Changes to 340B put patients at risk

As you may be aware, Care New England, as well as other providers in Rhode Island, operates what are referred to as “safety-net” hospitals, meaning our organizations treat all people regardless of their ability to pay. A significant number of our patients are on Medicaid, Medicare or lack health insurance altogether, and a little-known federal statute called the 340B drug-discount program helps us care for the neediest among us.

Signed into law by President George H.W. Bush in 1992, the program requires drug companies to sell discounted medications to health care providers that serve high numbers of Medicare and Medicaid patients with low incomes or who are located in remote, rural areas. These safety-net hospitals pass the discounts on to patients in need and use savings from the program to fund primary and specialty care for underserved patients with cancer, HIV/AIDS, and diabetes. Care New England saves approximately $16.5 million annually as a result of the 340B program, and has provided free or reduced-price care to more than 6,300 Rhode Islanders in 2016 alone.

Unfortunately, this critically important program is at risk. In recent years, pharmaceutical manufacturers have become less willing to share their profits to help those in need, and now they want to dramatically scale back the 340B program by limiting hospital and patient eligibility. They’ve taken this position even though 340B drugs amount to just 2 percent of the $457 billion annual U.S. pharmaceutical market. This is simply not acceptable.

Even with an increased number of patients insured under the Affordable Care Act, Care New England still provides more than $57 million in charity and uncompensated care per year. Savings from 340B help hospitals fund free and discounted medications for indigent patients, as well as supplement the operating costs of our neonatal care units, behavioral health services, emergency rooms and obstetric and gynecologic care, among other areas.

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Treating patients with limited or no financial means is tremendously expensive. Hospitals in the 340B program serve nearly twice as many needy patients as other providers. They also supply nearly 60 percent of all uncompensated care. Although we are going through a time of unprecedented change in health care, we continue to maintain an unwavering commitment to the underserved. This is who we are and will continue to be. It is this commitment that binds health care providers with a similar mission and why many of us have dedicated our careers to serving the patients and families who walk through our doors.

It’s important to understand that 340B is not taxpayer funded but instead requires very profitable drug companies to give a discount to health care providers that serve our most vulnerable citizens. These companies can afford to help. If the program were significantly reduced or eliminated, safety-net providers would be forced to cut back drug access and clinical care to the needy, which is in direct opposition to our collective vision of creating a community of healthier people. I hope you agree that our community deserves better.

While we do share Congress’ commitment to the highest level of integrity for and appropriate oversight of the 340B program, the omnibus guidance proposed by the Health Resources and Services Administration in August 2015 severely narrows the program’s scope and jeopardizes 340B access through an unreasonable patient definition that excludes children and indigent patients who use clinics expressly targeted to their needs, patients being discharged from the hospital and cancer patients who depend on hospital chemotherapy-infusion services.

Simply put, the HRSA guidance would derail our nation’s work to create a more integrated health care system.

We continue to work closely with our federal delegation, as well as safety-net hospitals nationwide, with the hopes that HRSA will withdraw or delay implementation of their guidance around 340B until a more comprehensive evaluation of the proposed changes can be determined and a policy can be developed to better meet everyone’s interests. •

Dennis D. Keefe is president and CEO of Care New England Health System.

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