HIV care professionals are raising an alarm about threats to 340B savings and their consequences for patient care.

HIV Care Providers Sound Alarm About Threats to 340B Savings

HIV care professionals are warning the public that threats to 340B drug discount savings “will compromise access to affordable care, treatment, and prevention services for underserved people with and at risk for HIV.”

The American Academy of HIV Medicine, the nonprofit trade association for physicians and other health care professionals involved in HIV prevention and care, launched a public awareness campaign with a news release yesterday. It might follow up with messaging on social media and other tools to keep raising public consciousness, academy Executive Director Bruce Packett said.

Packett said threats to HIV care professionals’ 340B savings include

  • A California executive order that takes effect on Jan. 1 and a New York state law postponed until April 2023 that will eliminate 340B savings on drugs dispensed to Medicaid managed care enrollees
  • Drug manufacturer Gilead’s reimbursement cut, effective Jan. 1, for its PrEP drugs Truvada and Descovy through the company’s Advancing Access patient assistance/medication assistance program
  • Federal legislation that would lower brand drug prices but also simultaneously shrink what providers could earn from billing for 340B purchased drugs at above acquisition cost
  • Substitution of generic drugs for brand drugs, with the same negative effect on providers’ 340B earnings as under bills that lower brand drug prices.

“As an organization, we’re trying to highlight an issue that has a lot of moving parts and say, ‘Hey, don’t forget about HIV and what this revenue stream means for the provision of those services to clients,’” Packett explained.

“We’re talking about clinics that use 340B savings to hire staff and to provide services to patients that they need in addition to just the medications,” he continued. Instability in 340B funding streams “affect not only services available to patients in those clinics but jeopardize the entire infrastructure of that clinic and its ability to do what they need to do to keep patients virally suppressed.”

“We need a good, honest evaluation of the 340B program—how it fits in with HIV programs as a whole,” Packett said. “We need to look at falling drug prices and a very significant move to generics. Any person with common sense would say, ‘Yes, falling drug prices should mean greater treatment access and prevention for patients.’ But, with the 340B drug model that’s now in play, those lower drug prices could damage the health care infrastructure built up by the 340B program, unless there is some kind of substantial reinvestment into community clinic services.”

In California and New York, the transfers of Medicaid managed care prescription drug benefits to Medicaid fee for service were accompanied by the creation of new state supplemental payment funds to offset providers’ 340B revenues losses due to the drug benefit transfers. 340B providers in both states say the money in the funds does not come close to matching what they will lose in 340B savings. They also predict the funding will be transitional, not permanent.

In its news release, the academy said reductions in 340B savings could mean

  • Less ability to help clients with prescription drug copays, medical expenses and premiums, transportation, housing, and food
  • Loss of clinical staff
  • Loss of patient navigators and other support staff.

“Our agency runs on about 70% 340B program income,” said Emily Blailock, pharmacy director at Positive Impact Health Centers in Atlanta. “Without the 340B program we would no longer be able to serve the number of patients or provide the high level of wrap-around services we currently do in order to have an undetectable viral load rate of over 90 percent for our patients engaged in care.”

“About 75% of our clinic’s funding comes from 340B income,” said Adam Lake, M.D., a practicing HIV care physician in Pennsylvania. “Without it, we would not be able to assist with insurance coverage, cover copays, offer bridge prescriptions for patients who have insurance lapses, offer rapid start treatments, provide housing assistance, transportation assistance or emergency relief. This would clearly impact the most vulnerable patients, as these are the ones who benefit the most from these services. We would have to lay off a large number, maybe all, of our staff who provide connections with these services.”

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