depend heavily on their compliance with prescriptions we write,” said GraceMed CEO Venus Lee. “The rapidly rising cost of medications would make it impossible for our patients to afford to fill their prescriptions if we were not able to provide them at significant discounts.”

“Hunter Health serves many patients who depend on the medications covered through the 340B program. The cost of medications can undoubtedly push our underserved patients further into poverty, disease, and even death. This is why this program is so crucial to Community Health Centers like us,” said Callie Wentling, PA, Hunter Health Director of Primary Care.

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 Kansans and the nation are depending on it.

ABOUT HUNTER HEALTH:
For more than 44 years, Hunter Health Clinic has been a critical health care resource in the community, especially through our service to those most vulnerable and underserved in Wichita and the surrounding cities. Hunter Health is a non-profit, Federally Qualified Health Center and the only Urban Indian Health Program in Kansas. We know that low-income and racial and ethnic minority ­­populations tend to be at greater risk for chronic health conditions related to healthy behaviors and clinical care, and part of our mission is to provide accessible, patient-centered care to every person. Hunter Health offers a wide range of primary care services including Medical, Dental, Behavioral Health, Vision, Nutrition, HIV Testing and Counseling, Pharmacy, Lab, X-Ray, and same-day appointments for urgent needs. From a common cold to minor surgery, we are a community health center providing more than basic healthcare needs. We exist to improve the health and well-being of everyone in our community. For more information, visit www.HunterHealth.org.