For over 35 years, Avita Care Solutions’ Chief Medical Officer, Dr. Christopher Hall, has devoted his career to democratizing and scaling compassionate and competent care initiatives to underserved communities—the very patients the 340B program was designed to help. In the following interview, he offers a provider’s point of view on why the drug discount program is essential to even the health equity playing field and on how clinicians play a fundamental role in securing its sustainable future.
Question: How long have you been serving marginalized patients with the help of safety net funding from the 340B drug discount program?
Dr. Hall: I’ve been working with clinical programs associated with the 340B program for just shy of 20 years. My very first interaction with 340B was as the medical co-director of a large HIV clinic in Oakland, California, which was associated with a disproportionate share hospital (DSH) and received Ryan White Care Act funding. Then—and now—the longevity, expansion, and success of these kinds of programs is based mainly on 340B.
Question: In your various clinical roles serving marginalized populations over the past three-plus decades, how have 340B resources helped you and your teams care for patients who otherwise might have met serious, even life-impacting, roadblocks to care?
Dr. Hall: Back when I saw patients in brick-and-mortar clinics, 340B funding allowed us to develop clinical programs for the community that we otherwise could not have initiated or maintained. As a result, we could reach new patients and offer expanded services.
As I’ve moved into 340B-supported telehealth, with a focus on telePrEP, the 340B program has helped us develop holistic patient programs that integrate with our clinical services. Examples include community engagement events, special outreach programs for women of color, and free transportation initiatives for patients who otherwise couldn’t access care. Simply put, the 340B program allows us to expand the quality and reach of our care in a way that wouldn’t be possible if we were solely relying on conventional grant funding.
Question: The 340B program has faced growing scrutiny from legislators and drug manufacturers over the past few years, and the future state of the program is still up in the air as legislators, advocacy groups, and pharma hash out a sustainable and acceptable solution to all parties. How have the changes and uncertainty surrounding the program impacted your teams’ ability to care for patients?
Dr. Hall: Believe it or not, even with the recent controversy, funding from the 340B program is often still more stable than some conventional funding opportunities that are very competitive or have limited terms.
But any time you have variability in funding, it’s the underserved patient populations that take the brunt of the impact in the long run. I’ve been involved with programs where funding changes have resulted in clinical and operational team layoffs, as well as the elimination of critical services.
The lack of political consensus about the program’s future is incredibly concerning for entities that depend on 340B to sustain necessary programming that would otherwise not be available to their communities.
Question: The health care industry is facing a historic workforce shortage, which has hit covered entities particularly hard. How is the uncertain future of the 340B program affecting the morale of clinicians who serve covered entity patients?
Dr. Hall: The current state of the 340B program adds to the stress community health organizations experience in recruiting talented providers and other staff, and that’s probably due to the lack of consensus around the importance of strengthening the program. If more focus were placed on fortifying 340B initiatives to meet gaps in patient care sustainably, it would alleviate some of the recruiting stress organizations are now facing.
On the other hand, many of the organizations reliant on the 340B program offer providers loan forgiveness, which has allowed clinics to hire and maintain a steady stream of individuals who are both talented and want to serve their communities. The bottom line is that covered entities and providers need to do a much better job of communicating how the 340B program has helped remove health care barriers for underserved patients over its 30-plus years of existence.
Question: What advice do you have for clinicians —especially the less-seasoned providers— who depend on the 340B program to serve patients but find themselves struggling to navigate recent changes?
Dr. Hall: I’d reassure providers that, despite the speed bumps and potholes associated with the 340B journey, there’s a whole cadre of talented and passionate advocates out there who are working to ensure the longevity and effective functioning of the program. They’re doing this work while we’re seeing patients.
Providers also need to understand their roles in helping secure the positive future of the 340B program. By publicly articulating how 340B has helped their patients, clinicians can educate and dramatically change the minds of policymakers.
340B advocates use providers’ real-life patient success stories to help the public and legislators understand the difference the program makes in the lives of patients who otherwise have a slim shot at health equity.
Years of stigma, systemic discrimination, poor policy choices, and flat-out ignorance have resulted in the life-threatening barriers to quality care providers see daily among their marginalized patient bases. As health care leaders on the front line, it’s our job to vocalize the importance of the 340B program to help eliminate long-rooted disparities—and actively work with industry stakeholders to strengthen the program’s future.To learn more about how Avita Care Solutions is committed to promoting health equities by providing comprehensive, compassionate, and inclusive health care and pharmacy services to underserved communities, reach out to us today.
Dr. Christopher Hall is chief medical officer at Avita Care Solutions.