As states move Medicaid prescription programs to managed care, many pharmacies are concerned that reimbursement rates — and their businesses – will plummet. According to KVUE News, pharmacies in Texas are going to Austin to fight back. According to one Lone Star R.Ph, “I will literally go broke trying to keep my pharmacy open….The reimbursement is so low that even if I let go of several employees, cut back on expenses and do not even pay myself a salary, I will still lose money.”
Although M&M Pharmacy in Natchitoches, LA has been a 340B contract pharmacy for less than a year, the owners are already seeing big benefits for their store and their customers. Read the case study.
Yesterday, HRSA released updates on 3 policies: Non-Discrimination, Penny Pricing and Manufacturer Audits of 340B Covered Entities. As the number of entities and patients participating in 340B rises, the program’s rules and complexity are also increasing. At the same time, Big Pharma, Capitol Hill, and others are calling for additional scrutiny of the program. To take advantage of the program, navigate the rules and mitigate the risks, eligible entities should partner with a vendor with a proven technology and expertise in regulatory compliance.
“Exhibiting effective financial leadership in drug purchasing when taking advantage of discounted 340B pricing can elevate the perception of the pharmacy from a department that drains resources from the hospital budget to a department that identifies and creates opportunities for drug savings.” This is one of many insights in this piece by E. Thomas Carey, PharmD, of SwedishAmerican Hospital in Pharmacy Purchasing and Products Online. We highly recommend this one.
Moving pharmacy programs to managed Medicaid can be a financial windfall for 340B eligible entities. We have blogged about this before. But it can take a bite out of pharmacies. This article from the Texas Tribune highlights the problem. And as states look for ways to close budget gaps (and several are looking at moving pharmacy programs to managed medicaid), we’re likely to read more stories like this in the coming years.
This week, the Wall Street Journal ran a story on the epidemic of medication non-compliance. Of note:
- “…patients who don’t take their medications as prescribed cost the U.S. health care system an estimated $290 billion in avoidable medical spending each year”
- “as many as half of Americans don’t stick to their regimens”
- Patients in integrated health systems with electronic health records linked to pharmacies have far higher levels of compliance and persistence.
Although non-compliance crosses all age and socioeconomic groups, clearly it impacts the low income families the hardest. That’s why SUNRx has integrated a persistence program into its 340B program. Trained specialists call, email and/or mail patients to remind them to fill their scripts and follow their doctors orders. Over the long run, this reduces costs for patients, third party payers and taxpayers, and reduces ER visits and overcrowding.
To learn more about this, click here.
It appears that the recent GAO study on the 340B program — some of which was very positive — could trigger additional scrutiny of the program in DC. This particular story is noteworthy on how inaccurate some of the facts are about the program. If the new scrutiny brings a better understanding in DC of the benefits of the program to our nation’s healthcare safety network, that would be a good start.
On September 23, GAO issued its long awaited report, “DRUG PRICING Manufacturer Discounts in the 340B Program Offer Benefits, but Federal Oversight Needs Improvement.”
The report summarizes the history and intent of the 340B program, and some noteworthy trends. Among the reports findings:
- About half of covered entities reported generating 340B revenue that exceeded drug- related costs.
- Covered entities reported using the 340B program to support or expand access to services.
- Manufacturers’ distribution of drugs at 340B prices generally did not affect providers’ access to drugs except in two situations.
- HRSA’s oversight of the 340B program is inadequate
GAO’s recommendations included having HRSA conduct audits of 340B entities to deter diversion and to finalize more specific guidance on the definition of a 340B patient.