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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.
Intro/Outro (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 Heather Armstrong with Comanche County Medical Center in Central Texas. We often highlight the innovative ways hospitals use their 340B savings to invest in healthcare services and assistance that are tailored to the communities they serve. In the case of Comanche County Medical Center, that involves health initiatives that bring care outside the hospital walls and directly to the residents who need it. Before we learn more about how they do that, let's take a minute to cover some of the latest news about 340B.
(01:06):
There have been several key 340B developments lately in Arkansas, which was the first state to outlaw drug company restrictions on access to 340B discounts through contract pharmacies. A federal appeals court declined to reconsider its decision, affirming that federal law does not preempt the Arkansas law. The Pharmaceutical Research and Manufacturers of America, which had sued to overturn the law, could attempt to appeal that decision to the US Supreme Court. The law also continues to face court challenges from drug companies based on other legal arguments. However, the latest ruling means that the Arkansas law remains in full effect for the time being.
(01:46):
The Arkansas Insurance Department announced that it would hold a public hearing to consider arguments that the drug company AstraZeneca has been in violation of the state law since this past August. The department is seeking to fine AstraZeneca $50,000 for every six-month period in which the drug maker is in violation of the law and to order the company to stop applying its 340B contract pharmacy limits to any covered entity in the state. More than 20 drug makers with restrictive contract pharmacy policies have publicly announced that they're suspending or loosening these policies in Arkansas because of the law. Similar laws are on the books in Louisiana, West Virginia and Mississippi and more states are considering legislation to impose their own prohibitions on drug companies 340B restrictions. 340B health members can read our full analysis of all these developments by visiting the show notes.
(02:49):
Now for our feature interview with Heather Armstrong from Comanche County Medical Center. Some of the areas of Texas that the medical center serves are considered remote and many of its residents are living with low incomes. That can create barriers to care that requires some innovative approaches on the part of the health providers who care for them. Monica Ferrara recently spoke with Heather to find out how the center uses its 340B savings to meet patients where they are. Here's that conversation.
Monica Forero (03:19):
Thank you, David. I'm joined by Heather Armstrong from Comanche County Medical Center. Heather, welcome to 340B Insight.
Heather Armstrong (03:28):
Thank you for having me.
Monica Forero (03:31):
Every once in a while on the podcast, we like to highlight some case studies that demonstrate the patient impact of 340B savings or what 340B savings can accomplish for patients and communities. Before we get into that, can you please tell our listeners about Comanche County Medical Center and the patients you serve?
Heather Armstrong (03:53):
Yes. We are in a very rural area, Central Texas, and we are a critical access hospital with four rural health clinics. One of them is attached to our critical access hospital, and then we have three more in the counties close to us. We have an LCSW that provides counseling services, and then of course we have three retail pharmacies for our health system. We're the only hospital in this area and I think the closest to us is about 35 miles away. Just in our area services are limited and we're, I want to say, about two hours from the closest Metroplex area that would have all of the specialty services that you can want too. So we're trying to fill a lot of gaps in care for our communities here at our critical access hospital and our multiple locations that we have just trying to make our residents not have to travel so far when they need services.
Monica Forero (05:12):
It sounds like you're very much a staple in your community. That all sounds interesting. Do you want to tell me about a specific health program that you have in your community and how it might work?
Heather Armstrong (05:26):
Yes. Our Health on Campus program is something that we started December of 2022 and when our COO mentioned that she was wanting to do this, I thought it sounded really interesting, but I had no idea what we were going to really be able to accomplish with this program. It's actually ended up being much more involved and much more beneficial than I was really envisioning it to be when we were first talking about this, but right now what we have is we have 14 different campuses that are a part of this program and we're in five ISDs, and for those that don't know what an ISD is, it stands for an independent school district, but that really represents each public school location that that town has.
(06:27):
What we have done is we've placed these devices that have otoscope, stethoscope, tongue depressor, and then we've put in point of care testing, which is strep, flu A, flu B, UA kits, COVID tests, anything that you would typically need to get a swab for or an additional test for the provider to make an educated diagnosis for a student, each campus that we've partnered with is going to have those tools with them there. So anytime a student comes in and they're saying, "Hey, I'm not feeling very well, my ear's really hurting or my throat hurts", the nurse can reach out to the parents and say, "Oh, your child has come in today saying that they're not feeling well. Would you like us to set up a Health on Campus appointment for them?"
(07:26):
If the parent says yes, then we start the visit on the campus side and then we connect them with the provider on screen so they're able to see each other just like we can right now. Then we can pull out those otoscopes, stethoscopes and really be able to see, and the picture is very clear, and they can look in the ear, see if there's any redness and really have a great telehealth experience that you wouldn't typically have if you don't have those tools. Then if there's some redness in the throat or some patches, they can say, "Hey, let's do a swab real quick to see if that's what it is." If they need a prescription, our pharmacy will deliver to the parent's home or work. Or if it's a staff member that we're seeing for this visit, we can deliver it to the school for the staff member. Really our goal for this is to reduce absent days, cut down on recovery time because the faster you get to a problem, the quicker they're going to be able to recover.
Monica Forero (08:43):
I love that, Heather. It really sounds like you take the typical equipment seen at a primary care office and bring it right directly to the school. Are there any patient examples that you have that demonstrate how this program benefits the residents in your service area?
Heather Armstrong (09:01):
One is medication refill. So say a student is on medication and they come in every couple of months to get their refills. That's now something that we can do while they are at school instead of anybody having to leave. Then the lice situation that schools are inevitably going to face each year, that's something that we've realized ... In our area we have a really high Medicaid population and there's this lice treatment that it's hundreds of dollars to get, but if you're on Medicaid, you can get that for free. But now that we can get these appointments done, parents not having to miss any work and we can just connect really fast, we're able to remove some of the challenges that just lice alone creates in the school system. Then there has been one situation where a student had missed weeks and weeks of school for an ear infection and the school called us, said, "Hey, the state's gotten involved and their new caregiver is a family member that's really wanting them to be seen. They don't have an established provider, though."
(10:31):
So our staff, as soon as we heard that this student had been suffering for weeks, we waited by the computers and as soon as they told us that they were ready to be seen, we immediately hopped on because we didn't want to make that student wait any longer than they already had. The last time I checked in with the school nurse for that location, that student has been happy and present at school every day and they haven't come to the office any at all for any pain medicine or any ear drops to complain about their ears because we were able to finally get that issue addressed and get that student some relief.
Monica Forero (11:17):
I think it's so important for children to be supported during their early years, so that's great to hear. What other programs and services does Comanche County Medical Center provide using 340B savings?
Heather Armstrong (11:32):
Well, we offer a lot for such a small rural hospital. We have van Transportation offering that we do. So if somebody needs a ride to their appointment, we get that set up for them. We have prescription delivery. We have three pharmacies that each have their own car, so if somebody needs a prescription delivered to them, we do that for free of charge. We have our MedAssist and our Indigent care program that we're able to provide without having to worry about how we're going to pay for those things, because that's a huge offering to our community. Then, of course, we have our mobile unit and we're really, really proud of that mobile unit that we've been able to purchase to help the surrounding communities in our area that don't have any clinics at all in their area.
Monica Forero (12:31):
Can you give an example of how this type of care or this mobile clinic helped during a time of need?
Heather Armstrong (12:39):
Our mobile clinic goes to four different locations every two weeks, and those are towns that have no clinics. So we offer that every two weeks just to the communities in that area. But some really unique ways we've been able to use this mobile unit is we've partnered with the food banks before and when they come to our area, we'll set up and offer some vaccines, flu shots, COVID shots, things that somebody may not want to come to a clinic for, but if we're there, set up with the food bank, they may utilize. Then since this mobile unit is ... it's equipped with all the things that you would get in the clinic setting, and of course we have some emergency supplies for it, we were able to go to the carbon fires that happened a few years ago. as soon as that started happening, we immediately thought, "this is what the mobile unit is made for. It's ready for anything that they need."
(13:59):
So within just a few hours of those fires starting, we were able to load up the mobile unit with any other emergency supplies, oxygen, breathing machines, breathing treatment machines. We had that as free care to anybody in that location. So whether you were first responder, you were just somebody making sure that those first responders were being fed. If you were a victim of losing your house or losing all your belongings, anybody that was in that area could come to our mobile unit and get whatever care they needed. When a fire comes through an entire town, there's a lot of people that now have none of their prescriptions that they need on a daily basis and these are really important things that nobody thinks about losing. You don't realize how important it is to grab your medication for your heart or something. But if people came by the mobile unit, we were figuring out how to take care of whatever that need was.
Monica Forero (15:13):
Yeah, the courage of those first responders and also the support that the medical staff showed, I guess it really demonstrates what you said, the collaboration among these different pieces. What should other 340B hospitals considering a similar mobile clinic know about setting one up?
Heather Armstrong (15:33):
You wouldn't think it, but there's a lot that goes into setting up a mobile unit. You have to make sure that you have experienced people manning it, first of all, with a wide range of talent. So you need to make sure that you've got a great nurse and a great provider that are almost ready for anything, and, of course, making sure that it's equipped with what it needs, but you can use it for so many things. We use it for sports physicals, we use it for vaccine outings, we use it for emergency situations. You can even use it to go to one of your local sporting events and just set up out there. Sometimes our EMTs have even asked that they could take our mobile unit just to have it there because it has so many things in it.
Monica Forero (16:29):
A lot of great things happening in Comanche because of 340B. How would you say you felt the effects of drug company restrictions on 340B pharmacy partnerships, if at all? Have these restrictions affected Comanche County in any way?
Heather Armstrong (16:45):
Yesterday, one of the pharmacists got asked almost that exact questions, and she just looked at me and she said, "Negatively. Very negatively." 340B program makes these programs possible and a loss of savings means fewer resources for the members of our community. If we're having to worry about how we're going to be paying for these things now that the 340B funds have been cut back by us losing the contract pharmacies, for instance, then we're going to obviously have to pare back some of those things that we do that aren't considered money makers. We're not ever going to be turning away a patient because they can't pay. We are going to work with each patient on an individual basis, and because of the 340B program, we're able to confidently say, "Don't worry about that. We're going to take care of you no matter what."
(17:50):
But I don't know if we would all feel empowered to say that as much if we were always counting every single penny that we have. We serve Comanche and 10 other counties where pharmacies are in low supply, so partnerships with those pharmacies is really important. There's so many things that we would like to offer the residents of our communities. We need to build more locations so we can keep expanding our services, but those things cost money. When 340B programs start cutting down on what funds we're receiving, then obviously what we can grow is going to be limited.
Monica Forero (18:42):
Can you discuss how 340B might factor into the operation plans or what you all have planned in the future for Comanche County Medical Center?
Heather Armstrong (18:54):
Well, one thing we would like to do is expand the Health on Campus program. We're in the process of opening another in-house pharmacy because the pharmacy that we have is ... it's so small that we could be doing a lot more if we had a larger pharmacies. Then adding another vehicle for prescription delivery is on the list as well. One of our biggest goals that we like to say and focus on with 340B money is the ability to expand services, to support our underserved community because they shouldn't have to travel for hours to get the care that they deserve. Most people go into healthcare because they have a love for people and a desire to help, and with the 340B programs, instead of worrying about how we're going to keep all of the services that we want to provide available, we're able to keep our focus on the number one priority. It's the people in our area that trust us with their care and their health and well-being.
Monica Forero (20:13):
That all sounds exciting, and I'm sure our listeners can draw inspiration for what you've all done at Comanche County and all that you have planned. So thank you, Heather, for your work and for your insight.
Heather Armstrong (20:25):
Thank you very much for having us or having me and letting me tell you about some of the things we're proud to offer here at Comanche County Medical Center.
David Glendinning (20:36):
Our thanks again to Heather Armstrong for her inspiring story about the lengths 340B hospitals go to serve all their patients in need. It's interesting to see all the ways they can use their to serve their communities in times of crisis and to treat health problems before they become a crisis. How does your health system use 340B in innovative ways? We would love to hear about it. You can contact us at podcast@340bhealth.org. We will be back in a few weeks with our next episode. In the meantime, as always, thanks for listening and be well.
Intro/Outro (21:16):
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.