The Shifting Landscape of Provider Reporting

00:00:00.017 --> 00:00:05.377Today on 340 Banter, we're live from the 340B Midwest Regional Conference.00:00:05.777 --> 00:00:10.457I'm joined by Felicity. Chelsea couldn't be with us today, but today we want00:00:10.457 --> 00:00:15.377to talk a little bit about what we've been seeing in the states around provider reporting.00:00:15.797 --> 00:00:21.117I know both of our states, Maine and Ohio, have seen quite a bit of changes00:00:21.117 --> 00:00:24.897here recently. Let's talk about what we're really seeing with that.00:00:45.041 --> 00:00:49.121Awesome. Thank you for having me here. It has been wonderful to make the00:00:49.121 --> 00:00:53.521trip from Maine, and I did not have any trouble with my flight. So that was amazing.00:00:53.801 --> 00:00:59.421We have had a lot of work around 340B lately in Maine.00:00:59.641 --> 00:01:03.921We were a little bit late starting, and we started with transparency,00:01:04.221 --> 00:01:09.981womp womp, in our state. We took a little bit of a different pathway00:01:09.981 --> 00:01:11.121from some of the other states.00:01:11.281 --> 00:01:14.521Most states have started with protections, and we started with transparency.00:01:14.961 --> 00:01:18.941We were a little bit different there, too, where we started more along the lines00:01:18.941 --> 00:01:22.141of the American Hospital Association, good stewardship principles,00:01:22.141 --> 00:01:27.321more with a narrative and a calculation that focused on, you know,00:01:27.341 --> 00:01:28.981what was that true 340B savings?00:01:29.161 --> 00:01:33.501So the difference between what we would have paid on 340B and what we would00:01:33.501 --> 00:01:35.661have paid if we bought the drug at a traditional price.00:01:35.761 --> 00:01:40.521So a little bit unusual, but we've had an evolution that we'll talk about during the conversation.00:01:40.761 --> 00:01:45.621Ohio actually is going to end up following the same pathway.00:01:45.941 --> 00:01:50.101We originally had a contract pharmacy bill in the last session,00:01:50.101 --> 00:01:51.881but it didn't go anywhere.00:01:52.061 --> 00:01:59.301And then a unique thing happened, and I think this is a great topic to talk about within advocacy.00:01:59.581 --> 00:02:06.441It's a place people don't think about. We didn't have a provider transparency bill that was passed.00:02:06.641 --> 00:02:13.141As part of our budget process, our House version had nothing involving 340B transparency.00:02:13.481 --> 00:02:18.321Then, the Senate version came out with language for hospitals only.00:02:18.761 --> 00:02:19.801It went to conference committees, 00:02:20.042 --> 00:02:23.842and that's when they take both versions00:02:23.842 --> 00:02:27.122of the bill, the Senate version and House version, and they blend them together.00:02:27.302 --> 00:02:33.642When they did that at like 11 o'clock at night, they changed hospital to covered00:02:33.642 --> 00:02:35.882entity. So it now applies to everyone.00:02:36.162 --> 00:02:41.042We're in a similar boat where we're starting with transparency that starts next July,00:02:41.362 --> 00:02:47.382but we still have a contract pharmacy bill live and will possibly pass this session.00:02:47.382 --> 00:02:52.802We're hoping that we can get it passed and that I'm kind of viewing this00:02:52.802 --> 00:02:59.022in glass half full and that these transparency requirements can actually help00:02:59.022 --> 00:03:04.802us in where there's less accusations that the 340B program is opaque.00:03:04.802 --> 00:03:08.822Yeah, we definitely have had success with that in Maine.00:03:08.842 --> 00:03:14.002It was funny, our experience was that we passed the transparency legislation.00:03:14.302 --> 00:03:19.942Then the following year, we were working on our contract pharmacy protections00:03:19.942 --> 00:03:23.582and did not anticipate this.00:03:23.582 --> 00:03:28.242As we were doing our testimony for moving forward with the contract pharmacy00:03:28.242 --> 00:03:33.822protections, we had calls for more transparency, more transparency.00:03:33.822 --> 00:03:37.522We had not gotten through that. We haven't even got a report yet.00:03:37.782 --> 00:03:42.022We had not gotten through our first reporting, so it was well played.00:03:42.022 --> 00:03:46.922They did get more transparency added to our transparency reporting.00:03:47.102 --> 00:03:53.072They'll be updating now. Now ours looks both like Maine did originally,00:03:53.092 --> 00:03:55.032but adding some of the Minnesota measures.00:03:55.412 --> 00:03:59.412So looking at not just what the true savings are on what we're purchasing,00:03:59.612 --> 00:04:03.232but also adding in that margin that any retail pharmacy would have.00:04:03.232 --> 00:04:04.852So what did you sell the drug for?00:04:04.972 --> 00:04:09.532And then minusing your 340B cost from that. So it does inflate the 340B savings00:04:09.532 --> 00:04:14.032to add in a retail pharmacy margin, but then do reporting with those numbers.00:04:14.052 --> 00:04:18.292We were able to move the contract pharmacy protection process.00:04:18.917 --> 00:04:23.417A lot of it had to do with the fact that we were both protecting the state's00:04:23.417 --> 00:04:26.937safety net providers and also being transparent about what was going on.00:04:27.337 --> 00:04:31.897You mentioned Minnesota. That's the one transparency00:04:31.897 --> 00:04:35.737report that we've actually seen come out.00:04:35.797 --> 00:04:40.037So let's talk about that a little bit, and what we saw ther,e and the nuances00:04:40.037 --> 00:04:46.517with it. I would say a lot of information, but it's unclear if there's been a lot of action from it.00:04:46.617 --> 00:04:51.877I personally refer to a lot of what's coming out of these state transparency00:04:51.877 --> 00:04:55.517bills as state-funded pharma research, which is unfortunate, right?00:04:55.597 --> 00:04:59.617We do want to be transparent with what's happening in our 340B Program,00:04:59.617 --> 00:05:03.277but many of the states are not asking for narratives.00:05:03.357 --> 00:05:08.397They are asking about the numbers, but they don't tell the full story.00:05:08.537 --> 00:05:12.617Minnesota is one of those states where they've gotten lots of numbers,00:05:12.617 --> 00:05:17.317but no actual information from the covered entities coming back about the true00:05:17.317 --> 00:05:19.457importance of their 340B Programs.00:05:19.637 --> 00:05:24.137I think that's challenging for state legislators and administrators because00:05:24.137 --> 00:05:29.657they're dealing with so many topics. They don't understand the nuances00:05:29.657 --> 00:05:34.137of 340B, so getting the information from the00:05:34.419 --> 00:05:37.839the numbers is not going to make sense to them.00:05:37.999 --> 00:05:42.539I think that I'd much rather see when these bills go through,00:05:42.599 --> 00:05:46.839I'd much rather see a narrative be added to it if it's going to be there.00:05:47.439 --> 00:05:52.199When we see these come out, I think that's important when you're talking00:05:52.199 --> 00:05:57.579to legislators that you have a bill that's proposed, that you explain that this00:05:57.579 --> 00:05:59.759data doesn't mean much without context.00:05:59.759 --> 00:06:02.739It's very much like healthcare, right? What are we testing for?00:06:03.299 --> 00:06:06.619What are the results that we need to see, right?00:06:06.699 --> 00:06:10.359If you want to understand what the 340B Program is doing,00:06:10.779 --> 00:06:13.039numbers aren't going to tell the whole story.00:06:13.379 --> 00:06:16.559You have to have the narrative to go with it.00:06:16.559 --> 00:06:21.519In those transparency bills, it's really important that we have an opportunity00:06:21.519 --> 00:06:26.919to explain along with the numbers so that the legislators can understand,00:06:27.119 --> 00:06:30.359so that it becomes something meaningful and usable, right?00:06:30.419 --> 00:06:35.199If you just get a list of lab tests coming back, and you don't have the report00:06:35.199 --> 00:06:39.479that comes back from the doctor to go with it, it's not meaningful to you as a patient.00:06:39.479 --> 00:06:43.179That's very much what we're seeing in the states that are getting their reports00:06:43.179 --> 00:06:47.979back, that aren't having that narrative coming in from the covered entities00:06:47.979 --> 00:06:49.919to help with that explanation.00:06:50.219 --> 00:06:53.379We're really thinking about that.00:06:53.519 --> 00:06:58.299The other piece that we're thinking about, too, is that there are other stakeholders00:06:58.299 --> 00:07:02.359in the 340B Program who have opportunities to be transparent.00:07:02.359 --> 00:07:09.859Big kudos to Michigan, who introduced in their transparency bill this00:07:09.859 --> 00:07:14.899year, some manufacturer transparency and something for us all to think about, right?00:07:15.039 --> 00:07:19.159Because as the manufacturers are restricting the 340B Program,00:07:19.159 --> 00:07:23.719as they are pulling back those savings from the safety net in each of our states,00:07:23.959 --> 00:07:27.379where are they reinvesting? Where are those dollars going?00:07:27.659 --> 00:07:30.479I think that's00:07:31.106 --> 00:07:36.526only fair. We are equal, covered entities are equal stakeholders with manufacturers.00:07:36.786 --> 00:07:40.326So what's good for the goose is good for the gander. Yeah, we would love to00:07:40.326 --> 00:07:44.506see states having transparency measures to get explanations of,00:07:44.586 --> 00:07:49.766what is that savings now going towards? How are you supporting our communities?00:07:50.006 --> 00:07:53.526How are you expanding care for our patients? Letting us know,00:07:53.706 --> 00:07:58.486what are you now spending in our state to create access for our communities?00:07:58.486 --> 00:08:01.286Also, what are you spending on your marketing?00:08:01.526 --> 00:08:07.466What does it cost to manufacture these drugs, right? So let's have transparency all around.00:08:07.686 --> 00:08:10.346We're very much in support of transparency,00:08:10.346 --> 00:08:13.506but we think that it's important to have it for both parties.00:08:14.407 --> 00:08:18.927To build on that, what we've seen is that with the data from the Office of Pharmacy00:08:18.927 --> 00:08:21.647Affairs and the audits that they've been doing,00:08:22.127 --> 00:08:27.127manufacturers actually have a three times higher rate of repayment on audits00:08:27.127 --> 00:08:32.927to the covered entities than the covered entities do to manufacturers when there are audit findings.00:08:33.607 --> 00:08:38.207We recently just saw a manufacturer that was overcharging for the entire00:08:38.207 --> 00:08:39.987length of the 340B Program.00:08:40.147 --> 00:08:44.287Yeah, and that's disheartening, right? So from the very beginning of their participation00:08:44.287 --> 00:08:47.167in the program for the medications that they were supplying,00:08:47.387 --> 00:08:50.667they did not calculate the 340B price correctly.00:08:51.107 --> 00:08:53.907They had major repayments that they had to do.00:08:54.027 --> 00:08:58.147They went back just a little over a decade. For the rest of the time,00:08:58.307 --> 00:09:00.987which we've been in the 340B program for over three decades,00:09:01.387 --> 00:09:05.687it was, if you would like the rest of this money, please calculate it yourself and let us know.00:09:06.087 --> 00:09:11.027We, as covered entities, are held to a very high threshold.00:09:11.027 --> 00:09:17.787We believe that the transparency measures are important and should go all around.00:09:18.027 --> 00:09:22.467I would say another area that could be included in that would be the pharmacy benefit00:09:22.467 --> 00:09:28.187managers or PBM, because we're hearing more and more about their participation00:09:28.187 --> 00:09:30.687in the program and taking those savings.00:09:30.907 --> 00:09:34.827I think that would be fair as well to add. 00:09:34.947 --> 00:09:39.047We hear a lot of stories about PBMs coming in and saying what the program will00:09:39.047 --> 00:09:42.787cost if the contract pharmacy restrictions are lifted.00:09:42.947 --> 00:09:48.247Every time we ask the question, has the state seen savings00:09:48.247 --> 00:09:51.607in the last few years when the restrictions have been in place?00:09:51.607 --> 00:09:56.607Every time we ask that question, the answer has been no. It's curious that00:09:56.607 --> 00:10:01.747it will cost us more if we remove them, but we didn't save one when they were00:10:01.747 --> 00:10:04.007in place. So how does that work?00:10:04.187 --> 00:10:08.567That's the same for employers, too. They're using that same argument00:10:08.567 --> 00:10:13.027with employers that 340B makes your costs go up because you get less00:10:13.027 --> 00:10:16.387rebates, but we haven't seen their costs go down in the last five years with00:10:16.387 --> 00:10:18.207contract pharmacy restrictions. 00:10:18.449 --> 00:10:22.669It's been significant if you look at our contract pharmacy savings that00:10:22.669 --> 00:10:24.149covered entities are noticing.00:10:24.469 --> 00:10:28.569I do think that there's opportunities for transparency for all of the00:10:28.569 --> 00:10:29.829participants in the program.00:10:30.209 --> 00:10:34.169I think this is something to explore as you work on your advocacy.00:10:34.569 --> 00:10:40.349I do think it's good for us just to talk a little bit about advocacy in general,00:10:40.609 --> 00:10:48.729It's an ongoing conversation, and it's really important to be prepared when you go in.00:10:49.089 --> 00:10:54.629Yeah, exactly. What would you say if a state is coming up with advocacy00:10:54.629 --> 00:11:00.909or with a provider reporting bill, what would the advocacy discussion points,00:11:00.949 --> 00:11:02.849would you go and talk about it?00:11:02.949 --> 00:11:08.429I think what comes to mind for me is what transparency do we already have in00:11:08.429 --> 00:11:15.089place as covered entities? Yeah, and so that is something we really leveraged in Maine. 00:11:15.677 --> 00:11:19.297We talked a lot about that, right? We were able to keep the federally qualified00:11:19.297 --> 00:11:23.017health centers out of the reporting requirements because we talked about what00:11:23.017 --> 00:11:26.957we were reporting in UDS, and with our fiscal audits that we have to do annually.00:11:27.257 --> 00:11:32.277Also thinking about what is meaningful and really articulating that,00:11:32.777 --> 00:11:36.537making sure that you have the narrative in there as well, creating a strong00:11:36.537 --> 00:11:39.577coalition without creating division, right?00:11:39.657 --> 00:11:43.897We worked with the health centers and the other grantees, who work closely with the hospital.00:11:44.097 --> 00:11:49.237Even though we were able to articulate the nuances of the health centers,00:11:49.457 --> 00:11:55.177it was never in a conversation that was disparaging to another covered entity00:11:55.177 --> 00:11:56.717type. They weren't throwing them under the bus.00:11:56.957 --> 00:12:02.317This makes us unique, but no, never that this makes somebody else,00:12:02.317 --> 00:12:07.757you know, less a participant of this program, right?00:12:08.117 --> 00:12:11.817It's just that this is our federal obligation, so this is why we're doing00:12:11.817 --> 00:12:15.757this and helping others highlight how they show as well.00:12:15.937 --> 00:12:21.057I think that fiscal audit, that was something I didn't think about at first.00:12:21.057 --> 00:12:28.617I always bring up UDS, but our fiscal audit is reported to the federal government. It's published.00:12:29.057 --> 00:12:33.337Anyone can go pull up a fiscal audit from a health center,00:12:33.357 --> 00:12:37.137and it's proving that we're using the funds to meet the mission of the health center.00:12:37.137 --> 00:12:40.217We, as health centers, have a lot of transparency already.00:12:40.217 --> 00:12:46.297We have been successful in a number of states by articulating that to be able to00:12:46.657 --> 00:12:51.917support transparency, but say that we already have extensive transparency reporting,00:12:51.917 --> 00:12:54.617so we have been able to be exempted from the state requirements.00:12:54.617 --> 00:12:57.477Because again, like you said, we're already publicly published.00:12:57.817 --> 00:13:02.577Then from there, just making sure that as we're having these conversations,00:13:02.577 --> 00:13:06.757that there is a focus on yes, okay, we're having transparency, but if00:13:07.125 --> 00:13:10.345we don't have protections in the state for the contract pharmacy,00:13:10.505 --> 00:13:13.245how does this feed into that conversation as well?00:13:13.365 --> 00:13:17.725Using every moment of advocacy to help move things forward as well.00:13:17.845 --> 00:13:20.285We are fully in support of transparency.00:13:20.865 --> 00:13:24.125Here's how we're doing it. Here's what the program means to our community.00:13:24.325 --> 00:13:29.225Also, here's what the contraction of the program has meant to the community.00:13:29.385 --> 00:13:31.825How do we continue to work together? 00:13:32.065 --> 00:13:36.685I think if you have one of these bills coming up, talking about the transparency00:13:36.685 --> 00:13:41.865that we already do, being supportive of transparency is a good thing.00:13:42.085 --> 00:13:45.765We see that benefit, but we're already doing it.00:13:45.885 --> 00:13:50.545So talking about the workforce requirements, but then also talking about how00:13:50.545 --> 00:13:57.265if we're transparent, then we should be able to open that contract pharmacy access back up.00:13:57.265 --> 00:14:04.645So really talking about the impact there and how it's hurting your patients,00:14:04.785 --> 00:14:05.645which are their constituents.00:14:06.756 --> 00:14:12.296I think that's all, the whole thing is talking about how it affects the constituents.00:14:12.576 --> 00:14:16.116At the end of the day, it's the patients who are missing out.00:14:16.256 --> 00:14:19.296One of the things that was most disheartening to me,00:14:19.416 --> 00:14:23.276just as we're wrapping up, is when we were down in the state house doing00:14:23.276 --> 00:14:27.176testimony, people from different groups who were coming00:14:27.176 --> 00:14:30.076in and saying that this hasn't hurt patients.00:14:30.756 --> 00:14:38.076I was flabbergasted, and I have no poker face, so I was told not to sit in front of the camera.00:14:38.256 --> 00:14:42.996That was for a reason, because I'm sure I was all sorts of everything.00:14:43.356 --> 00:14:46.956I can't tell you, how many patients and we're,00:14:47.116 --> 00:14:53.756a step removed as consultants, how many calls we receive as the consultant,00:14:54.056 --> 00:14:58.396from our covered entities saying, we can't get this medication for our00:14:58.396 --> 00:15:02.296patients, even those from contract pharmacies, for the covered entities we work with.00:15:02.376 --> 00:15:08.456What are we supposed to do about a regular restriction00:15:08.456 --> 00:15:11.936comes in, how are we supposed to deal with this? How are we supposed to deal with this?00:15:12.056 --> 00:15:17.656Patients are being impacted because, yes, the medication is at the pharmacy,00:15:17.836 --> 00:15:21.796but especially with where we work, which is with the FQHCs.00:15:22.348 --> 00:15:27.028We were previously passing on that 340B price to the patients.00:15:27.028 --> 00:15:32.368If that's not at the pharmacy, we can't pass that on, which means the patient's00:15:32.368 --> 00:15:36.948not able to afford their medication. They're having to make hard choices00:15:36.948 --> 00:15:41.668about what will they afford that month, or will they even take that medication home with them?00:15:41.788 --> 00:15:45.968So lots of changes, lots of impact.00:15:45.968 --> 00:15:52.668To hear people come in and testify that this has not had harm was so00:15:52.668 --> 00:15:58.788disheartening and one of the reasons that we worked so hard as our coalition to move this forward.00:15:59.028 --> 00:16:04.968I think that's a great point to end on, and that if you're getting started with advocacy,00:16:05.348 --> 00:16:09.808one of the easiest ways to do it is to just go in, talk about your patients,00:16:10.048 --> 00:16:14.748talk about the impact of whatever the bill is and how it's going to affect your00:16:14.748 --> 00:16:16.128patients, because that's easy.00:16:16.328 --> 00:16:18.728That's what covered entities do so well.00:16:19.328 --> 00:16:22.128That's why we're doing this. Yeah, it's a great way to start.