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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 (00:12):
Hello from Washington, DC and welcome back to 340B Insight, the podcast about the 340B drug pricing program. I'm your host, David Glendenning with 340B Health. Our guest for this episode is Matt Weber, director of Pharmacy Business at Novant Health based in North Carolina. Matt was one of the presenters at the most recent 340B Coalition Conference on the topic of 340B optimization. We wanted to speak with him while he was there to learn more about that popular topic for the 340B community. But before we get to that chat, let's take a minute to cover some of the latest news about 340B.
(00:58):
Mississippi recently became the fourth state to ban drug company restrictions on access to 340B drugs through contract pharmacies. When it takes effect July 1st, the law will stop drug makers from restricting or blocking acquisition or delivery of a 340B drug to a contract pharmacy in the state. It also will impose 340B non-discrimination requirements on pharmacy benefit managers and insurers doing business in the state. Arkansas and Louisiana were the first two states to enact laws protecting 340B contract pharmacy access, and West Virginia recently signed their own protections into law. More than 20 states have considered such legislation this year. You can learn more about Mississippi's law by visiting the show notes.
(01:46):
The Health Resources and Services Administration recently issued a final rule implementing changes to the 340B Administrative Dispute Resolution process or ADR for short. This process is designed to use panels of government officials to adjudicate disagreements between covered entities and drug companies over 340B pricing and compliance issues. 340B Health was among several organizations that submitted comments on an earlier proposed rule on the changes. In the final rule, HRSA adopted several of 340B Health's recommendations. They include clarifying that ADR claims can include accusations that a drugmaker has limited a covered entity's ability to purchase covered drugs at or below the 340B ceiling price. They also leave the door open to ADR consideration of claims that are the same as or similar to claims currently pending in federal courts. Take a look at the show notes to learn more about this final rule.
(02:52):
And now for our feature interview with Matt Weber from Novant Health. We often hear about 340B optimization efforts, but what does that mean exactly? For the answer to that question, we spoke with Matt about what optimization looks like at, one, 340B Health System, and how those experiences might apply to other systems that are contemplating optimization efforts. We spoke with Matt after he shared his insights with the attendees at the most recent 340B Coalition Conference. Here's that conversation.
(03:23):
I'm here with Matt Weber representing Novant Health at the 340B Coalition Winter Conference here in San Diego. Matt, thank you for your time and welcome to 340B Insight.
Matt Webber (03:34):
Thank you so much for having me. It's a pleasure.
David Glendinning (03:36):
Matt, you spoke at this conference about a popular topic in the 340B world lately, and that is 340B optimization. What do we mean when we discuss 340B optimization?
Matt Webber (03:48):
Well, what we mean by 340B optimization, it's about making 340B work best for hospitals and covered entities and the patients that they serve. It's about optimizing the opportunities to stretch scarce federal resources, reaching more patients and providing more care. What it's not about and what it does not mean is doing anything that is non-compliant with the 340B rules. At Novant Health, we take a conservative approach to the 340B program, always erring on the side of compliance. The 340B team partners closely with our compliance team, internal legal counsel, and multiple external counsels to ensure that we are meeting the intent of the 340B program at all times.
David Glendinning (04:30):
Thank you for clarifying what optimization is and is not in this case. Looking at Novant Health specifically, what approach does your health system take to 340B optimization?
Matt Webber (04:42):
The way Novant Health tends to approach is we try to implement multiple strategies to optimize the 340B program. One way is that we try to rethink the concept of a traditional 340B team based in just pharmacists and pharmacy technicians. Instead, we try to bring in complementary skills from the team of data analysts and auditors. This multidisciplinary team is still led by pharmacy, but with additional technical capacities to really optimize the 340B program and optimize compliance.
(05:13):
Compliance is always job number one for our 340B team, which is a fantastic team of absolute rock stars who bring their own unique set of skills to the team making the whole greater than the sum of its parts. And one of the things I like to say is another way it's said is one plus one equals three. So for example, we have team members with backgrounds in finance, analytics, we've had people who were certified EMR trainers and accountants in addition to pharmacy backgrounds, right? So the team continues to focus on technology and data, which allows us to increase efficiency when conducting internal audits. Currently, that team audits 100% of our claims, which is amazing because again, compliance is job number one, but that focus on data and technology allows the team to identify opportunities to increase patient access and provide high quality, safe and affordable healthcare to the patients of Novant Health.
David Glendinning (06:06):
That's interesting to learn how you're sort of marrying the pharmacy clinical side of things with the data tech side. So with such a multidisciplinary team, what are you able to accomplish with that specific pairing?
Matt Webber (06:22):
So I think anybody who's listening to this is most likely a covered entity. And one thing that we all know is most every covered entity has to manage data from multiple TPAs, whether it's their split billing software or through contract pharmacies. And so managing that data that comes in different formats, different file types, all of those different things, it's really important to be able to take that data and process it. Also, they're able to identify errors that lead to wax spend versus either 340B or GPO purchases. That could be coming from mischarges, crosswalk issues, data failures, a variety of different causes, but they're able to really identify that through all of those different data platforms. And once they analyze the data, the team identifies internal and external stakeholders to partner with to implement strategies for the optimized outcomes. Really, pharmacy is not an individual sport, so relationships are really key to a successful 340B program. So much of the success at Novant Health is due to teamwork with our 340B program.
David Glendinning (07:22):
Pharmacy is team sport, I like that. Can you give an example of how Novant Health implemented such a coordinated strategy?
Matt Webber (07:31):
Patients were utilizing pharmacies that we did not have contract pharmacy relationships with. Novant Health does not have a very large retail pharmacy footprint, so we rely on our contract pharmacy relationships. So in late 2022 and early 2023, we implemented a strategy to expand our contract pharmacy footprint. It's to better meet our patients where they're at. And so that was a fantastic example of teamwork and identifying trends within the data to really help improve patient care and access right there. And a second example is that the 340B team partnered with our pharmacy business team, the specialty retail and infusion teams, along with the pharmacy automation, analytics and informatics team to develop a set of dashboards to measure our internal KPIs and optimize the 340B program. And these dashboards that were created not only quantify missed opportunities, but they also track how Novant Health is helping patients navigate the complex US healthcare system to access care.
David Glendinning (08:31):
And of course, we are always focused when we're speaking about the 340B world, anything we're doing in the 340B world, how that translates to the patient side of things. So what can you say this data-driven approach has meant for your patients?
Matt Webber (08:47):
Well, in short, optimizing 340B also results in better patient health outcomes and increased access. So one example of that is our medication management program. In North Carolina, pharmacists are allowed to be clinical pharmacist practitioners through the North Carolina Board of Pharmacy. With that designation and licensing, they're able to prescribe medicines and order labs. And so through this program that we have where patients are referred to these pharmacist CPPs by their provider, data showed an opportunity for our pharmacists to manage medications for diabetes and heart patients pending that physician referral. And so we've seen a huge uptick in this program on the quality side. It really is a quality program. We see that through the data around patients who come to our CPPs who have diabetes. We're seeing an average A1C reduction of about 1.8 to 2.2%. We've seen increased screening rates for both eye exams and kidney health. Also, we're really proud of the fact that we've reduced out-of-pocket expenses for about 83% of the patients who fill out our home delivery pharmacy. So we're really proud about that, about helping our patients access these medicines.
(10:00):
Another example is that the data showed a need for meds-to-beds program, really helping facilitate transitions of care and getting 30-day supplies of medicines into the hands of our patients. So we partnered with one of our contract pharmacies so that the patient leaves the hospital with medicines in hand so that they can focus on healing. One example of that is that our Presbyterian medical center in Charlotte, almost 3,500 patients receive their discharge medicines through this program in 2023. And what that means is that almost 3,500 patients were able to go home with their medicines in hand and they were able to begin taking it without worry about getting the medicine about what it was going to cost and their loved ones were able to focus on taking care of those patients in their recovery instead of having to run to the pharmacy to pick up one more prescription and going through that. What this really does is it results in superior clinical outcomes by putting the medicines in the patient's hands so they can begin taking them from day one.
(10:59):
One other great example we have at Novant Health is we all are aware of the opioid epidemic. It's something that's been ravaging our country, and it's something that's near and dear to my heart. So the data showed an opportunity to partner with behavioral health in the emergency department to increase screenings for patients with opioid use disorder and to also implement medication assisted treatment for those patients both in behavioral health and in the emergency department. So we partnered with both behavioral health and the emergency department providers along with some other pharmacists within our organization to collaborate to increase prescribing of MAT, medicines for patients who are entering those care points.
(11:42):
And so what that means for our patients is that when they are identified for treatment, they're able to get a medicine, go to our contract pharmacy if they're uninsured, get that medicine at no charge, and they're also referred to longer-term outpatient care. So we connect them to longer-term treatment, but we're able to start treatment then. And it's a really powerful program that we're really proud of. And we're starting it as a pilot at our Forsyth Medical Center facility, but we are hoping to scale that across Novant Health over time once we are able to show superior outcomes with that as well. So these are the types of programs, all three of these that I've just mentioned. They really highlight programs that we offer that would not be possible without 340B.
David Glendinning (12:26):
That's wonderful to hear all those improved patient outcomes. And as you say, because of 340B. Are there any limitations or challenges that you can run into with trying to advance these 340B optimization efforts?
Matt Webber (12:39):
Yeah, there are many challenges out there, but also sometimes there are just complexities within the healthcare system that we can't control. One of those great examples are complexities around correct reimbursements in areas such as infusion. Payor formula area is often drive biosimilar utilization. We're starting to see increased trends in new generics coming to market that have been approved through the 505(b)(2) NDA approval pathway. And what we're seeing with that is that these generics, some examples of this would be like pemetrexed or gemcitabine, where even though these are generic drugs, new J codes are being assigned to these very specific manufacturers, and these complexities are making it harder and harder for covered entities to bill for these medicines and ensure that patients have access to them. So we have to, on the covered entity side, consider the financial impact on patients as we move toward value-based care as well. And so those are some of the complexities that we're dealing with in that space.
David Glendinning (13:49):
And those sound like complexities that will not just affect Novant Health, but will certainly affect most if not all hospitals in the 340B world. Based on your experience, what steps can those hospitals take to keep these considerations in mind?
Matt Webber (14:05):
Yeah, so one of the things that we do is we have a fantastic value and outcomes team at Novant Health. So we partner with them along with the P&T committee to navigate the complexity of these new drug therapies that are coming to market. As we've talked about a lot at the conference this week, drugs are increasing in complexity. They're not getting easier. There's incentives for manufacturers to continue to bring biosimilars for rare diseases to market. And what that means is it's no longer just administering the medicine. There's a lot of complexities to that. It can include things like monitoring, genetic testing, imaging, a lot of diagnostics as well. So as a covered entity, especially as we move towards a value-based healthcare model, we have to really look at the whole picture, the full picture, and understand that. And when we're considering a drug for addition to our formulary, we have to look at all of those factors. And really what we see is that the 340B program allows us to offer those medicines to our patients and offer those services and increasing access to those very valuable medicines.
(15:14):
Another example is our medication management specialists that we employ at our specialty pharmacies. These medication management specialists help our patients access these specialty medicines. I'm really proud of the work that they do. What that looks like from a patient standpoint is that there's an average one-day turnaround time on the prior authorizations that the insurance company makes the providers do, and that's facilitated through those MMSs. But they also, those MMSs, help patients access free drug. I'm really proud of the fact in 2023, that group of people helped our patients access over $7.5 million in free drug.
(15:55):
Another example very similar to the MMS model, we have an Infusion Access Team or IAT, and what they do is they determine the financial responsibility prior to treatment for our infusion patients. Again, fantastic one-day turnaround time on those prior authorizations from the insurance companies, which meant that they completed almost 3,600 prior authorizations in 2023, but they also helped those patients access the medicines. And in 2023, they helped the patients access over 1 million in patient assistance and over $4 million in free drug. And we are really proud of that ability for both of those service lines to really, again, provide access to our patients. And those programs would not be available without the 340B program.
David Glendinning (16:41):
This has been a great discussion. Any additional advice you have for hospitals on 340B optimization?
Matt Webber (16:49):
I think the first thing is to understand that each 340B covered entity is very unique, right? So your optimization strategy and needs might be different than what we have at Novant Health. So make sure you tailor your optimization strategies to your covered entity and the services that you provide.
(17:09):
And the other big takeaway is, collaboration is fundamental to success. Whether it's internal or external stakeholders, I would really encourage everybody to develop relationships with all of those stakeholders, nurture them, and partner with each other because together everyone can achieve great success and improve the patient access. There's a treasure trove of data out there for you to find sitting in your electronic medical record, pharmacy dispensing software and e-prescribing data. The answers may not always be clear when you start looking at it, so what I'd encourage listeners to do is to really approach that data from a place of curiosity. And when you do that, you can often find the answers hiding in that data. And that's a really great way to approach it. And you often learn new things that you didn't know you were looking for when you come at it that way.
David Glendinning (17:56):
So the truth is out there, I think we can leave it at that.
Matt Webber (17:59):
Yes. Yes.
David Glendinning (18:00):
Matt, I've learned so much about optimization I did not know before. I am hoping our listeners have too and have some new ideas for making 340B work best for their hospitals and the patients they serve. So thank you for this chat.
Matt Webber (18:15):
Oh, my pleasure. Thank you so much for having me. It's been a great week here at the conference.
David Glendinning (18:21):
Our thanks again to Matt Webber for running us through such an important topic and giving us a peek into how health systems like Novant Health are making the most of 340B for the benefit of their patients. And we thank all the experts who joined us in the booth at the 340B Coalition Winter Conference to share their insights. We look forward to speaking with more of you at the summer conference this July. If you've not already registered to attend, please do so today by visiting 340bsummerconference.org. 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 (19:04):
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, @340BHealth, and submit a question or idea to the show by emailing us at podcast@340bhealth.org.
Speaker 4 (19:26):
Voxtopica.