Pharmaceutical manufacturers have launched an all-out assault on a vital drug discount program that patients depend on for their medicines, and lives are at stake. The 340B program was created by Congress in the 1990s to give safety-net providers access to reduced pricing they could not negotiate on their own. Republicans and Democrats alike support the program because it stretches scarce federal resources as far as possible for the common good. Nothing is wasted.

In Maine, 340B makes medications and services affordable for nearly 210,000 Community Health Center patients, or 1 in 6 Maine people. These patients are our neighbors, veterans, seniors, people with HIV, or who have recently lost their jobs and health insurance, and even essential workers who test positive for COVID-19 but do not require hospitalization. Many suffer from a higher incidence of chronic disease, poverty and lack of health insurance. The cost of medicines can easily push them further into poverty, disease, even death. A pandemic is the worst possible time to threaten a critical program that makes medicines affordable. Yet that is precisely what is happening — and due to a lack of regulatory safeguards, drug makers are taking advantage of a climate that is ripe for abuse, even as they continue to rake in profits.

Big Pharma is aggressively trying to dismantle the program. Pharma’s tactics include imposing arbitrary reporting requirements (CHCs already comply, by law, with strict reporting standards describing how the discounts are to be used). Drug makers are also working to severely restrict how 340B providers can contract with pharmacies, which is a problem in Maine, where many people cannot rely on having transportation to get them to a remote pharmacy.

Making matters worse are third-party compliance vendors and pharmacy benefit managers intent on pocketing profits rather than supporting access to lower cost medications, providing additional critically needed services, and improving patient outcomes. A White House drug pricing executive order issued last month is the latest blow. The EO aims to lower out-of-pocket costs CHC patients pay for EpiPens and insulin, but it would have the opposite effect. Many patients will end up paying more for drugs and it would impose administrative burdens for both providers and patients.

Drug makers claim they are reining in 340B discounts under the guise of ensuring fiscal integrity. Yet, health centers have proven for decades to be excellent stewards of tax dollars and 340B discounts.

Community Health Centers are nonprofits that use all 340B savings to expand access to medication and other essential health care services. Section 330 of the Public Health Service Act, as well as the regulations governing CHC federal grants, require that every penny of savings resulting from participation in 340B is used for purposes that expand access to care and needed services that improve health.

If these attacks are allowed to continue, there will be catastrophic consequences for Maine’s health centers and their patients:

• At one health center, without the 340B program, approximately 60% of their patients would be unable to afford prescriptions, especially the uninsured patients with low incomes.

• Across all health centers, we would see closure, or significant curtailment of, recovery programs. Recovery services generally, and innovative ways of delivering MAT services especially, are not sustainable without 340B. This loss would be devastating at a time when Maine’s overdose deaths are increasing.

• We would see a loss of care management functions that serve to coordinate care and lower costs to the system.

• There would also be statewide health center job losses — estimates suggest that each CHC would be forced to lay off a percentage of their workforce, depending on the impact. At one CHC, they would have to eliminate over 40 FT jobs.

Congress must protect 340B, or we face overall instability across Maine’s CHCs, as the health centers already face a funding cliff and have taken on significant financial losses due to COVID-19. As they — and the patients they serve — struggle in the face of an already unprecedented situation, it is cruel to add insult to injury by decimating a program that provides crucial access to life-saving health care services.

Darcy Shargo is CEO of the Augusta-based Maine Primary Care Association.


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