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340B Insight provides members and supporters of 340B Health with timely updates and discussions about the 340B drug pricing program. The podcast helps listeners stay current with and learn more about 340B to help them serve their patients and communities and remain compliant. We publish new episodes twice a month, with news reports and in-depth interviews with leading health care practitioners, policy and legal experts, public policymakers, and our expert staff.
Speaker 1 (00:04):
Welcome to 340B Insight from 340B Health.
David Glendinning (00:11):
Hello from Washington DC and welcome back to 340B Insight, the podcast about the 340B Drug Pricing Program. I'm your host, David Glendinning with 340B Health. Our guest for this episode is Paul Orth with University Health Kansas City. As 340B program manager. Paul was integral in setting up an initiative to provide prescription drugs to uninsured and underinsured patients at the 340B discounted price. We wanted to hear how that direct savings initiative came about for his health system and how it's working to help individuals in need.
(00:50)
But first, let's take a minute to cover some of the latest news about 340B. In late August Johnson & Johnson, one of the world's largest drug companies, announced it would be replacing upfront 340B discounts on two of its biggest drugs with back-end rebates for disproportionate share hospitals. If it is permitted to take effect in October, this rebate program would represent a massive departure from how 340B has worked for its entire history. In a public statement, 340B president and CEO Maureen Testoni said, "This shift would impose massive financial and administrative burdens on 340B hospitals, which serve vulnerable patients and underserved communities. It would force these financially strapped hospitals to incur significant costs and float revenue to drug companies by paying full price for 340B eligible drugs. These hospitals would go without vital resources they need to treat their patients in need while drug makers and third parties determine when and whether to approve 340B rebates."
(02:05)
340B Health submitted a formal request to the Health Resources and Services Administration calling on the agency to act swiftly to block the J&J rebate policy from taking effect. HRSA responded that it had communicated to the company that the rebate model is inconsistent with the 340B statute, which requires the Secretary of Health and Human Services to approve any such proposal. The HRSA statement notes that the government, "Will take appropriate actions as warranted." Please visit the show notes to read 340B Health's public statement and to read member-only resources with more information about this development.
(02:52)
And now for our feature interview with Paul Orth. Paul was at the most recent 340B Coalition Summer Conference where he spoke on a panel about providing 340B discounts directly to patients. Our listeners in the 340B community know that supporting patients with their prescription drug costs is far from the only way that covered entities use their savings to serve patient needs. But it is an very important application of 340B for entities that determine their patient communities would benefit from such an initiative. We wanted to hear from someone who had experience standing up and maintaining a program that provides covered drugs at the discounted price for patients who otherwise might not be able to afford their drug bills. So we caught up with Paul during the conference to learn more, here's our conversation.
(03:41)
I am here with Paul Orth, the 340B program manager at University Health Kansas City, Truman Medical Centers. Paul, welcome to 340B Insight.
Paul Orth (03:51):
Thank you very much.
David Glendinning (03:52):
We are here to speak today about a program you have that provides 340B discounted drugs directly to patients. Now, we've spoken about this a lot on the program before, but we've never actually gone into detail with a guest specifically on this way of helping patients. So if you could, first of all, tell us a little bit about University Health and the patients you serve there.
Paul Orth (04:17):
Sure. University Health Kansas City is a academic medical center with two campuses. Both of them are disproportionate share hospitals. Our downtown campus offers a high risk pregnancy and chronic disease management. We're a level one trauma center. Our other campus is in Eastern Jackson County, we specialize in family medicine. We have a maternal care clinic and also a long-term care unit. We like to think that that is a facility that was from the start of your life to the end of your life. Our downtown campus has a dispercentage of over 58%, and our Lakewood campus has a dispercentage of over 45%.
(04:55)
As the primary safety net hospital of Kansas City, Missouri Metropolitan Area, University Health treats vulnerable populations with a high degree of healthcare disparity. These disparities cut across economic, racial and ethnic boundaries. Many of our patients and clients have multiple chronic diseases such as diabetes, asthma, heart failure, and hypertension. In fiscal year of 2023, more than 90,000 of our patients lived with one or more of these chronic diseases, and the 340B program really helps these patients manage those disease states through 340B discounts they receive at contract pharmacies.
David Glendinning (05:31):
So clearly a lot of patients in need that you serve. And in terms of serving them through this 340B direct savings program, I believe you call it an uninsured program, how did the idea for that program come about?
Paul Orth (05:45):
So the way that the 340B program is structured, it allows covered entities to stretch scarce federal resources as far as possible, reaching more patients and providing more comprehensive services. And so we realized that the difference between some of our patients needing to be admitted to the hospital and recovering at home could be as simple as an affordable prescription. So we teamed up with retail pharmacy in our area and really worked to build this program to expand access for affordable medications to our patients in the communities where they live and work.
David Glendinning (06:21):
Okay, so clearly the patient need is there and that's how this came about. How is the uninsured program structured at University Health?
Paul Orth (06:30):
We do mostly e-prescribing from our clinics and from our hospital EMR system. So eligible credential providers will see patients in eligible locations, and then when those prescriptions that generate from those visits are sent to pharmacies, there are eligibility codes for 340B attached to those prescriptions that allows the pharmacy to know that they are a 340B eligible patient for this prescription at the time of adjudication for when the prescription is being picked up. So it's a real time solution where patients are able to pick up prescriptions as they walk out of the hospital or as refills are needed for their prescriptions near their homes.
David Glendinning (07:12):
And what does this look like on the receiving end for the patient who is actually getting drugs through this uninsured program?
Paul Orth (07:19):
So when the patient presents to the pharmacy with their prescription, the pharmacy is going to check for insurance and they're not going to have any insurance, but there'll be those university health 340B eligibility codes attached to that prescription, which will allow the pharmacy know that they are qualifying for the 340B discount. And so what the patient ends up paying is the 340B price plus a pharmacy dispensing fee, which makes many medications affordable for our patient population. This also works for patients that have a high co-pay. If their co-pay is more than the dispensing fee plus the 340B price, they can also receive the 340B discount for those prescriptions.
David Glendinning (08:01):
Oh, interesting. So even though this is called an uninsured program, it could actually benefit people who are potentially underinsured?
Paul Orth (08:08):
Absolutely.
David Glendinning (08:09):
And do you have processes in place in this program to ensure compliance? We always speak about 340B rules and regulations and wanting to make sure that health systems are falling under those rules.
Paul Orth (08:23):
Yeah, so the way that the 340B eligibility codes are attached to prescriptions, it's written out of our EMR from credentialed providers seen in eligible locations. And we worked with our IT department to make sure that all of those checks 340B eligibility checks are in place before that code gets sent out electronically. If the prescription is not issued electronically and they have to print it off, the same code still applied to the prescriptions, but they're printed as a barcode on the paper. And then the pharmacies can scan the barcode for 340B eligibility.
David Glendinning (08:59):
So barcodes potentially on the claims themselves. It seems like there is a whole process in place here. Why not just give your eligible patients something along the lines of 340B discount cards that they could use when they pick up their prescriptions?
Paul Orth (09:15):
This is just a process that we've ensured compliance. Many of our patients could see other healthcare facilities, and we want to make sure that our patients are receiving 340B discounts just for our prescriptions and not any anybody else's prescriptions. Those cards could open up... it's hard to manage for us in our systems right now, so we just feel like this is the best process for us.
Monica Forero (09:37):
Hi there. It's Monica Forero with a message from 340B Health's Research Department. Each year, 340B health partners with member hospitals who are using applied data, transformative technology and community based insights to innovate their health equity efforts. We are currently seeking your stories to showcase in our annual health equity report. Please email Podcast@340BHealth.org if you're interested in helping us spread the good word about your hospital or health system's advancements in health equity. We appreciate your time and consideration. Please be sure to check out our 2023 health equity report that is linked in the show notes. And now back to the interview.
David Glendinning (10:19):
And at the end of the day, we're always interested with whatever way health systems use their 340B savings, what does it mean for the patients? So for this uninsured program, what has it meant for those patients?
Paul Orth (10:32):
So this is the difference between a patient receiving a medication and a patient not receiving a medication. Many of these medications also prevent hospital admissions, emergency department visits, so it's really helpful for our patients to stay healthy.
David Glendinning (10:46):
We've spoken in the past about that medication adherence issue and how important that is for patients to stay on their drug regimens and stay healthy. Is this uninsured program the only way that University Health Kansas City patients are benefiting from the 340B program?
Paul Orth (11:04):
We have multilingual interpreters and cultural healthcare navigators on staff at both our downtown campus and our Lakewood campus to ensure patients with limited English proficiency or patients who are deaf receive high quality individualized care with communication and healthcare navigation assistance. We're one of the few hospitals that have staff interpreters on site. University Health has 38 language interpreters on staff to provide face-to-face interpreting services for three major languages, Spanish Somali and Arabic. We have phone and video remote interpreters to provide over 200 languages available.
David Glendinning (11:42):
So it seems to me that this uninsured program relies on what would be a contract pharmacy for your health system. So how have the drug maker contract pharmacy restrictions that we've been speaking about since 2020, how have those affected this program?
Paul Orth (11:58):
They've affected it negatively. The way that our program was set up, we had a retail pharmacy chain that was close to where patients live and work throughout the Kansas City area. With these contract pharmacy restrictions limiting 340B pricing to a single contract pharmacy, it really limits where our patients are able to pick up their prescriptions. If they were used to picking it up next to their house and now they have to come downtown to pick up their prescription, it's just an extra barrier for care. We have a offsite behavioral health clinic that also has a retail pharmacy very close to it. Patients used to be able to pick up their prescriptions as they're leaving their behavioral health clinics visits that now have to make an extra stop to a different pharmacy to pick up their prescriptions. It's just adding barriers to care that we're trying to reduce.
David Glendinning (12:50):
If there are other hospitals out there listening, considering passing through their 340B savings in this way through their own uninsured program or some other sort of direct savings program for patients, what advice might you have for them as they're thinking about implementing this?
Paul Orth (13:07):
I would say work with your leadership, work with your IT departments to figure out what you're capable of doing. Team up with a pharmacy that you have a good partnership with because they're going to have to understand the program and how your patients interact with that pharmacy to ensure compliance and making sure that there's the high quality patient care.
David Glendinning (13:28):
Well, Paul, this has been a very interesting look at a program where the 340B dollars are going more directly to patients. So thank you for taking the time to walk us through this program.
Paul Orth (13:40):
Thank you. Thanks for having me.
David Glendinning (13:43):
Our thanks again to Paul Orth for taking the time to explain one of the more direct ways that the 340B benefit can go to help uninsured and underinsured patients.
(13:53)
We enjoy speaking with health providers on this show about the multitude of methods in which they use 340B to serve patients in need, whether that's through more comprehensive services, wrap around support or help with medical costs, and even after more than 100 episodes, we are still learning more about all the ways that patients benefit because of 340B. So how does your health system prioritize the use of 340B savings for patient care? We would love to hear from you and consider featuring your initiative on the show. Please email us at Podcast@340BHealth.org. We will be back in a few weeks with our next episode. In the meantime, as always, thanks for listening and to be well.
Speaker 1 (14:41):
Thanks for listening to 340B Insight. Subscribe and rate us on Apple Podcasts, Google Play, Spotify, or wherever you listen to podcasts. For more information, visit our website at 340BPodcast.org. You can also follow us on Twitter @304BHealth and submit a question or idea to the show by emailing us at Podcast@340BHealth.org.