Subscribe
Share
Share
Embed
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, D.C., 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 Sherstin Willyerd Director of Pharmacy at Montgomery County Memorial Hospital in Red Oak, Iowa. We met up with Sherstin at the most recent 340B Coalition Summer Conference in Washington, D.C., where we interviewed several attendees who were also conference presenters.
She appeared at a rural roundtable where she discussed how her hospital launched its own in-house retail pharmacy and paired it with a prescription drug insurance plan for patients with low incomes and hospital employees. But before we get to that interview, let's do a quick recap of some of the latest news about 340B.
Covered entity purchases of drugs through 340B reached $100 billion in 2025, an increase of $18.6 billion over the 2024 total. That's according to recently released data from the Health Resources and Services Administration. It is important to note that this figure includes total purchases, which is the amount that drug companies received for selling their products through 340B accounts. The figures do not represent the amount of 340B savings.
That covered entities receive for purchasing those drugs at a discount. As Hearsa noted in its release, trends impacting the broader healthcare market are reflected in the 340B purchase growth. These include a continued shift toward outpatient care and increased use of expensive specialty drugs. 340B Health members can learn more about the new spending figures and the details behind the numbers by visiting the show notes.
And now for our feature interview with Sherstin Willyerd with Montgomery County Memorial Hospital. Many 340B hospitals have made the move to open their own retail pharmacies to serve their patients. But how exactly does a hospital do that? And what are some of the issues to consider before making such a move? We sat down with her to learn more. Here's that conversation. I am speaking with Sherstin Willyerd, who is
⁓ Director of Pharmacy at Montgomery County Memorial Hospital. We are here at the three forty B Coalition Summer Conference. Sherston, welcome to three forty B Inside. Thank you for being here.
Sherstin Willyerd (02:50)
Yeah, thank you. Thanks for having me.
David Glendinning (02:52)
And we are getting you sort of right on the tail of ⁓ your presentation at the rural round table here at the conference. Yes. where you spoke about a very particular topic that we will get into. First, please, ⁓ tell us a little bit about Montgomery County Memorial Hospital and the community you serve there.
Sherstin Willyerd (03:11)
We're a critical access hospital in Southwest Iowa, about an hour away from Omaha. And we have five rural health clinics and a retail pharmacy ⁓ entity owned. So we're under twenty five beds hospital. But we serve a pretty broad area land wise. About if you think about a thirty mile radius all around us is about the size we serve. So a good good bit of people.
David Glendinning (03:38)
And your presentation at the round table focused on something that sure is of interest to rural hospitals, but I would imagine any three forty B hospital at this point, which was starting and operating your own retail pharmacy. So what led ⁓ your hospital to make that transition?
Sherstin Willyerd (03:58)
We were kind of a lot lower in our three forty B savings overall. ⁓ and we noticed one of those differences was really coming from that retail side. Contract pharmacies not really giving us good enough contracts ⁓ to see that benefit. And those manufacturer exclusions really coming into play. So we ended up looking into ⁓ starting our own and we just happened to get pretty lucky.
Timing wise, we had a couple of independent pharmacies that were nearing retirement. ⁓ their owners were nearing retirement, so we ended up buying both of them out and ⁓ making our own retail pharmacy as a result in one of the locations.
David Glendinning (04:39)
Wow, that was great timing. So these were ⁓ brick and mortar, independently owned sort of mom and pop pharmacies that you ended up buying.
Sherstin Willyerd (04:46)
Yep, one was attached, ⁓ actually working in the hospital. Another was was off site, but really close by, like within a couple blocks. ⁓ and that one has the drive-thru and is a little bit bigger footprint. So we had to go with that one because combining the two as you can imagine, with both of them together it's a much bigger volume than one of them alone. So we just did the best we could to be able to put that in a location that was that was would support that volume. But we're
outgrowing that really fast.
David Glendinning (05:18)
So h how has having your own retail pharmacy after you made these purchases and and opened up the the in house retail, how has that changed what you're able to do for your patients in the community?
Sherstin Willyerd (05:31)
Well, it has given us much better access into really seeing where patients are having struggles. From the clinic perspective, when when they notice that patients are having financial struggles with their medications and just unable to afford their medications, then we are able to a little bit more quickly say, Hey, why don't you talk with our pharmacy about options for financial assistance or things that we could be doing to help you with adherence or just other elements.
That people struggle with. People struggle daily with I don't know how to get through the PA process. I don't know how to get through these little things that we take advantage of in healthcare all the time. Like we know how to get through that stuff. We've we do it every day. But our patients don't necessarily. So it really helps to kind of get that communication a little bit more key in between retail and our clinics and our hospital side as well. We've had multiple referrals coming from our inpatient side where
We had a patient struggling with compliance on their medications, end up in the hospital because of, you know, side effects related to that. And our hospital pharmacist able to say, Hey, you know, this person really needs help med packing and refer them over to us as a result. So that's been really good for our community as a whole.
David Glendinning (06:49)
And when I was speaking with you earlier about this, one of the things that struck me, one of the most sort of innovative aspects to me of your pharmacy program is what I believe you call the Care RX Health Plan. So maybe you could explain a little bit about how that works.
Sherstin Willyerd (07:05)
Yeah, so we partnered with our our pharmacy management system as well as our PBM and we ended up making our own insurance plan. So there's a primary side and a secondary side of that plan, just depending on what the patient really needs. So there are many folks out there who their copay is just way too high for example, I'll use ⁓ the anticoagulants. We'd love to get everybody on a doac if we can.
Those direct oral anticoagulants though are really expensive, depending on the plan. So they often need some financial help for that. So we've been able to basically use the secondary plan for some of those patients in order to basically bring their copay down, but with a a real insurance. So it's supplementing their primary, just like you would any other supplementary insurance. So we have a full-fledged plan with a PVM.
it has copies and a formulary and all the things that you would expect. It has an application. If we see somebody who's really in need, we'll have them fill out their application, ⁓ make sure that they qualify for the plan. And then if everything qualifies and there they are three forty B claims going through, then we can bring down some of that cost for them and help pass on some of that direct three forty B savings to the patient. So
That really has been very, very helpful for our population, especially who's really ne in need of that. So our application process for the Care RX plan ⁓ includes that financial qualifiers. And so we actually pushed it up to 500% of the poverty line, trying to capture a good bit of our population. One of our other qualifiers is or options is to be an employee of the hospital. Because you can imagine for us as an employee, it's also very helpful.
⁓ we wanna retain as many of our employees as possible, so that's part of that effort.
David Glendinning (09:07)
I'm sensing this theme here through the, you know, both the in house retail pharmacy and this ⁓ health plan, the theme of affordability. So what kind of impact have you seen since you put both of these into place?
Sherstin Willyerd (09:20)
There's some patients who have saved like five hundred dollars a month, ⁓ which is huge. I mean, if you're especially on if you're on a really tight budget, fixed income. So, that's certainly not the case for everybody, but especially these ones where their formulary was very specific or very tight, but we know through their clinical status this drug was was gonna be very important for them and way better than some of the other options.
It's helping them to kind of get out of some of those being put in a corner by your insurance. So helping them to f be able to afford some of those higher tier products ⁓ that they may have really needed, just not been able to be within their reach before. So that I think has been really, really good for our patients. We've definitely seen ⁓ increased use of our pharmacy for that reason as well.
David Glendinning (10:12)
And affordability for the patients is very important, of course, but programs like this also have to be financially sustainable, affordable for the hospital to provide. What lessons have you learned from this process about balancing that assistance to the patient with the hospital's ability to keep offering it?
Sherstin Willyerd (10:32)
So that's something that we've actually been having to reevaluate on a constant basis. So we've had to look at there's new drugs and new payment plans, new reimbursement schemes that all these manufacturers are trying. ⁓ and particularly now. ⁓ and I use the example with you about ⁓ GLP medications. That reimbursement has been ever changing. So many of the insurances now or
using so many of the manufacturer cards to pay back and they're not always paying the same amount and they just have different agreements with those manufacturers and the insurance company. So what you're getting in reimbursement is is just vastly different depending on your manufacturer. And it's something that I get a call on almost weekly of like, okay, we need to consider our options here and whether we can really sustain this program. So we definitely make adjustments on the fly
in talking with our P VM and in talking with, you know, our our partners in this process of how do we deal with these challenges as they come. We kinda evaluate probably on a quarterly basis more regularly, but ⁓ some of these things have been coming pretty fast. So the ones that are coming quickly, we've been, you know, reviewing week to week and one of the things that we have built into the system is it'll automatically flag us if if we're gonna lose money on this situation. It'll
automatically stop that claim and say, okay, what do you want to do as a result? And we have the ability to override some of those. If with we have extenuating circumstances, we certainly consider that on a patient by patient basis. But you do have to consider that financial stability for sure. ⁓ and it and it sometimes is a drug by drug basis.
David Glendinning (12:13)
How does all of this appear ⁓ from the patient perspective? So how would a typical patient get connected with both the pharmacy that you have and this Care Rx program?
Sherstin Willyerd (12:23)
So we always tell to come and talk to us, have a conversation, give us a call. You know, we'd like to look at both what medications you're getting and what insurance you have, what providers you're seeing, talk to them about the whole system and get a really full picture of where they're at clinically and where they're at financially to see what we can really offer them. We like to have them come in and have a full conversation with us before we get signed up for for everything. In part
That's so that we can make sure they get the right services. You know, maybe they are someone who really does qualify for those bubble packs and and really needs that. You know, we want to have that conversation up front so that we understand. You know, maybe they are somebody who really needs help with one drug in particular and the rest of them aren't as big of a deal. We always tell them to just give us a call or come by the pharmacy, talk with us. We're always willing to have that conversation, even last minute or, you know, unscheduled.
We do get provider referrals for CareX or for ⁓ financial assistance. Usually how that works is the the clinic will be talking with a patient in a normal doctor's appointment and s and patient will say, Well, I haven't been able to pick up this medication because it's just too expensive and they'll ask, Well, where have we been trying to get it from? Like, talk to me more about this. And when patients are struggling and they haven't been using our pharmacy
They will usually refer him our way and just say, Hey, see what our pharmacy can do for you because they could probably help you through this situation.
David Glendinning (13:53)
I can see other hospitals, perhaps even some of the attendees of your round table thinking about pursuing similar models here. ⁓ what would you say for them are gonna be some of the biggest operational or compliance considerations before doing something like that?
Sherstin Willyerd (14:09)
We always need to look at, you know, a strong legal and compliance review. What's the best way to develop this? Look at your insurance rules and ⁓ all the different requirements that that might be needed for that. Talk with your three forty B compliance. Make sure that everything looks lined up for ⁓ you you ensuring real time eligibility is part of that process. So you do need to be with a TPA or a program that can get you that at least as close as possible.
And just getting reliable support on on making sure everything is qualifying at the time that you're not letting things slip through that shouldn't be.
David Glendinning (14:47)
And for hospitals that maybe aren't quite ready to have their own ⁓ insurance plan, or maybe that doesn't necessarily make sense for them, but they are considering just opening their own retail pharmacy to start with, ⁓ what practical advice would you offer to those hospitals based on your experience here?
Sherstin Willyerd (15:03)
Obviously always acquiring is is really nice. It's makes a much ⁓ much smoother transition process, but starting your own or building from scratch is still really worthwhile, especially because you're gonna avoid again the all those manufacturer restrictions, all these real headaches that we face day to day using contract pharmacies. And we still have contract pharmacies. I'm not saying that you have to break all your relationships, but having your own is really beneficial. ⁓ location is a big thing too, keeping them
Within close proximity. And then considering that patient convenience, drive throughs or easy pick up places, you know, what's gonna matter most to your patients and community?
David Glendinning (15:43)
So any closing messages you you would leave with rural hospitals or really three forty B hospitals of any size ⁓ or location about the role an owned retail pharmacy can play in on both the patient care side, strengthening that and for the hospital itself.
Sherstin Willyerd (16:01)
I'd say it really strengthens your impact with post hospital care, post clinical care, you know, making sure your transistors are really strong. It also is going to make a big impact for your community presence, knowing that you're willing to back your community and and provide them with something that you know they're gonna need. Lots of pharmacies are struggling. This is a way to keep a pharmacy up and running using that 340 B savings. So it's a big thing to help ensure that.
You've got pharmacy access in your harium.
David Glendinning (16:33)
Well, Sherson, I appreciate you running through all of this with us. Hopefully, ⁓ for the folks at the round table you've perhaps given them some confidence to proceed on this if they were thinking about it or perhaps inspiring them to do this in the first place. ⁓ and certainly this is a a success story that they can aspire to. So thank you for sharing it with us.
Sherstin Willyerd (16:52)
Thanks for having me.
David Glendinning (16:54)
Our thanks again to Sherstin Willyerd and to all the 340B experts who came to DC to share their best practices with the more than 1400 other attendees at the 340B Coalition Summer Conference. This is the first of several interviews from that event that we'll be sharing in the weeks ahead. So if you've not already done so, please subscribe to 340B Insight so you can hear them all as soon as they come out. And do you have colleagues or friends in the 340B world who don't know about the podcast yet? If so,
please share the details with them so they can subscribe too. We will be back in a few weeks with our next episode. In the meantime, as always, thanks for listening and be well.
Narration (17:36)
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.