Purse Strings of Affordable Prescriptions

Strings on the Purse

Unless you’ve been under a rock we all wish we could hide under, you’ve probably seen more than your fair share of the barrage of commercials put out by pharmaceuticals manufacturers. You know, the ones that have those long lists of potential side effects that seem at least as dangerous as the conditions they treat.

There’s one side effect they all have in common but never mention: the prospect that purchasing the drugs will empty your bank account. As we are all painfully aware, prescription medications have been rising in cost, so much so that for too many of us, neither insurance coverage nor a spoonful of sugar can do much to help the medicine go down.

In the beginning, an act of Congress all the way back in 1992, Congress enacted Section 340B of the Public Health Service Act to require substantial discounts on certain prescriptions that are in  high demand for patients who are uninsured, underinsured or low-income.  There was one other requirement: the discounts were to be made available to community health centers, like GraceMed, with the stipulation that the savings generated by the discounts would allow these “covered entities,” as the law refers to them, to put more resources into patient care. Of course, it would also have the added benefit of making it possible for patients to afford to fill their prescriptions.

That last part is something you hear doctors and nurses referring to as “compliance,” the actual taking of a medication as prescribed to get the desired outcome. It’s important to them and nothing less than critical to the health of their patients.

Atif Henen, RPh

“We are living in a time when we have made enormous strides in what we can treat with medicine,” said Atif Henen, pharmacist at GraceMed’s Helen Galloway Clinic. “If these medications are priced beyond the reach of the patients who need them, however, it does no good; we end up unable to help them recover their health.”

In the years since the program’s inception, it’s use has predictably grown. Part of the reason for this is the expansion of the list of covered entities to include a variety of hospitals serving low-income populations. Then, too, the continued growth of uninsured or underinsured patient populations has increased demand for 340B discounts.

Contracting pharmacies: A key ingredient

But the program has also grown because of the increased participation of pharmacies that contract with health centers like GraceMed to fill prescriptions for qualifying patients within the  guidelines of the 340B program.

“Contracting pharmacies are an essential part of the success of the 340B program,” Atif 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.

Profit for patients vs. profit for manufacturers

304B by the numbers

Although the program has opened up Medicaid and Medicare markets for drug manufacturers, the expanding use of the program has also given rise to detractors who argue that excessive profits are being reaped by some of the covered entities.

Now major manufacturers are taking action to impose new requirements on health centers effectively designed to reduce the use of the 340B program. The strategy is to eliminate the involvement of contracting pharmacies with each company pursuing its own tactics. Some companies, like AstraZeneca, are openly refusing to sell to contracting pharmacies.  Others, like Merck, are setting up requirements for detailed claims data reporting that will create an administrative burden too difficult for sustained participation in the program.

“The perception that 340B has become a profit center for health centers is really a myth,” Atif explained. “If a patient is uninsured, the discount is passed directly to them. In some cases, an insured patient may qualify for the discount, but we can file with their insurance company at the pre-discount cost. In that case, we are required to reinvest 100% of the difference in patient care. Community Health Centers are by definition nonprofit, and our 340B drug program is no exception.”

In fact, at GraceMed proceeds from our participation in the 340B program have helped to fund care for thousands of patients who couldn’t afford to pay for their care. If these attacks from the drug companies are successfully implemented, it will not only make a lot of medications too expensive for our patients to afford, it will also defund a lot of other medical care we provide.

The prescription? People power

Right now, action is being taken by the National Association of Community Health Centers to bring a lawsuit against the drug companies involved. The legislation that established the 340B program was intended to provide these companies access to the expansive market of Medicaid patients in exchange for pricing that made their prescription medications accessible within those patients’ limited means. The rules were established by Congress, and there was no right given to the drug companies to change those rules.

Congress can play a role in this as well, exercising their authority over the program to direct the companies to curtail their efforts. Of course, there’s nothing like the expressed will of the people to get the ball rolling. Whether you benefit directly from 340B discounts or you see the need for this program to save lives and restore health, please let your voice be heard by contacting your representative in Washington. Lifesaving medications should be available to everyone, and if we can save the 340B discounts, we can make sure they are.