340B Winter Coalition 2022 – Congratulations on 30 Years! Continue to Share Your Story

For the first time in two years, an opportunity to attend the 340B Winter Coalition in person brought out a record number of attendees while also allowing virtual attendance as an option. 340B Health unveiled the new logo representing the 30-year evolution of covered entities ensuring access to patient care. Maureen Testoni, 340B Health President and CEO, explained during the welcome address that, “conference sessions provide the most important intelligence needed to operate compliant, effective 340B programs. Attendees share innovative approaches to using resources to expand care access and improve patient health outcomes. The event provides valuable opportunities to meet with peers during stakeholder breakout sessions, at networking receptions, and in the exhibit hall.” There was no greater evidence of this, than when hearing the amazing testimonial of a Consolidated Health Center while at dinner. We learned that an outstanding team of 340B providers from Colorado, in addition to meeting the health care needs of their patients, have also been able to set up food vouchers for quality fresh produce and meat for those in need. They are also in the process of building affordable housing with the clinic as the epicenter to promote and sustain population health initiatives. Now that is an amazing use of savings! These are the conversations that need to be shared to ensure the continued vitality of the program. The knowledge shared at the coalition is why Turnkey, now SpendMend Pharmacy, chooses to send a small contingent of staff to participate, even during these times of risk. Key takeaways from the conference are outlined below.

1. Contract Pharmacy Limitations
   1. Six companies have been referred to OIG for fines by HRSA
      1. Three courts are hearing appeals
         1. Two sided with HRSA and one sided with the manufacturer
   1. There are now thirteen manufacturers restricting pricing
      1. Shout out to the numerous (>700) manufacturers still keeping their promise
   1. The reduction of Contract Pharmacy benefit has caused worsening harm for CAHs by 39% and 23% for DSH/RRC/SCH
   1. A reminder that sharing claims data has a negative impact downstream regarding PBMs and rebates.
      1. 340B Health suggests restructuring of commercial rebates is a better plan
      1. What can CEs do? Open In-house retail pharmacies; Ship drug to CE for delivery to its contract pharmacies (cautions apply); Apply for an exception – designation of pharmacies under common ownership.
   1. 340B ESP Considerations:
      1. Manufacturers want to avoid paying commercial rebates to pharmacy benefit managers (PBMs) and payers on 340B drugs.
      1. Could undermine congress’s intent for how 340B should operate.
      1. Risk of reduced payment for 340B claims by PBMs/insurers.
      1. Risk of exclusion from provider networks.
      1. CE Call to Action:
         1. Report overcharges to HRSA
         1. Ask lawmakers to co-sponsor the PROTECT 340B ACT
      1. 340B Health Stance – Do not share data with ESP as The Berkely Research Group has historically not been a neutral party with collected data.
2. Federal and State Payer Developments and Trends
3. Fourteen states have enacted anti-discrimination laws, others considering, so half could have laws this year.
4. The Rutledge Supreme Court decision supports State efforts to protect CEs from lower reimbursement terms for Employee retirement income security act (ERISA) plans, but is silent on Medicare Part D.
5. Medicare Part D preempts State’s from creating laws. Some payers argue the applicability of anti-discrimination laws to Medicare Part D plans, making State laws ineffective.
6. There are no Federal Laws to Protect 340B – Over the decade, PBMs and Health Insurers have increased their discriminatory practices against covered entities impacting reimbursement.
7. Protect 340B ACT – Will prevent insurers and PBMs from engaging in discriminatory contracting practices at the federal level (pickpocketing) – Major call to support this act. Share your Story!
8. 340B DSH Eligibility Bipartisan bills introduced in the Senate and House to protect hospitals from losing 340B eligibility due to the pandemic
   1. S. 773 and H.R. 3203
   1. HHS thus far has not felt like they could take action with waivers.
9. White House Budget Proposal FY 22 issued May 21
   1. Two requests for changes to 340B statute:
      1. Permit HHS to issue regulations on all aspects of the 340B program
      1. Permit HHS to audit covered entities to “determine how net income from purchases under this section are used by the covered entity”
10. FQHCS are a major factor that have contributed to the growth of the 340B program with over 28 million patients served.
11. Grantees topped the number of attendees at 32% followed by hospitals at 25%. For the first time, Grantees outnumbered hospitals at 340B University representing over 50% of attendees.

As stated by multiple presenters during the 340B Coalition, now is the time to advocate and here are some tips:

• Stay informed
• Monitor your state for legislative and regulatory activity that could impact 340B
• Update your organization’s state government relations team and state provider associations of these issues, so they are aware and can monitor for activity too
• Have state and federal advocacy plans
• Complete your 340B Impact Profile and share the importance of the 340B program to your organization and patients
• Engage state officials and educate them about the 340B program
• Advocate for policies that make the 340B program stronger and against policies that undermine 340B

Let’s continue to spread the word about how important this program is for the patients you serve.  I can only imagine what we can do in the next 30 years! If you have a story you would like to share, please let us know and we will highlight it in our newsletter.  SpendMend Pharmacy loves hearing the exciting and creative ways our clients are using their 340B savings. Please Share!