Please consider the following. The 340b drug program is a well-intended public policy with unintended consequences. It is a $55 billion net revenue flow to all the intermediaries with little evidence that it is shared with the patients it was designed to benefit. Here are some suggestions for reform by Lown Institute. 8/23 "But there are ways that 340B could be tweaked to optimize the benefit for low-income patients and the hospitals that serve them. In a recent Viewpoint article in JAMA, Dr. Sanjay Kishore at The University of Alabama, Dr. Rahul K. Nayak at the Emory University School of Medicine, and Dr. Aaron S. Kesselheim at Harvard Medical School explore policy solutions to improve oversight and eligibility for the 340B program. Here are a few of their proposals: Alter eligibility requirements for hospitals to redefine “ *safety net” hospitals beyond disproportionate share percentage, to include other criteria such as “measures of uncompensated care and area socioeconomic disadvantage.” *Offer 340B discounts on a sliding scale based on hospitals with the neediest patients, rather than having 340B eligibility be “all or nothing.” *Add more reporting requirements and utilize audits to better understand how 340B hospitals are using their discounts and gain more data around whether these discounts are being passed along to patients. “ Instead of heeding calls to cancel the program amid growth, policymakers should consider reforms that better ensure 340B benefits are targeted toward people with the most need. It is the least patients, clinicians, and health care facilities deserve.” "The 340B contract pharmacy market shows little sign of slowing down. Drug Channels Institute’s exclusive analysis of the 2024 market reveals that: About 33,000 pharmacy locations—more than half of the entire U.S. pharmacy industry—act as contract pharmacies for the hospitals and federal grantees that participate in the 340B program. Five multi-billion-dollar, for-profit, publicly traded pharmacy chains and pharmacy benefit managers (PBMs)—Cigna (via Express Scripts), CVS Health, UnitedHealth Group (via OptumRx), and Walgreens, Walmart—continue to dominate the 340B contract pharmacy market. Federal grantees are aligned primarily with the vertically intergated organizations' retail pharmacies, while hospitals rely on mail and specialty pharmacies. Over the past four years, manufacturers’ restrictions on 340B contract pharmacies have led hospitals to deepen their relationships with the largest PBMs—even as those PBMs have simultaneously limited hospitals’ direct participation in specialty pharmacy networks." Adam FeinShawn GremmingerStacey RichterJeffrey HoganGe BaiChris DeaconScott Conard, MDRob Marty, DBA, MHADave Chase, Health Rosetta-discovering archaeologistDan BurkeChris SkisakStacy MaysAnn M. Richardson, MBA https://lnkd.in/g_dtN8Mm
Not to give you homework Peter Hayes, but can you provide any documentation that proves or supports the discussion that the patients have received anything from this policy? I appreciate your time and input, as I'm sure you dug deep into the data around this program.
Bob Charles
3w
Interesting concept from the panelists in the article, to use a sliding-scale and reduce patient OOP cost. Wonder if the PBMs would then treat that subsidy like a co-pay card, and put a "accumulator/maximizer" type penalty on the hospital? Just thinking out loud...
Do you want to see who knows what we need to do and what is most important to fix health care? Listen to Sue Veer addressing this Committee. Hear from those who have a heart for serving most Americans most behind and are willing to sacrifice to address the next generation always ignored - and then we wonder why outcomes get worse. She was discussing 340B in about the most balanced and informative way possible. https://www.linkedin.com/posts/robert-bowman-3b271933_healthcenters-save340b-valuechcs-activity-7203854211027984385-_gAo?utm_source=share&utm_medium=member_desktop
Stacy Mays
3w
Some ancient history... since I was there at the beginning....the initial intent was to give FQHCs and rural hospitals a way to purchase drugs at a discount which would be passed on to patients. When the program started, Medicare and Medicaid did not provide coverage for retail pharmacy. The legislation was poorly written and the entire industry has taken advantage of the giant loopholes.
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3wPeter Hayes, I've worked for CEOs and hospital execs who made a lucrative career for themselves by following the money to hospitals that benefitted most from DSH and 340B payments. I'm not convinced the patients benefited as intended. 😉