Christina Crooks Bryan is the vice president of external affairs for the Delaware Healthcare Association.
Recent op-eds on the 340B program cite the need to work together to serve our communities. We couldn’t agree more, but one-sided reforms to the 340B program will not move us toward true solutions.
We need to address the root causes of our health care challenges and work together to tackle the most immediate threat to care in our state: looming federal cuts in Medicaid and other programs.
The 340B program allows providers who care for a high number of low-income and uninsured patients to, in the words of Congress, “stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.”
Indeed, many of Delaware’s nonprofit hospitals, community health centers and other safety net providers use the 340B program to provide care and support for their patients and communities, including a range of services that benefit the uninsured, underinsured, underserved and most vulnerable in our state. These services may include, but are not limited to, reducing outpatient pharmaceutical costs.
Essentially, 340B acts as a coupon for safety net providers, with the savings reinvested into the community. The investments in Delaware have been substantial.
In fiscal year 2023, the $46 million in 340B benefits that Delaware’s adult acute care hospitals utilized was reinvested back into the area with more than $309 million in community benefit spending. That has helped Delaware hospitals fund charity care, free health screenings, maternity clinics, transportation services to get patients to needed medical appointments, mobile health clinics, vaccination drives, preventive care in high-need areas and more.
All those benefits don’t overshadow the fact that the cost of prescription drug medication has skyrocketed. In fact, 340B program growth is directly tied to dramatically increasing drug prices. Program participation is a matter of necessity. Nationally, the average drug price increase from January 2022 to January 2023 was 15.2%, according to the U.S. Department of Health and Human Services. In Delaware, pharmacy spending increased by 12.4% from 2021-22, far faster than any other sector’s growth, according to the latest health care spending benchmark report. Far too often, high prescription costs can have folks choosing between needed medicine and keeping the lights on.
Rising pharmaceutical drug costs are also adding to the financial strain nonprofit hospitals have been facing in recent years, contributing to higher expenses and lower margins, which can have a detrimental impact on care delivered to the community.
We have heard the pharmaceutical industry call for more transparency in the 340B program, which is regularly audited and regulated on the national level. Transparency is a key to trust in health care, and we are committed to working transparently with our partners for the common good of quality, accessible and affordable care for all.
Unlike other federal programs, 340B has no impact on the federal budget or on taxpayers. Without the 340B program, pharmaceutical companies could pocket more money at the expense of critical community benefits. Ensuring safety net hospitals can continue to utilize 340B is vital to preserving access to care for all patients.
That’s all the more true as the financial pressure is likely to get worse with $880 billion in federal cuts to Medicaid and other key health programs looming. In a recent Delaware Joint Finance Committee hearing, it was stated that these federal cuts could translate into a loss of as much as $2.9 billion to Delaware. Cuts to the Medicaid program would mean more uninsured patients, fewer people seeking preventive care, more emergency department visits and low to no reimbursement to hospitals for the care they provide.
We should be focused on working together to serve our communities, not chasing threats that aren’t there. Still, if policymakers want to improve the 340B program, the first priority should be to stop pharmaceutical companies from restricting 340B discounts for drugs dispensed at community and specialty contract pharmacies.
We need collaboration to address the impending billion-dollar crisis: preventing cuts to the Medicaid program that currently provides health coverage to over 260,000 vulnerable Delawareans.
We want to work together to address Delaware’s most pressing health challenges and welcome our pharmaceutical company colleagues and community partners to join us in raising our voices against cuts to the Medicaid program.
Reader reactions, pro or con, are welcomed at civiltalk@iniusa.org.
