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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.
Narration (00:04)
Welcome to 340B Insight from 340B Health.
David Glendinning (00:12)
Hello from Washington, DC, and welcome back to 340B Insight, the premiere podcast about the 340B drug pricing program. I'm your host, David Glendinning with 340B Health. Our guest for this episode is Kayla Ciampi, senior 340B analyst at Dartmouth Health. We caught up with Kayla at the 340B Coalition Summer Conference, where she participated in a panel highlighting the growing role of pharmacy technicians in 340B.
Kayla joined us to discuss her own journey from her first pharmacy tech position to senior 340B analyst, how pharmacy techs are helping hospitals navigate an increasingly complex 340B program, and what skills can help tech succeed in the field. But first, let's do a quick recap of some of the latest news about 340B.
340B Health is urging the Centers for Medicare and Medicaid Services to abandon proposed Medicare Part B payment cuts to 340B hospitals that would take effect next year. In comments we recently submitted to CMS, we strongly oppose the agency's proposal to cut Medicare reimbursement for most 340B hospital drugs by about 37%, which would reduce payments to 340B hospitals by an estimated $2.5 billion next year alone.
We also oppose a proposal to accelerate separate payment reductions for non-drug hospital outpatient services. Our comments included findings and examples from 340B hospitals showing how the cuts could threaten services for low income and rural patients, particularly as hospitals prepare for steep upcoming Medicaid cuts. We also outlined why we believe the Medicare proposal violates federal law.
CMS is expected to finalize its 2027 hospital outpatient payment rule later this fall, and 340B Health will continue urging the agency to abandon the cuts.
And now for our feature interview with Kayla Ciampi of Dartmouth Health. Pharmacy technicians have long played an important role in hospital pharmacy operations, but their work increasingly extends into 340B compliance, auditing, data analysis, purchasing, and program management. Kayla joined us to discuss how her own career has evolved, along with the increasingly complex 340B landscape.
And what opportunities she sees for other pharmacy techs interested in the field. Here's that conversation. I'm here with Kayla Campi, who is senior 340B analyst at Dartmouth Health. Kayla, thank you for joining us at 340B Insight.
Kayla Ciampi (03:08)
Thank you for having me. I'm super excited.
David Glendinning (03:11)
You came to this conference to present on the panel that featured pharmacy technicians, pharmacy techs for short. So we're gonna be speaking about that. You're not the first pharmacy tech we've had on the program. You probably won't be the last. but we're always
Kayla Ciampi (03:27)
Exactly.
David Glendinning (03:29)
So we're always interested in in hearing stories about how people get into that and how they find 340 B from there. So before we do that, could you please tell us a little bit about Dartmouth Health and the communities you serve and a little bit maybe about how the three forty B program helps you support your patients.
Kayla Ciampi (03:48)
Dartmouth Health is in a rural area. A lot of patients travel an hour plus getting to their health care, getting to the hospital. So being able to extend the services into more of like the community being being able to keep the hospital open so they don't have to drive even further for healthcare. And also being able to provide extra services like possibly transportation, possibly
Food services, being able to provide a little bit extra stuff to the community with this program so that the patients are more supported outside the hospital and have less readmits.
David Glendinning (04:30)
And as I mentioned your presentation focused on three forty B pharmacy techs. tell us a little bit about your own three forty B journey as a pharmacy tech.
Kayla Ciampi (04:41)
It's been an interesting one. In 2014, I started as a pharmacy tech at a large national chain pharmacy. And I heard a little bit about 340B, but I was only 18 and I didn't think I need a retirement plan at that point. So I just was like, nah, I'm gonna stick with what I'm doing. And then once I worked for a couple years in retail, I moved to inpatient pharmacy.
And I moved to a larger system in Vermont and that's when I actually learned more about three forty B, but it was more of like we got a large order two times a week and so I'm like, Okay, I really don't like that. Like that's extra work for me, you know, as a pharmacy tech having to put all the extra medications away. And so I got more into three forty B when in two thousand nineteen, when I got hired
at my previous position as a pharmacy tech and it we had a pharmacy that was for the employees who had the insurance and so we would determine three footb eligibility right on the spot and so I had to learn which ones were gonna be eligible, which ones weren't, because we also had patients going outside of the hospital for their healthcare. it was also a sole community hospital, so we had to
Make sure that we didn't purchase any orphans and stuff like that. So that's kind of where I got like my little crash course of 340B. And then I saw a position open up with Dartmouth Health and I put my resume in on a Wednesday. I got a call on a Thursday saying, Hey, can you interview tomorrow? And I'm like, that's really short notice, but I did it in my car in the rain.
And they took a chance on me and I started and I'm like, holy moly, this is three forty B on steroids. I did the three forty B university. So then back in March I decided that I was going to take my ACE certification and I passed and that that was a great feeling.
David Glendinning (07:01)
Well, congratulations and yeah, thank you for thank you for sticking with all the paperwork. I know there's a lot more to do, but also also very important work. Yeah, that's that's funny to hear you say that the experience of coming to Dartmouth was 340B on steroids. So what maybe we could talk a little bit more about that. What changed when you made that move?
Kayla Ciampi (07:23)
The first thing that changed was I could barely do a V lookup, didn't really know how to do a pivot table. And so when I moved to Dartmouth, we're we're pulling Excel files. We're working Excel every single day. And I got really good at learning how to do a pivot table and doing a V lookup. I learned how to do an X lookup, which is so much better. And I'm currently dabbling in learning how to do a power query.
So lots of Excel exposure. That was probably the biggest change. Also, we went way more in depth with the auditing. The place I was at previously, we did twenty claims a month per TPA. There wasn't really a mock audit that was in place. So when I first started here, we would do mock audits just to
make sure that we're hearsa ready and that the first time I went through that that was a huge experience but it really opened my eyes of how complex the program is. You have your R C but that's gonna be completely different than your critical access or your dish hospitals. Every single contract is different.
David Glendinning (08:36)
I'd like to talk about the role of pharmacy techs more broadly. I think many people or I mean too many people think that pharmacy techs mainly are the ones dispensing the medications and certainly that's part of it, but we know it's a whole lot more. How has the role of a pharmacy tech changed, you know, in your view, particularly in the 340B field?
Kayla Ciampi (08:57)
The role of the pharmacy techs have changed quite a bit. Everybody thinks, you're counting pills, you're making IVs, you're running meds to the floors, but in reality, you're also doing the purchasing, so you're also figuring out where to buy something from. You're figuring out is something 340 B initially so that you can set it up correctly in your system or purchase it correctly on the correct account. Pharmacy techs are doing
ordering for like contract pharmacies. They are doing analytical work, making sure that claims are eligible because let's say you're not a pharmacy tech and you come across a claim for glucagon and it's for a hundred milligrams. To somebody that's not a pharmacy tech, they're gonna be like, okay, that's fine. But to a pharmacy tech, you're like a hundred milligrams of glucagon, that is a huge red flag. I don't think that's correct. So
It it really just kinda rounds everything out.
David Glendinning (09:59)
And what about the three forty B landscape more broadly? What how have you seen that world change since you first started working in three forty B
Kayla Ciampi (10:10)
So I started, you know, back in 2019 a little bit on the surface. And then in 2020 was when the first manufacturer restriction came in. And once, you know, the other manufacturers saw that that was successful, everybody decided, hey, I'm gonna jump on that bandwagon. And so it I would say has gotten way more complicated because, you know, you would just have to worry about
If it's an orphan or if have to worry about the GPO prohibition. But now you have to think, am I in a state that has passed a bill? Is this a medication that the manufacturer has restricted? Do I need to submit this claim, these claims to the manufacturers for visibility in order to get pricing back? So you kind of really need to take all these moving parts and kind of make them
put on hold just for like a couple hours you can get your your stuff done and then wait for the next email to come in saying that another restriction came in or you know, another bill got passed. It was a little bit more steady, whereas now I feel like I'm on like a freight train just trying to like see what's happening outside but it's going a hundred miles an hour.
David Glendinning (11:24)
Really like freight train analogy. That's very very evocative. I understand your team has grown quite a bit over the past few years. Talk a little bit about that growth and what does that say about where three forty B programs at hospitals in general are are headed these days.
Kayla Ciampi (11:42)
When I first started at Dartmouth Health back in 2021, there was five of us total. And we were we also had our flagship, our dish, but at the time it was an RRC. And we also only had two critical access hospitals and then the Rhine Right and the HTC programs. So we had less hospitals, less people, but now with
the seven hospitals, the grantees and having we have grown to a team of thirteen now. And so each of us is able kind of to be able to specialize in an area. We each have hospitals that we manage and so we're able to really deep dive into those specific programs because we don't have to look at all seven hospitals. We can focus on one hospital. We can go through everything in the program and then make sure
that we're compliant, make sure that we get missed opportunities. Because again, with all these restrictions, we're like, how can we maintain these relied savings so that we can continue to provide care to the community?
David Glendinning (12:56)
And over the time since you started at Dartmouth, you've moved from being an analyst to a senior analyst, which is what your current current title is. How along the way has your job changed going from analyst to senior analyst?
Kayla Ciampi (13:12)
That has changed because when I was an analyst I focused more on auditing and the compliance and making sure everything, you know, lines up. And if there was an issue that came up, we would bring it up to our managers and making sure that we can handle the problem the correct way. And so now as a senior, I am the person that is going to
find the the solution to the problem that you bring to me. And I also focus more on like program expansion, missed opportunities, and just making sure that we stay hearsa ready. So, you know, checking all those boxes, especially when you're looking on OPACE, you really want to make sure that everything is correct because that is where a lot of people get findings.
David Glendinning (14:06)
Sure, you want to make sure you have those clean audits that everything is is built in suspenders and all in the right place. In terms of your day to day work, can you give us a sense of the kinds of problems your team is solving?
Kayla Ciampi (14:21)
We
like to make sure that when we're pulling our information out of our TPAs that when a claim is captured, that it's captured for the right reason. So, you know, if a a claim gets brought to us and it's captured because it's an orphan and it's not supposed to be, or the it's a Medicaid and we're carve out. So we then take that information and we then go to the TPA and we're like
Hey, why is this coming through? So then we we work with the TPAs and make sure that if something is not in place, that it is in place to make sure that claims don't get qualified when they shouldn't be. Especially if like you're not able to audit a hundred percent and catch all those claims, those could sneak through and then you would never catch it, you would never know and it's not actually eligible.
David Glendinning (15:12)
certainly so much to keep track of and make sure is compliant. For other pharmacy techs out there who are curious about moving into the 340B world as you have, what skills do you think matter most for those techs?
Kayla Ciampi (15:30)
I would say for sure attention to detail because which obviously being a tech, you're always super attentive to detail. You you need to make sure you feel the right med, enter in the prescription correctly. I would say you really want to like keep learning, right? Because three forty B is not stagnant. Everything is changing. It's changing hour to hour at this point.
So you really gotta be open to change and being able to adapt in new situations. A good, really good is being able to collaborate with team members because 340B is complicated. You're gonna have questions, you're not gonna know anything on day one, day a thousand, day five thousand. And I would say getting comfortable working in Excel because everything is done in Excel. And the more that you are comfortable with it,
the more that you are going to be able to, you know, get an analysis that you need to do and you're like, instead of being, what do I need to do? I need help. I need to find somebody, you can you're gonna get it and you're gonna be like, I know exactly what to do because I know how to work Excel.
David Glendinning (16:40)
That's great advice. After you spoke with fellow pharmacy techs at this conference, what's what's the biggest message from your presentation that you hope they took away?
Kayla Ciampi (16:52)
I hope that they took away that being in 340B is very rewarding. I love sitting making spreadsheets pretty and making data pretty and the community in the three forty B world is just different because nobody knows about three forty B. So when you find somebody that you're able to talk freely about it with, it's so great and you're able to make I would say deeper connections with people because not to say we're trauma bonded, but we're trauma bonded, you know?
But it's so rewarding when you you come across an issue and you're you're like, I don't know what to do with this and you spend hours and then when you finally find that solution, it's like you just won the jackpot. You you're so excited, you wanna tell the whole world. So it the work is complicated, but once you get it done it and y it just feels so good. It's so satisfying.
David Glendinning (17:48)
Well, Kayla, whether it's day one or day one thousand, we're all sort of learning three forty B along with you, so keep it up and keep keep sharing your story. We're we're happy to help you help you tell it.
Kayla Ciampi (18:01)
So thank you so much.
David Glendinning (18:05)
Our thanks again to Kayla Ciampi for sharing her 340B journey and her perspective on the growing role of pharmacy technicians. As Kayla discussed, succeeding in 340B requires attention to detail, adaptability, collaboration, and a willingness to keep learning as the program continues to change. And for pharmacy techs looking for a new career path, 340B can offer opportunities to put those skills to work in new and rewarding ways.
We will be back in a few weeks with our next episode. In the meantime, as always, thanks for listening and be well.
Narration (18:45)
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 at 340B Health and submit a question or idea to the show by emailing us at podcast at 340bhealth.org.