Over 100 U.S. House Members Want More Help for 340B Hospitals During Pandemic

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More than one out of four U.S. House representatives have signed a letter seeking more protection and flexibility for 340B hospitals during the COVID-19 pandemic. It’s unclear if their request will make it into the next COVID-19 stimulus bill. | (Source: Shutterstock)

Over 100 U.S. House Members Want More Help for 340B Hospitals During Pandemic

A bipartisan group of more than 100 U.S. House members have signed Reps. Doris Matsui (D-Calif.) and Chris Stewart’s (R-Utah) letter to House and Senate party leaders seeking more protection and flexibility for 340B hospitals during the COVID-19 pandemic.

Matsui and Stewart asked Speaker Nancy Pelosi (D-Calif.) and Minority Leader Kevin McCarthy (D-Calif.) on April 28 to ensure that future pandemic relief legislation protects hospitals from losing their 340B eligibility due to changes in patient mix during the emergency. They also asked their leaders to use a future relief bill to let 340B hospitals buy covered outpatient drugs through group purchasing organizations during the pandemic.

Next, Matsui and Stewart circulated a “Dear Colleague” letter enlisting support for their effort. Including themselves, 123 representatives signed the second letter, more than one out of four House members. In addition to Pelosi and McCarthy, the new letter also is addressed to Senate Majority Leader Mitch McConnell (R-Ky.) and Minority Leader Chuck Schumer (D-N.Y.).

House Democrats could release their next COVID-19 relief bill this week. Whether it will include 340B-related provisions is unknown. Congressional Republican leaders and the White House have indicated they want to give the first rounds of stimulus spending time to work before passing another bill.

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Specialty Pharmacy: Sustaining Patient Engagement and 340B Savings During COVID-19

Jerry Buller, Chief Pharmacy Officer at Trellis Rx

340B health systems that have created specialty pharmacy services continue to provide high-touch, personalized support to their patients and generate 340B savings even in the midst of the COVID-19 pandemic.

Embedded pharmacists and liaisons excel at maintaining patient engagement remotely based on their long-standing patient relationships. Though specialty pharmacy teams cannot see patients in the clinic right now, they can still conduct clinical assessments, provide clinical input, coordinate refills, secure financial assistance, provide counseling, and ensure medication adherence.

As an integrated part of the care team, with access to the EHR, these clinicians can also coordinate with health system physicians to ensure continuity of patient therapy and treatment even through this unforeseen disruption.

Enhancing Patient Care & Outcomes During the COVID-19 Pandemic

There are significant benefits of offering embedded specialty pharmacy service during this crisis says Brandon Hardin, Clinical Services Manager at Trellis Rx. “A health system’s specialty pharmacy team ensures continuity of care. In addition to addressing patients’ concerns about COVID-19, clinical pharmacists can help navigate drug access challenges.”

Hardin shared recommendations on how health system specialty pharmacy teams can support patients and providers in a recent article. One suggestion: “take responsibility for sharing patient care guidelines published by medical associations, such as the American College of Rheumatology.”

Brandon Newman, Vice President of Clinical Affairs at Trellis Rx, identified the ability to monitor if patients are responding to their therapy regimen as another benefit of offering specialty pharmacy services. “Clinical pharmacists can collect patient-reported outcomes measures over the phone using tools like the RAPID-3 assessment for rheumatoid arthritis,” he explained. “This data indicates if a patient’s condition is under control and allows the care team to quickly intervene if it isn’t.” Newman discussed measuring disease-specific outcomes in a recent article and addressed the topic earlier today in a webinar. (Missed the webinar? Don’t worry. Visit the Trellis Rx Resources webpage in the coming days, where you can access our recording of the May 12 Measuring Disease-Specific Outcomes to Create Value webinar.)

A Much-Needed Revenue Source for Health Systems

340B covered entities that have an on-site specialty pharmacy service also face less financial uncertainty as they navigate the impact of the COVID-19 pandemic. Health systems throughout the nation face significant budget shortfalls due to postponed elective procedures and temporary closures of specialty practices, but those with an established specialty pharmacy can rely on its revenue stream.

I asked Stuart Deal, who leads the Summa Health Specialty Pharmacy in Akron, Ohio, to elaborate. He shared: “As a specialty pharmacy service sustains patient engagement through this period, the resulting financial savings will also support the mission even as other areas of the health system suffer temporary setbacks. It’s a win-win for the community, patients, and the health system.”

Is Now the Right Time to Start a Specialty Pharmacy?

The COVID-19 pandemic underscores strategic reasons 340B health systems should offer specialty pharmacy services: to enhance patient care, improve clinical outcomes, and boost financial results.

As such, the pandemic provides an excellent opportunity to gain support for starting or enhancing a health system specialty pharmacy service. Pharmacy leaders can learn about key factors required to successfully launch a program at their organization by watching a Trellis Rx webinar on the topic or by contacting Trellis Rx. They can also utilize a third party such as Trellis Rx to review their current specialty pharmacy program, evaluate its effectiveness and determine whether there is an opportunity for growth.  Trellis Rx conducts these analyses free of charge.

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COVID-19 Forces Hospital and Health Center Groups to Cancel Annual Conferences

COVID-19 has scuttled two more flagship health care conferences that draw hundreds of 340B stakeholders.

America’s Essential Hospitals announced May 5 it cancelled its June 17-19 annual conference, Vital2020, in Chicago “due to the ongoing threat of COVID-19.” The National Association of Community Health Centers (NACHC) similarly announced May 4 it cancelled its 2020 Community Health Institute & Expo (CHI) set for Aug. 30–Sept. 1 in San Diego, also due to the pandemic.

“The health and safety of our conference attendees is our No. 1 concern,” America’s Essential Hospitals said on the VITAL2020 website. “We also recognize and respect the severe constraints on travel our members face as they respond to this pandemic. Now is not the time to ask these brave caregivers to leave their patients and communities.” The group said it will share details soon on holding a virtual annual conference. It said is refunding registrants’ payments and reaching out to corporate partners about their event sponsorships.

NACHC said on its website its decision to cancel its annual meeting “reconfirms our first priority: to keep our members, staff, and their families and colleagues safe and healthy—and of equal importance, the well-being of our patients and communities who need us to continue to meet their health needs.”

“We’ve said along that this is an important time for health centers to stay at home and focus on their mission to fight the spread of COVID-19 in their communities,” NACHC Director of Communications Amy Simmons Farber said. “We made the CHI decision early on enough that registration was not yet open for the conference.” On its website, NACHC said it was refunding all exhibitors. Farber said NACHC is exploring holding a virtual conference that helps “members as they continue their frontline response to the coronavirus and prepare their centers for a new normal.

Apexus cancelled its Aug. 29 340B University session at the NACHC annual meeting, according to the 340B prime vendor website.

The 340B Coalition 2020 summer conference, overseen by hospital group 340B Health, is still on for July 20-22 in Washington, D.C. The annual event has drawn 1,700 or more attendees.

According to the conference website, “if current restrictions are extended through July, the 340B Coalition Summer Conference will be held virtually, and your registration will be applied to the virtual event.” Conference organizers have also told prospective attendees that they can cancel their rooms until 72-hours prior to arrival and receive a 100 percent refund of their hotel deposit. The coalition has also suggested that registrants either wait to book airfare or purchase a refundable ticket. “We will be closely monitoring this situation and will provide updates as soon as they are available,” according to a recent announcement.

The July 19 Apexus 340B University session at the coalition meeting also is still on, according to the prime vendor website. “Apexus will continue closely monitoring developments related to COVID-19,” it said on the 340B Coalition conference website. “The health of our staff, faculty and attendees is a priority. We will email 340B University registrants if there is a schedule change.”

Health Centers’ Precarious Finances

Trade associations rely on conference revenues to help fund their operations. Losing any such revenues on top of any other income potentially lost due to COVID-19 is doubly painful. Take NACHC, for example. The New York Times Magazine, for example, published a May 6 feature story about how health centers in New York City and across the country “are being strained like never before.” It describes how, as the pandemic multiplied patients’ needs at a health center in the city,

the drop in face-to-face consultations was slowing the flow of Medicaid reimbursements to a trickle. The center applied for a loan from the federal government under the Paycheck Protection Program, but received no feedback beyond an acknowledgment that the application had been received. In April, senior staff members began discussions about the possibility that they would have to furlough staff. Outside New York, hundreds of other community health centers were grappling with similar problems—a spike in the need for urgent medical care for their patients, coupled with a sudden shortfall in government funding. The virus was doing more than filling up hospital I.C.U.s beyond capacity; it was stretching the resources of the country’s shadow medical safety net, the one that reaches patients whose location, economic circumstances or existing health status already puts them at greater risk.

NACHC spokesperson Faber said it is too early to tell whether COVID-19 will affect centers’ ability to afford their association membership dues. “NACHC is willing to work with all of our members to maintain their membership,” she said. “Most of our members recognize now more than ever the value of NACHC and membership. That said, many health centers will have to make tough decisions on how they allocate their financial resources. It is our hope that they will take into consideration the strong advocacy and operational support that NACHC continues to provide, in addition to the COVID-19 funding we have collectively been able to secure for community health centers.”

The U.S. Health and Human Services Department (HHS) last week awarded about $583 million to health centers nationwide to expand COVID-19 testing. The money came from the pandemic relief bill that Congress passed and the president signed in late April. As of May 1, according to NACHC, health centers had tested more than 356,000 patients for the virus. Nearly 4,000 health center staff members have tested positive for COVID-19, it said. During the last week of April, centers served about half the number of patients as they would have during a normal week, reducing reimbursements significantly. Twelve percent of center staff members were unable to report to work due to the pandemic and 1,810 center sites were closed, also due to COVID-19.

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Ryan White Clinics Want More Flexibility to Help Fight COVID-19

Federally funded clinics that serve over half a million people living with HIV/AIDS have asked the Trump administration to waive regulations preventing them from using “their resources and expertise to assist in the fight against the spread of COVID-19.”

In an April 10 letter, Ryan White Clinics for 340B Access (RWC-340B) asked the Health Resources and Services Administration (HRSA) to let Ryan White Clinics (RWCs) use program income they get by billing and collecting reimbursement from patients and third-party payers “to pay for the services and supplies needed by patients who have contracted COVID-19 or are at risk of contracting the infection.” Federal regulations prevent RWCs from using program income to provide care to individuals who are not diagnosed with HIV/AIDS. With the restrictions lifted, RWCs could use program income, for example, to test people with and without HIV/AIDS for COVID-19, pay for lab costs or medical supplies related to such tests, and to educate communities about COVID-19 risks, the group said. Waiving program income restrictions, it added, “would not impose any additional costs on the federal government nor would they require legislative action.”

“RWCs have the unique expertise and capacity to address the COVID-19 emergency and to prevent the spread of COVID-19; however, regulatory restrictions currently limit RWCs’ ability to fully leverage their existing resources to assist in this historic fight,” RWC-340B concluded. “A targeted waiver of program income restrictions would allow RWCs to tap into their unique expertise, without the need for additional federal spending or legislation, and would allow them to assist in this historic fight against COVID-19.” 

RWC-340B is now enlisting Congress to help relax the restrictions.

Report Describes How Hospitals Use 340B Savings to Help Patients with Diabetes

Hospital group 340B Health has issued a new report describing how seven hospitals use money saved through the 340B program to help patients living with diabetes. Enhanced services include:

• Providing access to free or low-cost insulin and other supplies

• Disease management by multi-disciplinary teams and training in self-management

• Education about the use of insulin, glucose monitors and other supplies as well as the role of diet and exercise in managing blood sugar

• Community programs to educate high risk populations on how to prevent diabetes.

“The efforts of these hospitals have improved access to medications and ongoing care, increased medication adherence, improved A1C levels, reduced readmissions, and turned around the lives of many patients with diabetes,” the report says.

Two Manufacturers Post Notices to 340B Providers on OPA Website

Drug manufacturer Purdue Pharma is providing 340B covered entities with refunds for overcharges on 13 drug products during the fourth quarter of 2017 (Intermezzo tablets and Butrans patches) and during the third and fourth quarters of 2019 (Adhansia XR capsules), according to a public notice the company posted on the Health Resources and Services Administration (HRSA) Office of Pharmacy Affairs (OPA) website. Purdue Pharma said is working with Apexus to issue credits to affected entities.

Drug manufacturer Bayer has posted a notice to 340B entities on the OPA website about its limited distribution system for Adempas, which is prescribed to treat two types of pulmonary hypertension.

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