A large HIV/AIDS health care group, a Democratic 340B provider ally in Congress, and three national hospital groups lambasted community health centers and drug makers’ historic announcement yesterday that they are working together to remake the 340B program. Other 340B provider representatives, however, either commented on the deal obliquely or said they were still studying it.
AIDS Healthcare Foundation called it a “deal with the devil” and U.S. Rep. Doris Matsui (D-Calif.) called it the “latest attack on the 340B program.” The American Hospital Association suggested the agreement used evasive doublespeak.
The National Association of Community Health Centers and Pharmaceutical Research and Manufacturers of America jolted the 340B world yesterday by disclosing that they co-wrote 10 core principles to guide federal 340B legislation and have created a nonprofit group, ASAP 340B, to fight for their plan. NACHC’s decision to break ranks with fellow 340B provider groups and reach a deal with PhRMA was unprecedented.
NACHC Director of Policy & Regulatory Affairs Vacheria Keys said during an interview this morning that NACHC members made it clear last summer they could wait no longer for relief from drug manufacturer conditions on 340B pricing when health centers use contract pharmacies and from pharmacy benefit manager policies that deplete centers’ 340B revenues.
Keys disclosed that her group and PhRMA “have been working at this for six or seven months.”
Yesterday was NACHC’s spring lobby day on Capitol Hill. A health center representative told 340B Report that when NACHC and PhRMA’s 10-point plan was explained to a Democratic member of Congress, the lawmaker asked, “Can you trust PhRMA?”
“I completely get that,” Keys said when asked to comment on the lawmaker’s reaction.
“It takes time to build trust,” she said. “But this is a genuine partnership. There are differences of opinion about how the program should work, but not about whether the program should exist.”
“PhRMA can be trusted on this,” Keys continued. “The manufacturers are at the table. Their board approved this just like NACHC’s board. There’s no hiding of the ball, no gotcha moment. Everything is transparent—our goals, what we want to accomplish, how we want to work together.”
Keys was asked how NACHC will engage with 340B provider groups that criticize it for cooperating with PhRMA.
“Before NACHC went to work with PhRMA, we tried to work with other covered entities,” she said. “It’s very clear that health centers are on a different timeline than … larger health systems [that] can afford to wait. Health centers simply cannot wait.”
Keys said critics “are open to join this coalition and come to the table and work with us so their perspective is represented.”
She was asked if any of the groups that issued statements yesterday criticizing NACHC for cooperating with PhRMA reached out to NACHC.
“No,” Keys said.
AIDS Healthcare Foundation’s criticism was the sharpest.
“Health centers are doing a deal with the devil, giving PhRMA the means to kill 340B,” said AHF President Michael Weinstein said. “NACHC, selfishly, has thrown all nonprofit 340B providers, hospitals, and clinics under the bus. This is a betrayal by the community clinics that invites the fox into the henhouse. We will fight this unholy alliance fiercely.”
U.S. Rep. Doris Matsui, a long-time 340B champion who serves on the congressional committee that has jurisdiction over the program, said in a statement, “this new proposal … would play right into the hands of its authors, the drug manufacturers, and put money back into the pockets of Big Pharma.”
“While we don’t yet have all the details about this deal, I am very concerned about any potential proposal that would undercut the efficacy of the program by excluding people who rely on these drugs and critical safety net providers, who play an essential role in providing care to low-income and underserved populations,” Matsui said. “This latest attack on the 340B program underscores our need to work together to strengthen the program, not further undermine it by sacrificing benefits for vulnerable patients.”
American Hospital Association Vice President for Government Relations Aimee Kuhlman said, “They can try to call themselves ‘Alliance to Save America’s 340B Program,’ but the drug companies don’t want to ‘save’ the 340B program—they want to end it because it makes a small dent in their sky-high profits.”
“No amount of Orwellian language can hide the fact that the real victims of this self-interested proposal will be the millions of patients and communities that 340B hospitals serve each day,” Kulhman said. “The AHA will continue to fight to protect the 340B program and the patients it benefits against unfounded attacks by big drug companies.”
340B Health President and CEO Maureen Testoni called it “the latest in a long series of efforts by the pharmaceutical industry to back away from its obligations to health care safety-net hospitals and their patients by advocating for Congress to reduce 340B eligibility.” If it follows past drug industry 340B efforts, she said, “it would involve massive cutbacks in access to discounts for safety-net hospitals that provide the vast majority of hospital care received by Medicaid patients as well as most of the uncompensated and unreimbursed care in the U.S.” Testoni said her group will explain to lawmakers how “major additional cuts to 340B eligibility would devastate the health care safety net and the patients in need who rely on it.”
America’s Essential Hospitals Senior Vice President of Policy and Advocacy Beth Feldpush said Congress and the Biden administration should enforce existing 340B policies more strongly instead of “limiting these hospitals’ use of the program only to line drug companies’ pockets with more profits.”
“Congress and the administration can do more to counter drug companies’ illegal restrictions on 340B drugs dispensed by contract pharmacies, and we urge them to act,” Feldpush said.
A representative of the National Rural Health Association, which represents both rural hospitals and rural health centers enrolled in 340B, said the group was reviewing the proposal and had no comment at this time.
Executive Director Amanda Pears Kelly of Advocates for Community Health, a newer association of 30 large community health centers, said, “We remain committed to ensuring health centers are protected as reforms to the 340B program are considered in Congress. Our 340C proposal—which was released last year—aims to do just that through a provision under the existing 340B program. The provision maintains the core principles and intentions of the program, while also creating protections and assurances for health centers and other covered entities in exchange for transparency and accountability.”
“As additional proposals for reforming the 340B program are introduced, we look forward to finding common ground and working with leaders in Congress to achieve the mission all health center advocates have: to protect this vital lifeline for the nation’s most important safety net,” Kelly said.
Shannon Burger Stephenson, President of Ryan White Clinics for 340B Access, said it was “carefully reviewing the proposal.”
“RWC-340B has long opposed drug companies’ attacks on the 340B program and any limitations on access to drugs for vulnerable patients,” Stephenson said. “Any proposed ‘reform’ of the 340B program must NOT, intentionally or unintentionally, harm any person affected by the HIV epidemic or the Ryan White Clinics that serve them.”