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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 (00:13):
Hello from Washington, D.C. 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 Dr. Tony Jackson with Scripps Health based in San Diego. Tony is a pharmacist who has been working for health systems for more than three decades. He also is a leader in the pursuit of greater health equity for patients and better black representation in the pharmacy field. So we wanted to hear from him on how he sees 340B fitting into that equity issue. But first, let's take a minute to cover some of the latest news about 340B.
(01:02)
Recently, a group of US senators wrote to the Health and Human Services secretary about the issue of drug makers attempting to implement 340B rebates in place of discounts. The letter effort was led by Peter Welch, a Democrat from Vermont. In the letter, the senators thanked federal health officials for blocking Johnson & Johnson's recent attempt to impose a 340B rebate scheme, and they express ongoing concerns that drug companies still may try to put in place similar rebates.
(01:35)
The senators urged HHS to continue blocking any such attempts. The letter states quote, "The legislative intent of 340B was to prevent companies from implementing a rebate model like J&J attempted. We agree that the statute is clear on that point," end quote. You can visit the show notes to read the full letter.
(02:07)
And now for our feature interview with Tony Jackson. Tony has many responsibilities as the Chief Pharmacy officer at Scripps Health, but he also spends significant amounts of his time advocating for 340B and working on health equity issues. We sat down with him to learn more about the connection between the two. Here's our conversation. I'm here with Dr. Tony Jackson, who is the Assistant Vice President for Pharmacy Services at Scripps Health. Tony, thank you for being here and welcome to 340B Insight.
Dr. Tony Jackson (02:39):
Thank you, David.
David Glendinning (02:41):
We typically start out by asking our guests to describe their health system and the 340B hospital where they are based. Please tell us a little bit about Scripps Health and Scripps Mercy Hospital?
Dr. Tony Jackson (02:54):
Scripps Health is a regional health system located in San Diego, formed about a hundred years ago. We actually are celebrating our hundredth year anniversary this year. Four acute hospitals on five campus. That's because our 340B hospital, Mercy, actually has two campuses and more than 30 outpatient centers. We have about 3000 physician providing care across the region, and we also have about 1500 employees that are actively involved in delivering healthcare here in San Diego.
(03:29)
We have served about 600,000 patients in the San Diego County in the past year. And Scripps Mercy, our hospital that is 340B qualified was actually founded in 1890 by the Sisters of Mercy. They were the first and only Catholic hospital in San Diego. And they serve the downtown area where we have a really large underserved indigent population. That campus was expanded to also serve the South Bay, which is really close to the border of Mexico. So you can imagine we get a lot of mixed population, black and brown in that community that are underserved, and that is the real impetus for us moving to the South Bay and expanding our coverage.
David Glendinning (04:15):
The 340B community is definitely out in force in your backyard once a year when we come out to San Diego for the 340B Coalition Winter Conference. You spoke a little bit about the patient population and their needs, so go into more detail if you could. How would you describe the community you serve and the health challenges you see?
Dr. Tony Jackson (04:35):
About three-quarters of our patient population are underserved, are on government subsidy. And with a large black and brown population in the South Bay and downtown, they are a part of that primary core community that we spend our time supporting, extending care to and making sure that they have access in terms of overall healthcare. Now, Scripps Health provided about 768 million in community benefit service last year, and about 60% of that was in just that community in downtown and South Bay.
(05:12)
Because that area really has a large homeless population along with those who are at the margins in terms of being able to live here in San Diego. Scripps Mercy has a dish percentage of about 36%. If you understand this proportion and share of underserved areas, that's a pretty high percentage of patients that are coming in that really don't have the means to really access healthcare. We serve a large percentage of individuals that, as I said, from Chula Vista, which is in the South Bay all the way down to the border.
(05:50)
Just to give you a sense of the population and what we do, we have served at least 500 people just in the last month that are right at the border who have absolutely no healthcare, can't speak English, and they wind up in our Chula Vista hospital. In terms of our homeless population downtown, one of the things we really involve ourselves in is trying to keep them from using our ED as their primary care. We really have to try to work through our partners in the community who are accessing those individuals to help them try to have some sense of healthcare, chronic care, and be able to take care of themselves from a health perspective.
David Glendinning (06:36):
Clearly a patient population that needs your health system, and that relies on that safety net you described. What are some of the ways that Scripps Mercy uses its 340B savings to care for those patients?
Dr. Tony Jackson (06:50):
Both of our EDs are over extended on a regular basis. We're the largest serving ED in terms of patient population in the downtown South Bay area. We also have to be able to provide specialty care in those EDs such as you show up, you got to break in your bone, we need to have a orthopedic available for your service. You show up, you have GI problem, and now all of a sudden you need a GI specialist to serve you.
(07:17)
Well, our 340B dollars allow us to make sure that they have access to that in those underserved areas. Another area is that we serve a large Medi-Cal population. Well, Medi-Cal has a tremendous shortfall, as my CEO likes to make sure that people understand is that we as a hospital system have not had any increases from Medi-Cal in over 15 years. It's only through those 340B savings can we offer that care.
(07:50)
Now, we also do direct care with those funds. Direct care, meaning that in the South Bay, most patients that are discharged from my hospital, they receive medications on discharge. And if they can't pay for them, that doesn't mean they don't get their medications. Now, in our downtown areas, we go a step farther.
(08:11)
We partner with a number of organizations that have outreach to the homeless population. And if they can keep track of those individual, we not only provide medication at discharge, but we also provide chronic medications on a monthly basis.
(08:28)
At some shelters where they might have long stay, we actually provide it on a weekly basis because it is a better way for the shelters to keep these patients medicated for their chronic conditions. These are just ways that we try to reach out to the community. And if we did not have access to the 340B and the savings that they bring to us, we would not be able to do that type of work.
David Glendinning (08:53):
We're here today primarily to speak about the issue of healthcare equity and care for some of the underserved populations that you're speaking of, some of the broader work you do in that area. But I'd like to stick with Scripps for the time being, so how does 340B play into the pursuit of health equity at your health system?
Dr. Tony Jackson (09:14):
Well, for us, 340B is all about health equity. Many of the population in our area have to access healthcare either through FQHCs or through outreach programs, and for providers that are willing to take underserved individuals. How do we support that? We partner with the FQHCs. We are the primary hospital for three FQHCs here in the San Diego area for primarily downtown. We actually have one right across the street from our campus, which we provide medical residents.
(09:54)
We provide behavioral health support for them. In the South Bay, we have two large FQHCs who we partner with, again, serving as their primary hospital. We utilize our internal hospitals so that they don't have to hire a hospitalist to take care of those patients when they come in. Those FQHCs in turn are out there in the community providing that chronic care, maternal child health, breast cancer screening, diabetes management, hypertension and cardiac screenings and management.
(10:30)
All of that is done through both our organization and their organization being able to access 340B funds. We also serve as their 340B pharmacy. And this has become a real issue with some of the changes that people are talking about with the 340B program. The manufacturers are really trying to change the game, which will negatively affect not only at our hospital, but these critical access organizations in the community. If you take these out of their community, where they're going to go? They're going to become a healthcare desert. So it's our job to make sure that that doesn't happen.
David Glendinning (11:08):
Speak about that a little bit more if you could. You mentioned the restrictions. If 340B were to go away or face some of the more major restrictions that are being contemplated, what would that mean for Scripps Mercy? What is the most at risk?
Dr. Tony Jackson (11:23):
For Scripps Mercy, if that went away, we would not be able to support the ED in the manner that we do today. That's probably the number one issue. The second piece is that we would not be able to provide any type of chronic care outreach that we spoke of before in the homeless population. A third piece is that we wouldn't be able to support the FQHCs, which are out in the community providing care for those underserved communities.
(11:52)
There are also things like cancer screening. Breast cancer is very high among the underserved. The other one is GI cancer. People don't realize GI cancer is on the rise in young people and young people in these black and brown and underserved communities is three times that of those with financial means. So it is important that we continue to screen in those areas in order to identify early so that those individuals have access to that kind of care. So that's just some of the programs that would be done.
Monica Forero (12:31):
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.
(12:46)
We are currently seeking your stories to showcase in our annual health equity report. Please email podcasts@340Bhealth.org if you're interested in helping us spread the good word about your hospital or health systems 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 (13:13):
We first connected with you over your work with an organization known as the Association of Black Health System Pharmacists or ABHP for short. Please explain how this association came into being?
Dr. Tony Jackson (13:28):
Well, it was founded in 1978 to facilitate communication among black pharmacists and it really started its essence was around partnering with ASHP, the Association of Health System Pharmacists and the Black Colleges of Pharmacists, both primarily located at our historically black universities.
(13:50)
So the kind of work we do today, the Association of Health System Pharmacists and the Association of Black Health System Pharmacists partner to promote healthcare equity in black and brown communities, encourage and grow black and brown participation in the pharmacy [inaudible 00:14:07] profession and to promote the benefits and success of the pharmacy schools at our historically black universities. Our job as black pharmacists is to reach it to those communities and make sure that those communities are represented in the profession.
David Glendinning (14:25):
I will also note the mention in your bio of being a proud graduate of Florida A&M University, one of those historically black universities. So I suppose you're encouraging more of those students to follow in your footsteps. Why is it important to have better black representation in the hospital pharmacy field?
Dr. Tony Jackson (14:46):
The practice of hospital pharmacy has grown and we have more pharmacists involved in direct face-to-face care with our patients. Many of our black and brown population have greater trust of pharmacists and see them as someone that they can open up to, be more genuine about their concerns and their challenges.
(15:12)
Black and brown pharmacists are more often coming from the underserved communities and have a direct connection that allows them to better understand, interpret, and empathize with the challenges of this population. Therefore, we can do a better job to support, encourage, and serve these patients' needs.
David Glendinning (15:32):
Tell us about the 340B Opinion piece, the op-ed you co-wrote last year with several other leaders from ABHP?
Dr. Tony Jackson (15:43):
Wrote this piece in conjunction with Dr. Ken Schell, a board advisory member and Dr. Clark, our past president at ABHP. The article was published in the Los Angeles Sentinel, a black-owned operated newspaper, and we really wanted to raise awareness about the impact of changes to the 340B will have on the underserved community.
(16:07)
Cutting or altering these 340B program is a major push of manufacturers who see this as a means to augment their profits and they are risking the survival of these hospital and their ability to effectively serve these black and brown communities. I spoke earlier that we are the primary provider pharmacy for the FQHC.
(16:29)
What happens when we lose funding for their program? Primary care doesn't go on in the community, screening like breast cancer doesn't go on, GI cancer screening doesn't go on, diabetes care doesn't go on. You can see how this would severely impact this. All of this scales down because they don't have the funding they need to provide the care.
David Glendinning (16:53):
We very much appreciated being able to promote that Opinion piece here at 340B Health and bring such an important viewpoint to the Pro 340B debate. This type of advocacy is very influential when it comes to educating policymakers. What other ways have you advocated for 340B?
Dr. Tony Jackson (17:12):
Last year, I met with our Congressman Peters. Sitting down with him, we showed him by the numbers what this program, the 340B program means to our organization. We showed him without 340B, here's programs that may be lost to the community. It's the way that we support the organization, Mercy and the FQHCs, and how that reaches out into community and makes sure that they have access to equitable care, access to specialists, access to screening, access to medications.
(17:52)
The manufacturers really wanted to say, "Oh, you're supposed to be giving that to the patient." The program was never designed that way. The program was designed to create resources for these underserved providers so that they can make the right decision to serve the community in the right way. So it is very important that we continue to advocate for this.
(18:19)
Other ways that we advocate for the 340B program is by partnering with other organizations such as ASHP, NMA, National Medical Association, the American Pharmacists Association, and others to educate our legislators not only about the purpose and the meaning of their predecessors when they started the program, but also the impact that this program is having in their individual congressional areas.
(18:53)
We also go to talk to our members at the state level. I met with our local district, our representative for California. I spoke with her. I showed her our program and she said, "Well, that's a national program." I said, "Yes, but you sit with the senator, you talk to them. They listen to you. You are their constituent as much as I am." And I said, "If you can influence them, talk to them.
(19:24)
Let them know what's happening in our district if they don't support this program. That's an important piece." I'll give you a last example. We actually were working with the California Hospital Association and on one of their town hall meetings with legislators, we were able to really talk about three patients. I had three patients. I had my clinician, my pharmacist, frontline people talking about how we care for those patients, what their course of therapy was.
(20:00)
We did that only because we had 340B funding. This young lady had a tumor at the base of her skull. We were able to remove that tumor surgically. We then put her on chemotherapy and we then gave her her follow-up care, all of this at the cost of the system. The only reason we were able to do that was 340B.
(20:26)
So advocacy at the grassroots level, advocacy through organizational partnership, advocacy through local partnership is key to us ensuring that these safety net hospitals and FQHC organizations remain in our underserved community, particularly our black and brown communities, and making sure that they have access to affordable equitable healthcare.
David Glendinning (20:59):
Tony, we appreciate that work you do in helping promote the value of 340B, being able to connect it to that crucial issue of pursuing healthcare equity. Thank you so much for being here today.
Dr. Tony Jackson (21:12):
Really appreciate it. Thank you so much for allowing me this platform to advocate for our patients, for those who really need and deserve equitable healthcare.
David Glendinning (21:25):
Our thanks again to Tony Jackson and all the leaders of the Association of Black Health System Pharmacists who have spoken out on the importance of 340B to ensuring all patients receive the care they need. 340B Health invites you to share your own health equity initiatives for our upcoming report. You can read our most recent case studies in the show notes and email us at podcast@340Bhealth.org so we can help you tell your story. We will be back in a few weeks with our next episode. In the meantime, as always, thanks for listening and be well.
Speaker 1 (22:04):
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@340Bhealth.org.
Speaker 5 (22:26):
Voxtopica.