Preserve 340B

Patients deserve the protection

Especially during a pandemic, health-care providers and patients shouldn’t have to worry about the skyrocketing cost of medicine.

But we must, and pharmaceutical manufacturers have seen to that. They are suing the state to block an innovative law the Arkansas Legislature passed last year. The law protects what’s known as the 340B Program.

The program provides pharmaceutical discounts for low-income and vulnerable patients—people without insurance or whose insurance won’t cover the drugs they need. Other savings are passed on to health-care providers that participate in 340B, including Community Health Centers (CHCs) and certain types of hospitals, so they can keep serving patients in rural and underserved areas. And it’s certainly not charity. In 1992, Congress set up 340B as a condition for the pharmaceutical industry to participate in Medicaid and Medicare. In other words, they get to sell their drugs in the lucrative federally funded entitlement market—if they also provide discounts through 340B.

That’s a pretty good deal for the manufacturers.

But now they don’t see it that way. They suddenly changed their position on 340B after years of participation. They’ve placed arbitrary limits on discounts in defiance of direct federal orders. The manufacturers are severely hindering the ability of CHCs and hospitals to provide affordable drugs to our patients. They’ve put up roadblock after roadblock.

The Community Health Centers of Arkansas, along with the Arkansas Hospital Association and the Arkansas Pharmacists Association, believe 340B should not be held hostage to the whims of the drug manufacturers.

Most troublesome are the damaging cutbacks on discounts for drugs at “contract pharmacies.”

In Arkansas, contract pharmacies include a very large number of neighborhood drug stores partnering with CHCs and hospitals to dispense 340B drugs to patients.

The CHC that I lead—1st Choice Healthcare based in Corning—does not have a single in-house pharmacy. Some of the communities in our area don’t have a pharmacy at all. That means we must rely on our local contract pharmacies if we are to adequately serve patients in our six-county area in northeast Arkansas.

With these restrictions placed by manufacturers, patients are forced to drive long distances to get their medication—if they can even get them at all. And patients may be forced to either pay a much higher price for their prescription or take a less expensive prescription that doesn’t help. Worse, they may just drop their medication altogether.

So, the manufacturers are literally profiting at the expense of our most needy patients and our ability to keep our clinics open and staffed in underserved areas. All in the middle of a pandemic.

But Arkansas refused to stand idly by.

Act 1103 passed by significant margins during the 2021 legislative session (65-14 in the House and 35-0 in the Senate) and was signed by Gov. Asa Hutchinson. The law sends a message to the manufacturers that Arkansas strongly supports 340B and that they must comply with federal law in our state. Act 1103 aims to enforce 340B contract pharmacy standards at the state level. With this law, Arkansas is leading the way nationally on 340B.

Sadly, but not surprisingly, the big drug manufacturers have sued the state over the law in U.S. District Court, which is just another hurdle and delaying tactic by the industry.

CHCs across Arkansas have so many real-life stories of how 340B has positively impacted our communities.

At 1st Choice, the clinic has several chronic care patients who need 340B for diabetic medications. One elderly gentleman on a fixed income requires insulin, but his insurance was requiring that he pay $600. With 340B, the insulin cost no more than $25. He expressed to us how extremely grateful he was for 340B.

The relief in his voice reinforced to us why we, at CHCs, do what we do to help rural Arkansans.

Without 340B savings, we couldn’t have opened a clinic in Salem in Fulton County where health-care options are few compared to urban areas.

Another CHC shared that a patient in Lamar went to his usual drug store in nearby Clarksville but was quoted an astronomical price for insulin. This was due to the manufacturers’ new contract pharmacy restrictions.

So the patient had to drive an hour to River Valley Primary Care Services, a CHC based in Ratcliff, which has an in-house pharmacy. It offered the insulin for about $10 with the help of 340B.

What an immense inconvenience for a patient just to be able to get a reasonable price for a drug needed for survival.

Things just shouldn’t be that hard. Act 1103 is a good law. It protects 340B, which protects Arkansans.