Background: Many people in Jefferson County have been discussing the rising price of drugs, including retired physicians, pharmacists and patients. While the President has made bold statements that have never materialized into actions, (and only seem to provide a buying opportunity to purchase drug stocks at a discount during the 24 hours after the tweet), the industry has chosen to continue to raise it’s prices. Many horrific stories are starting to appear on NPR and the mainstream media.
Here’s an overview of some ideas on why this is happening.
Jefferson Healthcare and many other rural hospitals, take advantage of a Federal program called 340B.
As the article states:
This little-known federal program was created to help uninsured or vulnerable patients get access valuable medications regardless of their abilities to pay. This was done by providing certain participating hospitals or safety net clinics with discounted medicines. The 340B program has become an extremely important program for patients in need in this era of unaffordable and unsustainable drug prices.
The article lays out the problems with the 340B program and how some hospitals are abusing it to help themselves remain profitable.
While the point of sharing this article is not to infer that Jefferson Healthcare is in any way one of the ‘bad actors’ in the 340B debate, this article gives the average person a very good quick overview of the controversy. The battle over 340B is playing out in Congress, and it’s outcome will affect JHC. JHC does a great deal charity care, including use of 340B funds, and the program to offer charity care has been recently reformatted to allow people who do not have the means to afford to get needed care. (More on that can be found at the JHC website, JHC Charity Care overview )
I will be looking into the local ramifications of this issue in upcoming months, and should have a more comprehensive overview on them later.
But for now. Here’s a good quote:
For too many hospitals, the 340B program has become a road to profits, not a safety net and not a way to expand charity care for uninsured, indigent patients. For too many patients, particularly those with cancer, the 340B program has not reduced their cost of care 1 cent.
Read the whole opinion piece here:
There have been questions raised here in Jefferson County about the issues that are covered in this article. A good example is the following statement:
A study in the journal Health Services Research examined the impact of the 340B program on the cost of cancer care. It found that hospital participation in the program is associated with a shift of patients’ care from more affordable physician offices to more expensive hospital outpatient care centers, contributing to market-wide increases in per-patient spending.
Finally, a study has come out in the journal Addiction, with some real data to counter the hysteria at the Federal and State level that has been shutting down high volume opioid providers, a class of doctor that was created and supported by the very Federal Government that is now shutting them down with no warning. This crisis, which was created because just twenty years ago because the medical establishment was urged to provide opioids as pain relief, now finds itself resorting to lies and raids on doctors that usually have ended up, after years of court time, having the Feds drop all the charges. Rather than treat these physicians and pharmacies like criminals, they should be working cooperatively to rein them in and offer their patients relief.
The study also found that “opioid shoppers” — people who obtain prescriptions from multiple doctors and pharmacies — accounted for just 0.1 percent of opioid users in the study.
Our local physicians here on the Peninsula have often been complicit in this behavior, shunting high pain patients to the one doctor who was willing to work with them, then talking behind his back about how he was somehow “a renegade” and not coming to his defense when he was raided. They had nothing to say when the charges were finally dropped.
All prescribers of opioid pain medications — not just high-volume prescribers — play a role in the U.S. epidemic of opioid abuse and overdoses, a new study says.
“This crisis has been misconstrued as one involving just a small subset of doctors and patients,” senior author Dr. G. Caleb Alexander said in a Hopkins news release. “Our results underscore the need for targeted interventions aimed at all opioid prescribers, not just high-volume prescribers alone,” Alexander added.
full abstract and article available at
This is an ugly story from both sides of the issue. The big Pharma companies are looking to claw back some of their profits, and some hospital districts, such as Jefferson County Healthcare, may be using the system in a way it was not intended, meaning that it is unclear that the patients who were intended to benefit from this, actually are seeing benefits. JHC has a relationship to somehow share these discounts with Safeway, where they send patients for filling the discounted drug. Is the patient actually seeing a discounted price or is the hospital somehow using this to generate more profits? I am under the impression that Kitsap County is using the program more as it was originally intended, meaning that the monies are passed directly to the consumer who benefits from the discount. Is that not true here? It appears not to be.
The program, known as 340B, requires pharmaceutical companies to give steep discounts to hospitals and clinics that serve high volumes of low-income patients.
Under 340B, named after the section of the Public Health Service Act that authorizes it, eligible hospitals buy drugs at a discount from the pharmaceutical companies and then are reimbursed for those purchases from Medicare. The drugs are purchased under the Part B program, which covers expensive chemotherapy and other treatments in a hospital, doctor’s office and clinics.
Heated And Deep-Pocketed Battle Erupts Over 340B Drug Discount Program
This was sent out by the Jefferson Healthcare on their concerns to changes to the 340B program. This program has been used to theoretically fund low cost prescriptions. There are a variety of points of view about what the program has actually achieved, but the hospital is adamantly opposed to the cuts to it. We likely can discuss this more at the next Citizen’s Healthcare Access group meeting in September in Port Townsend.
340b letter PDF file. Here’s the first page so you can decide if you want to read the whole PDF.
Following the discussion we had with Dr. Art Zoloph this month on the subject of stockpiling medicines, is this superb story by ProPublica. It begs the question of why not spend the money to appropriately test drug potency over time, given the expense of buying them?
Hospitals and pharmacies are required to toss expired drugs, no matter how expensive or vital. Meanwhile the FDA has long known that many remain safe and potent for years longer.
by Marshall Allen
ProPublica, July 18, 2017