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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 (00:03)
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 Glenn-Dinning with 340B Health. Our guest for this episode is Ben Frederick, one of the leaders of the government relations team at Memorial Health Care, a 340B hospital in Michigan. Like many hospital GR professionals, Ben has been spending more time in recent months advocating on 340B issues and legislation
the state level. We wanted to hear about some of those experiences and advice he has for others who are speaking more about 340b lately at their state houses. But first, let's do a quick recap of some of the latest news about 340b.
Health Resources and Services Administration recently indicated it is considering a broader 340B rebate model than the pilot program that was set to take effect January 1st before being withdrawn. HRSA released an information collection request that says the agency is considering expanding both the list of eligible drug companies and the list of drugs that could be subject to rebates. HRSA also announced a 30-day extension to the comment period
on its related request for information on a potential revival of rebates, giving stakeholders additional time to weigh in. Comment periods for both the ICR and the RFI will be open through late April. 340B Health members can read more about these developments in the show notes.
And now for a feature interview with Ben Frederick from Memorial Health Care. Michigan has been one of the many recent hotspots for state legislative action on 340B, and Ben presented at the recent 340B Coalition Winter Conference on what he has seen lately in that area as an advocate for his hospital. We met up with him to chat more about that subject. Here's that conversation.
David Glendinning (02:22)
I am sitting here with Ben Frederick, who is Associate Vice President of Advocacy and Government Relations at Memorial Health Care. Ben, thank you very much for joining us and welcome to 340B Insight. So we appreciate you coming on, especially since it's the start of happy hour here at the 340B Coalition Winter Conference. So we'll try to get you out to meet some people afterwards and enjoy the networking here. But we are here today to speak about ⁓ state
Ben Frederick (02:35)
Pleasure joining you, David.
David Glendinning (02:51)
legislative advocacy on 340B issues, which is very much in your wheelhouse. But first, before we get started, could you please tell us a little bit about Memorial Health Care and the patients you serve?
Ben Frederick (03:02)
Memorial Health Care is an 105 year old independent hospital centered in Owasso, ⁓ city of less than 15,000 people in the heart of rural mid-Michigan. So right between urban centers of Lansing, Flint and Saginaw. We serve a large geographic region across seven counties, 40 outpatient sites across those seven counties, which tend to also be rural slash suburban, bringing a lot.
of focus on access and the dignity of access to care close to home. So in rural settings, in small town settings, not just primary care, although we do a lot of that, we also are talking about access and providing access to specialty care, the dignity of oncology, of neurology in an area where you live. And as part of our ongoing sustainability as a rural independent, 340B stands out as an absolutely critical tool.
for sustaining our services, sustaining our resiliency and sustainability as an independent hospital.
David Glendinning (04:04)
And with this experience you've been having on the advocacy side, why do you think state policy has become such an important focus for 340-B hospitals like yours in recent years?
Ben Frederick (04:15)
Well, I think the contract pharmacy blocks and restrictions really started to put that in the wheelhouse of state legislative attention because prior to that, obviously seen as a predominantly as it was federally dictated federally directed program. But when you started to see that contract challenge and the blocks that really put it into the wheelhouse of the states and how did each state kind of address that. The attention of this issue from an advocacy perspective too.
really started to shift to kind of like its own snowball because you'd have lobbying efforts, know, the pharma lobbying became pretty intense. The characterizations around the contract side opened up a can of worms about the entire premise of 340B and they had a very steep learning curve on this issue as compared to others. So this legislation is really driving narratives, some of which are accurate, some of which are not. Just the very core premise of 340B and what it represents as a support to safety net hospitals.
providers. And you also are seeing, you know, with 50 states there's different levels of activity, different levels of progress with legislation. So if you have something pass or get that attention, you're seeing model legislation being thought about in other states as well.
David Glendinning (05:27)
I do know that Michigan has seen several 340B related proposals over the past couple of legislative sessions you've had. I know you speak to a lot of those state lawmakers as part of your day job. what are you hearing from them?
Ben Frederick (05:41)
Well think again very much well-meaning in most cases that seeking a general understanding of what is a truly complex program. And there's obviously a broader attention, broader frustration about drug prices and obviously a desire for transparency, accountability, which of course we have no disagreement with but the devil's in the details with those types of things. And so we have to educate what's already being done in the way of transparency and reporting in audits and things of that nature.
And then there's the premise that's been created by Pharma that in some ways is moving away from the true origin of 340B as truly a sustainability tool for covered entities like Memorial Health Care. It really is about keeping our doors open, keeping us providing those critical operations in our community. In many ways, I think that a hospital like Memorial, our community benefit is being present in an area that otherwise would be a true health care desert 25, 30 miles around.
with no birthing services, no inpatient psych services, the entire network of family practice, you know, vulnerable, these types of things that are macro issues, just being articulated that that truly was the intent of 340B. in doing that, in the form of a savings from the pharma manufacturers to the covered entities, taking off tremendous exposure to the federal government and state governments in the form of what would be uncompensated care.
Medicare, Medicaid based exposure. it's getting back to the basics of that. And in effect, you have to kind of draw that argument right back to the basics on what really is a complex federal policy. But those are all things that are contributing to lawmaker interest in this issue.
David Glendinning (07:21)
As we speak, I know there's currently some contract pharmacy protection language in play in the legislature and ⁓ what's being billed as a 340B transparency bill as well, both of which you discussed in your presentation here at the conference. At a high level, what does that legislation aim to do?
Ben Frederick (07:41)
The initial legislation really was about preserving the contract integrity between a contracted entity and a 340B entity, which is in our case, you know, we look at making sure that we have the best possible access to pharmacy services, not only where people live, but also where their prescriptions are being filled. There was also a focus of additional language related to hospital reporting.
which was certainly reasonable as it was modeling what the federal government has prioritized and things that we comply with on the different audits, the different reports, the community benefit is represented through our community health needs assessment process. And as we saw more emphasis or more attempts on some more duplicative or more burdensome transparency reports, we also saw some move toward language that would be specific to pharma manufacturers as well.
And generally we've seen that flexed in. There's still some conversation about additional, know, what do we do or don't do perhaps on additional reporting. We have concerns about what the overall scope may end up being. We have seen some advancement in the legislature on this and we're proceeding in good faith. We're coming to things with solutions while still standing firm on what would really be impediments.
David Glendinning (08:54)
I'd like to drill down a little bit more on that reporting issue that you mentioned from your perspective, the hospital perspective. What are the key things you're watching for when lawmakers are speaking about reporting and transparency?
Ben Frederick (09:08)
Well, we want to first of all not lose what we're already doing because I think it's important to note that we have rigorous reporting, we have compliance, we have audits, and as an independent hospital, rural hospital, we have the staffing to reflect that. ⁓ smaller organization but still has that heavy staff burden and administrative burden. So every time there's something that may add another requirement, that's a further pressure or administrative tension for us that
distracts and deviates from patient care. So we want to make sure that those types of requirements are reasonable. We also want to, as I mentioned earlier, ensure that there's parity. If we have this type of emphasis on reporting and transparency, we think it's quite important to the public that that transparency applies to the drug manufacturers as well as the hospitals. It's also important that we really look at the origins of drug pricing increases and how we really can get to a place of affordability. And I think you really have to explore
different parts of the healthcare ecosystem. And just frankly to me, I think those areas that are most profitable probably have some additional scrutiny that should be coming their way in what is really a quasi-public-private system. So there's some things that really need to be looked at that I think you could get at with some of this.
David Glendinning (10:20)
I know there has been some discussion during the current legislative session about some provisions that might go a bit beyond 340B reporting and actually impose some limits on how hospitals can use their 340B savings. Can you talk a little bit about that and why that caused some concern among hospitals?
Ben Frederick (10:40)
Again, I think this goes back to the earlier challenge, a true challenge where Pharma has been quite successful at shifting understandings of the premise of 340B, which even in the congressional intent language spoke to, you know, acknowledgement of the exposure, the upcoming exposure at the time, decades ago, for Medicare and Medicaid as unsustainable. And that to limit and help with that exposure for the federal government, there was going to be this revision from the Pharma manufacturer, profitable, highly profitable side of the ecosystem.
to your vulnerable covered entities, like in our case, a disproportionate share of Medicaid, Medicare hospital, your pediatric hospital, cancer hospitals, high-level urban indigent hospitals, and so on. And that was really about our sustainability, our operational sustainability to provide services. Memorial has a number of things we do from a charity care perspective, from a supports perspective, but a lot of it also was simply about our ongoing resiliency as a fragile institution.
that is living in that less than 1 % to 3 % margin if we're having a good year and many are negative and have been negative. And that is where I think the premise has been challenged and what's so concerning about those types of proposals where we start constricting how those quote savings are being utilized when truly that was not the intent. The flexibility is absolutely necessary for hospitals to.
maintain because each hospital is going to have a different landscape, a different need, different populations to serve.
David Glendinning (12:08)
That's certainly a theme we're hearing from many different types of 340b hospitals and health systems that if you're guardrails, so to speak, on how they can be using those savings, that really shuts off some areas in which they are reinvesting in patient care. In your presentation, I know that you talked a good amount about rural hospitals and cancer providers being the face, as you say, of 340b advocacy in Michigan. Why do you find that that
approach, putting them out there as the face resonates with lawmakers.
Ben Frederick (12:39)
Well I think at the end of the day in anything with advocacy, government relations, we're storytellers and we should be storytellers first. And 340B is particularly vulnerable to complexity. when it comes right down to it, the motivation oftentimes is just simply dollars and cents. And we've seen that happen in this argument ⁓ over and over again. I think you have to make the 340B impact tangible. You have to make it local and approachable. You have to also demonstrate, you what problem is this really helping to solve?
And that means highlighting access to care in areas that are more challenged like rural areas or the provision of a pediatric cancer hospital in an area as an example. You also are in building the value in tangible programs and stories, you're showing what could be lost, what patients could tangibly lose in areas that are already challenging from a operational sustainability perspective. And that's really the heart of 340B is it's about how that filters into the community side of things.
And again, I say yes on the community side that may be tangible programs, but also not losing sight of the fact that being supportive of a resilient community hospital is in itself a tremendous boon to a community just for health, for wellness, for employment sustainability, for economic activities, so many other areas. And those are the stories that are out there that need to be said. And it also in being more assertive, we're also helping to.
counter those misleading narratives as well.
David Glendinning (14:09)
When thinking about the human side of things as you put it, I know you've shared a very personal story about your father to help illustrate why 340B is so important to hospitals like yours and to patients they serve. Why have you made that story so central to your advocacy?
Ben Frederick (14:27)
Well, I think that, as I mentioned in my presentation, we should all know our why of 340B, and it shouldn't be an operational answer. And my why is my father's access to dignity and local palliative, unfortunately in his case, cancer treatment. My father was ⁓ in a situation where, like many dads in a low-income situation, blue collar, health care was a nice to have that was for his wife and for us, his kids first.
didn't really have a medical relationship, medical home. In fact, his first time in the hospital that I can recall, unfortunately, was his intervention emergency surgery for what we discovered was a terminal cancer situation, unfortunately. And as we went through that process and he went through the initial surgery and then we entered that physical therapy space as he's also starting to get ready for palliative chemo. And then moving into, unfortunately, the hospice care.
The fact is we really had this blessing of local access that would not have been there even 20 years ago, but for in part the access to the 340B sustainability component for Memorial to make strategic investments in world-class cancer care in that hometown. And what sticks out to me in particular was the slow release cancer treatments he would have where you'd have that pack installed on a Friday.
And then he'd come back a couple days later, let's say, and it's had that slow release. So he's getting that drug that's causing, it's not curative, but it has a challenge, of course, physically. He's coming in, drained to that appointment, 40 some hours later. It's a five minute process. he does that and he goes home. Well, because of what had happened with 340B, that was a five minute drive to and from. And before, it would have been 45 minutes one way. And he was in...
he was really in bad shape, particularly on the way back from that trip. So I think about that when I think about the dignity of local access. And that really is the my why of 340B and meant to encourage, because I know that so many of our team members hearing this, they have those stories themselves or they know somebody. These are the things to humanize and make a part of your advocacy efforts to really explain the why of why it's so important to maintain it. It also helps your audience, whether a lawmaker,
or just somebody that's seeing the messaging to really connect the issue from an emotional standpoint. We need to tell more stories about the true impact of care in that way.
David Glendinning (16:59)
Well, Ben, thank you for sharing that story. My condolences on your father. I'm glad he was able to find that access to some of that palliative care and that comfort and dignity, as you mentioned at the end. Based on your experience, what advocacy strategies have you found to be the most effective when hospitals are engaging lawmakers on 340 issues?
Ben Frederick (17:09)
Thank you.
David Glendinning (17:20)
Be a
Ben Frederick (17:21)
There's a few things I think where we can be constructive and find areas of agreement first before just coming and talking about the harms and challenges we need to do that. As I mentioned before there is a shared premise on affordability certainly on a desire for access. There is a shared focus on transparency understanding that there's going to be different definitions of that depending on the audience of course and the levels and the details on some of those things. But we need to find those areas where we can be constructive and engagement offer good solutions.
The second area I think is when you do that direct engagement, you need to have the combination of the technical expertise alongside the patient stories. And you need to have your local leadership and clinicians a part of that conversation as much as possible. The legislator in particular is going to have that first question of who's from my district? And there needs to be that connection with that community level, whether it's a multi-hospital system that that local hospital that's in that particular district.
making sure that relationship is there, that it's strong, and that is a component of that meeting. And we also need to be clear in what our ask is, ⁓ focused in our argumentation, and effective in how we connect emotionally, but also on the true policy side of this issue.
David Glendinning (18:37)
Well, you're a pro at this now, Ben, but for hospital leaders who may be a little bit newer to the state level 340B advocacy world, what advice would you give for those just getting started out?
Ben Frederick (18:48)
think the first is what was already stated, which is know your organization's why for 340B. Those stories are there. 340B Health encourages impact profiles. If the organization has not done one of those, those are absolutely wonderful to crystallize their leave behinds. Federal, memorials use those. ⁓ Local, federal, and state meetings to really speak to what impact we're having as an organization. Also, being engaged with your state hospital association.
is particularly key. We have a tremendous organization in Michigan, 100 % membership represented in Michigan, and the coordination and the unity created by that relationship is just tremendous. And 340B Health from a national perspective really has been tremendous as well, just with the thought leadership, with the access to resources, the ability to really pivot and lean in on particular issues and questions. I also recommend the opportunities at 340B.
health offers for the engagement on Capitol Hill, the annual fly-ins, have done those a few times. Those have been tremendously effective in really making that impression, telling those stories with our local lawmakers. A few other things really don't wait until the last minute. If there's a talk of legislation, these things can move quickly. And it's important to have those engagements early.
Even perhaps if you have a conversation with a legislator that is sympathetic to the issue, perhaps they're the ones putting in legislation instead of responding to another doing so. But being engaged early is tremendously important and having that again, that connectivity to the state. Other things, the state association will help to kind of get those early drafts, get access to that language, provide specific feedback, which is always invited by those that are doing advocacy on your behalf. The other thing is to really focus on the impacts to patients and the current harm being done.
In Michigan, each day that goes by, that contract pharmacy situation remains suppressed, remains broken, remains ⁓ in a vulnerable state where the remainder of it is happening. And that's having a direct impact on patient care and on relationships with ⁓ pharmacies in our own communities and so on. So those things are immediate needs that need to be represented rather than these theoretical things that could happen. And then...
Just a ⁓ final thought that, again, the storytelling is equally as important as the data. When you're in a policymaker meeting or a lawmaker meeting, oftentimes that time is pretty constricted. And so there certainly needs to be some of those things from an impact perspective. I think that's why the impact profile is such a terrific help there. But the storytelling, the true impact stories are what will leave the impression with that lawmaker.
David Glendinning (21:30)
Well, good advice all. I made our GR team here very happy by mentioning and plugging the ⁓ Impact profile. So thank you for that. thank you for fighting the good fight. Keep it up and we are happy to be partners with you on that.
Ben Frederick (21:37)
Easy to do.
Thank you, David. It's been a pleasure.
David Glendinning (21:47)
Our thanks again to Ben Frederick for bringing his expertise and personal passion to the forefront of his 340B advocacy work. you want to learn more about the 340B impact profiles that Ben mentioned, please visit the show notes to find a link. We will be back in a few weeks with our next episode. In the meantime, as always, thanks for listening and be well.
Narration (22:11)
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 @340BHealth and submit a question or idea to the show by emailing us at podcast@340Bhealth.org.