By Scott Bertani / For The Herald
COVID-19 has put our country’s most vulnerable patient populations at further risk. The pandemic puts into perspective the critical role our safety-net health care providers play in ensuring all patients have access to lifesaving medications and quality health care.
While community health centers and federally qualified health clinics pivot to respond to rapidly changing front-line needs, so too should federal health care programs pivot to better support that work. One of these programs, the 340B Drug Discount Program, recently targeted by an executive order issued by the Trump administration, needs to be protected so organizations such as Lifelong can continue using it to support better health outcomes for vulnerable patient populations.
Congress should resist misguided executive action that would compromise the integrity of federal grantee programs that comprise the backbone of the current public health response and ensure that benefits derived from programs like 340B go to helping patients as they were intended.
At Lifelong, a non-profit health advocacy organization, we believe everyone deserves to live a healthy life. We have been fighting for our most vulnerable and disenfranchised communities for 35 years by providing high-quality care for those living with HIV. We’ve taken that knowledge and experience to expand recently so we can provide care and advocate for communities fighting other serious illnesses.
The 340B drug-pricing program helps health care facilities that serve vulnerable or uninsured communities, including federally qualified health centers, direct federal grantees and disproportionate share hospitals. Here’s how it works for federal grantees like us: Pharmaceutical companies provide steep discounts on medications through the program, and grantees are held to strict reporting requirements to show they are reinvesting the money back into providing care for the communities they serve.
Unfortunately, due to loopholes in the system, not all 340B program participants are held to the same high standards as we are. Since 2010, when reimbursement standards were relaxed for large hospital systems, most of the growth in spending for 340B dollars has occurred in wealthier, less-diverse suburbs. Fast-forward to today, and local community health centers serving the neediest patients are now lowest on the list for 340B reimbursement dollars in absolute terms.
Recently, the Trump administration issued an executive order that would further restrict the use of 340B program dollars for Federally Qualified Health Centers while leaving untouched the less accountable actors in the system. From our perspective, strict reporting requirements borne by community health centers and direct federal grantees mean additional costs to facilitate and participate in the program.
We’re fine providing details on how we are putting these important resources to work on behalf of the community, but we think everyone should be held to the same level of transparency and accountability. Instead of tightening the screws on 340B participants who already adhere to rigorous reporting requirements, reform efforts should focus on putting patients first.
Lifelong’s 340B program is on pause currently while we work through a whole host of issues. A complex and expensive network of third-party compliance vendors, pharmacy benefit managers, and contract pharmacies stymie many would-be entrants into the program and squeeze precious dollars away from current providers who could be using those funds to help improve outcomes and focus on delivering better health outcomes for our most vulnerable. The administration’s 340B executive order will only serve to worsen these problematic trends.
As Congress now considers action to strengthen the backbone of our country’s public health response infrastructure, doubling down on investments in front-line community health clinics would be a potent way to enhance resources dedicated to the most vulnerable communities. Reforming the 340B program must be done carefully so that the neediest patients are prioritized. By refocusing oversight where it’s needed and increasing transparency of the program, we can make sure patients, not large hospital systems, are the primary beneficiaries.
Scott Bertani is the director of policy and community relations at Lifelong, a non-profit health advocacy organization focused on serving the holistic needs of HIV patients and their families, as well as other vulnerable patient populations in Washington state.