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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.
Narrator (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 premiere podcast about the 340B drug pricing program. I'm your host, David Glendinning with 340B Health. Our guest for this episode is Thomas Yu, System Director of Ambulatory Pharmacy Services for Sinai Chicago. Thomas's hospital was one of many that played a key role in a successful two-year effort that resulted in Illinois approving landmark legislation.
To protect 340B contract pharmacy access and prohibit drug maker claims data demands. Along the way, hospitals, community health centers, patients, and other supporters came together for two 340B Saves Lives Days of Action that helped build momentum for the legislation. We wanted to learn more about how that coalition came together and what hospitals in other states can learn from Illinois's success. But first, let's do a quick recap.
Of some of the latest news about 340B.
The Centers for Medicare and Medicaid Services has proposed significant Medicare Part B payment cuts for many 340B hospitals as part of its proposed outpatient payment rule for 2027. Under the proposal, CMS would reduce reimbursement for most separately payable 340B drugs by about 37%, an even deeper cut than the payment reductions the agency imposed between 2018 and 2022.
Before the Supreme Court ruled those cuts to be unlawful, 340B Health strongly opposes the proposal and will submit comments urging CMS to withdraw the payment cuts. 340B Health members can read more by visiting the show notes.
And now for our feature interview with Thomas Yu of Sinai Chicago. Illinois legislative victory is an encouraging reminder that strong advocacy can make a difference. Thomas joins us to discuss more about how that all came together. Here's that conversation. Today I am speaking with Thomas Yu, System Director of Ambulatory Pharmacy Services at Sinai Chicago. Thomas, thank you for joining us today and welcome to 340B Insights.
Thomas Yu (02:40)
Glad to be here.
David Glendinning (02:41)
So we are gonna be speaking about some very important 340B advocacy events that you have been involved with recently with your hospital in Illinois. But before we get into that, ⁓ please tell us a little bit about Sinai Chicago and the patients you serve there and how 340B helps make that work possible.
Thomas Yu (03:02)
Sinai Chicago is the largest safety net hospital, private safety net hospital in the state of Illinois. We have three hospitals. Two of them are 3-4B eligible dish and one rehab hospital. We also have clinics all around Chicago, ⁓ Chicagoland, both on the west side and south side. ⁓ we do have a level one trauma at our main flagship hospital, ⁓ Mount Sinai. And we also have a level three NICU as well.
Cyanai Chicago is also one of the leading most charitable health system organizations. we've been voted at least for the last two years, with the loan institute being top five in the nation with regards to how much charity care we give in relation to the amount of revenue that we receive. You know, Sinai Chicago is not just the biggest safety net from a Illinois perspective. We're one of the most charitable safety nets in the nation.
David Glendinning (03:59)
And we're speaking to you because Illinois recently approved some what I would call landmark 340B legislation after what I understand was a a multi-year effort. ⁓ but before we get into that, ⁓ first tell us a little bit about the 340B Saves Lives Days of Action that helped build momentum for that legislative effort.
Thomas Yu (04:23)
Yeah, I think ⁓ that is probably one of the more remarkable, I think, stories in Illinois in order to increase our efforts with regards to ⁓ advocacy and really shining a spotlight on 340B and the positive things it does for the community. The 340B Saves Lives event, it was a two-day event from on February first and March first. We had more than 2,000 people that came to both events.
I mean, the first event was the largest in success, which makes sense because it's like the first event of its kind in Illinois. It was basically standing room only. In fact, I had people texting me that said they couldn't get in because of the amount of traffic it created within ⁓ within the area. But we had everyone come through. It wasn't just the health systems and FQHCs just having a powwow. It was an invite to all the major legislators. We had both ⁓ state.
House representatives and senators, as well as even on the federal level. we had Danny Davis come as well, and he's always been a supporter of the program too. But truthfully, the story even goes before that because we tried passing ⁓ legislation the year before. And it went like how it typically does, I think, on three, four B topics. It went to the wire and unfortunately it didn't get pushed through.
And I think the major thing that we did in partnership with the other organizations around Illinois, the Illinois Primary Health Care Association being one of those that represents the FQHCs for the state, as well as the Illinois Hospital Association as well. We came together to reiterate the importance of 340B for all these organizations. And from that discussion, we really wanted to make sure that.
There was something past for 340B that really benefited everybody and not just, you know, a single organization.
David Glendinning (06:26)
One of the most memorable visuals for me was seeing that you had held this first event, I I believe on Chicago's West Side at a closed Walgreens in the middle of a pharmacy desert. What was the decision making behind that location?
Thomas Yu (06:42)
Chicago, like I feel like everywhere else in the nation, you know, for many reasons, we're seeing pharmacies close and creating pharmacy deserts. And, you know, this pharmacy actually is not very far from Sinai Chicago either. It's one of the closer Walgreens to us as well. One of the FQHCs in our area decided to buy that pharmacy to service their patients that no longer had a brick and mortar to go to.
And I think we typically see with population preferences, they want to still go to the pharmacy and get their medications. They don't want it delivered or mailed to them. and that and that's a big thing in terms of access of care. So that that was like an idea that stemmed again from the Illinois Primary Healthcare Association as spotlighting two issues really at hand access to care and 340B.
David Glendinning (07:37)
That's really interesting to hear that they were planning on buying that that location and reopening a pharmacy there to the extent they're using 340B savings for that. That seems like a wonderful, wonderful use of it. One thing that stood out to me about these Illinois advocacy days was how unified the safety net community appeared to be. ⁓ you had mentioned the ⁓ FQHCs being part of the leadership and working with hospitals on this. How important was that?
Collaboration.
Thomas Yu (08:08)
I mean, it was the key success, I think, to passing legislation, ⁓ I believe, because unfortunately, Pharma has a very, very good ability of making wedge issues in all different sorts of ways, including trying to separate safety nets with other hospitals and with FQHCs with hospitals. it was really important to provide a unified vision.
simply because I think a lot of legislators are already confused by a lot of the details that 340B has. And unfortunately there's just so much information out there, but they definitely feel, you know, the importance of 340B because everybody is kind of coming at them with all their talking points.
David Glendinning (08:52)
Drug companies have often tried to divide the 340B community, as you say, wedge issues by, you know, suggesting different types of of covered entities have interests that conflict with each other. So maybe we could dig a little bit deeper into that. How did your coalition in this case respond to those, those wedge issue attempts?
Thomas Yu (09:13)
I mean, oftentimes what it comes down to is really making yourself available for those questions that come up. It could come from a caucus, it could come from your local legislator, it can come from one of the leaders within, you know, the House or the Senate. And it's really about getting those answers to them. ⁓ but it's also the preparation work. For us at Sinai, this has been
A multi, multi-year journey of telling our story. ⁓ we have worked with our government affair folks to, you know, create talking points and fact sheets about the 340B program. And having all of that is very, very important. Oftentimes, especially if you do have a government affairs or other external representatives, they're gonna go to those parties because that's the relationship that they have. They're not gonna come to, you know, the director of pharmacy directly.
Oftentimes we come in because, you know, they want the subject matter expert to come and to really affirm what they've already been hearing. ⁓ or maybe just to hear it from, you know, directly from that perspective. But a lot of the times working with your government affair folks, if you have that, or, you know, again, working directly with your associations that are also representing the interest of 340B with their constituents.
David Glendinning (10:39)
And when you had those meetings, what messages about 340B did you find resonated the most with lawmakers?
Thomas Yu (10:50)
Yes, lawmakers definitely don't want to hear all the technical stuff. That is probably the most major thing. Oftentimes they're looking for high level talking points, like does 34B help with medication access? ⁓ what do you use for your 340b savings? What programs can you point in that? And I think the reason ⁓ that they respond to those things the best is because they need to hear the actual story and not just the number.
Some folks care about the dollars too, but other folks from when we've talked to them, they oftentimes are dealing with numbers that are so big at the state level that, you know, a hundred thousand or even like a million dollars or a couple million dollars, they don't know what that means. You know, th they really want to hear like how you improve the community with those dollars and you know, why should those dollars be given to us versus, you know, that going back into
The drug companies.
David Glendinning (11:51)
Now the those days of action you had talked about were were very impressive in terms of the the turnout and how effective they seemed to be. ⁓ but I would imagine it wasn't the only advocacy you did. So what what other advocacy do you think made the difference during this two year legislative journey to getting this ⁓ getting this bill passed?
Thomas Yu (12:11)
If I had to make an analogy, it's kind of like because I'm just like a runner and I'm a marathon runner. So I guess I'll just make a bad analogy here. But you know, it's not like one run or it's not one event that makes the whole effort. It's really everything leading up to that point and that journey. And I think what we see around the nation is that sometimes these stories and action take years of foundational development and telling that same story until
You know, it's sort of like ⁓ there comes a point where that decision point is critical for the constituents and for the state itself to making sure that 34B is protected. The 34B Saves Lives events, if those events didn't happen, you know, it probably wouldn't have passed either. But if we didn't do all the work and talking with people individually and meeting with caucuses in a responsive manner, were the or the associations doing that as well.
It also wouldn't happen. It really required everything.
David Glendinning (13:14)
Well, I'm a marathon runner too, Thomas. So I that certainly resonates with me. I appreciate the analogy. Let's talk a little bit about this legislation that got over the finish line. So the the main bill that we're looking at, from my understanding, it ultimately addressed ⁓ both contract pharmacy protections for covered entities and ⁓ prohibitions on claims data demands from drug companies. So
Maybe you could explain from your perspective as to why those provisions are so important.
Thomas Yu (13:45)
I think contract pharmacies, you know, that is protection with regards to how you know we reap some of those savings. ⁓ it's how we reap the savings with the program that we were always used to from years ago before the manufacturer restrictions. As far as the data requirements, that was also important because we've seen a lot of the times where drug companies are, even when you do provide data, they are utilizing that against.
covered entities in some shape or form, us included, have seen that where they use that as a mechanism to to stop 3-4B pricing to the covered entity until something is adequately resolved in their minds. ⁓ it doesn't really give consistency with the program for covered entities and makes it harder for ⁓ programs to administer and for patients to receive their drugs consistently. So it was really important to protect those items, especially when we look at
what is happening today, we have started seeing that that's another reason why covered NDs are losing ⁓ 3, 4B pricing. And there's just a lot of questions about the need for all of this data and how it's being executed by pharma companies. And, you know, this is the kind of stuff that unfortunately you know, a lot of 3, 4B covered ends like ourselves, have major concerns about.
David Glendinning (15:12)
We should speak about ⁓ another element of the Illinois package, which is a ⁓ sort of a companion measure that includes reporting requirements for covered entities. Three forty B hospitals in other states listening to that might have some hesitation when they hear about that becoming law as well. So what lessons should they take from Illinois's example here?
Thomas Yu (15:37)
Bill would not have passed if it wasn't for this trailer bill for transparency to come through. It is very clear that legislators want to see transparency also. While there were many, you know, House representatives and you know Senate leaders that really bought into the need for 340 B, they really needed to have you know a transparency measure that they could rely on. And you really needed to see that because.
When you look at how this was passed, it was literally at the twenty-fifth hour. So Illinois, the legislature, you know, they closed May 31st and this bill was passed June first, you know. So like they were they were up in the wheat hours worrying about 340 B provisions, right? ⁓ and when you look at the final vote, it was like a hundred and thirteen yes and one nay. We had to make all of this effort.
Not just telling our story over the years and all of that, but even at the final hour, it was about also giving what the legislator needed, which is hey, we need to ⁓ show some more transparency here. But if you look at it at its overall four, I I actually really think it's a big win for Illinois covered entities, in the sense that, you know, it's a transparency report that is required for us to provide to the Department of Insurance of Illinois.
It's not a report that goes to the drug manufacturers, which is everyone's concerned, I think, from a covered entity perspective. And for us, it's a one-time report. And at the same time, it's not just aimed at covered entities. It's also aimed at the drug manufacturers, which I think, you know, when you look around the nation, there's very few transparency bills that also include a side for the drug manufacturers to report, also. So I really do think at the end of the day.
This was required. This is what it took to get both bills passed at the same time. And I think it is a big win for covered entities, ⁓ when we look at it and its totality.
David Glendinning (17:44)
I'm starting to see some potential lessons learned here or guidance for covered entities in other states that might be trying to navigate this same pathway toward legislation to protect 340 B. What advice would you offer them? What would you offer hospitals and other covered entities that are trying to get some of these similar legislative victories in their own states?
Thomas Yu (18:07)
Yes. I would say first you gotta do your homework and you know put together your impact and advocacy documents. That's number one. And then number two is to engage with your associations that represent you on the hill of your state. ⁓ and then thirdly, talk to each other. I think it's important for us all to meet. And I think where we saw that in Illinois, it's like
showing up to the 34B saves lives and then I can't state how inspiring it was for a pharmacy leader to see that because you know I saw FQHCs and all these major health systems represented all in one building. I mean it was a standing room only situation and that's what a lot of legislators that came to visit us that day ⁓ got to see. If someone puts the event together, I know people will show up.
I mean, that's kind of how things happen in Illinois. It kind of happened fairly quickly. And, you know, I'm sure there was like a lot of like texting and just being like, you guys gotta show up. Can I come? And it wasn't just, you know, pharmacy folks or just like leaders of health system. Like we had like just broad support, even from from within our health system, whether it was like people that don't work.
Directly with 3, 4B, or you saw like community healthcare workers and patients ⁓ coming to support, physicians coming to support, all of which was very important. And that was also like part of the event, too, was like, you know, all the leaders and all the physicians standing up on podium together to show the legislators, hey, this is a really important program. We need you to listen. And I think having that type of event is powerful.
David Glendinning (20:01)
Well, to the extent that success belongs to to everybody who shows up, then 340B Health. And I know many of our listeners thank you for showing up, Thomas. This really was an important and and hard fought legislative victory that you were part of. So congratulations again on the success. And thank you for sharing this inspiring story with us. Our thanks again to Thomas Yu for sharing the story behind Illinois's successful legislative effort.
Thomas Yu (20:24)
Thank you.
David Glendinning (20:30)
And for offering practical advice that hospitals and other covered entities can apply in their own advocacy work. If you are attending the 340B Coalition Summer Conference and are listening to this episode the day it came out, be sure to visit us in the exhibit hall. We will be interviewing several conference attendees while we are there, and we would love to meet you. We will be back in a few weeks with our next episode. In the meantime, as always, thanks for listening and be well.
Narrator (20:57)
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.