How is provider reporting evolving in today’s 340B environment? Recorded live from the conference floor, this episode of 340Banter brings together co-host Logan Yoho and guest co-host Felicity Homsted to unpack the shifting landscape that covered entities are facing. From new reporting requirements to the impact of technology and data management.
Felicity Homsted works with health centers across the country to manage and improve their 340B and pharmacy programs. Felicity is the creator and host of 340B Ladies Who Lunch and Learn Webinar Series, for women in 340B to learn, grown and build community. Dr. Homsted is also a Co-Lead Investigator for the National Institute on Drug Abuse - Clinical Trials Network Research Study CTN-0116: Pharmacist-Integrated Collaborative Model of Medication Treatment for Opioid Use Disorder.
Prior to transitioning into the consulting space to support more entities nationally, Dr. Homsted was Chief Pharmacy Officer for Penobscot Community Health Center, Maine’s largest FQHC. She was responsible for the administration of four pharmacies, integrated pharmacy services, and two accredited pharmacy residency programs. She served as Subject Matter Expert for the Apexus 340B Prime Vendor Program, Apexus 340B University Faculty, and Apexus 340B Operations Certificate modules author.
00:00:00.017 --> 00:00:05.377
Today on 340 Banter, we're live from the 340B Midwest Regional Conference.
00:00:05.777 --> 00:00:10.457
I'm joined by Felicity. Chelsea couldn't be with us today, but today we want
00:00:10.457 --> 00:00:15.377
to talk a little bit about what we've been seeing in the states around provider reporting.
00:00:15.797 --> 00:00:21.117
I know both of our states, Maine and Ohio, have seen quite a bit of changes
00:00:21.117 --> 00:00:24.897
here recently. Let's talk about what we're really seeing with that.
00:00:45.041 --> 00:00:49.121
Awesome. Thank you for having me here. It has been wonderful to make the
00:00:49.121 --> 00:00:53.521
trip from Maine, and I did not have any trouble with my flight. So that was amazing.
00:00:53.801 --> 00:00:59.421
We have had a lot of work around 340B lately in Maine.
00:00:59.641 --> 00:01:03.921
We were a little bit late starting, and we started with transparency,
00:01:04.221 --> 00:01:09.981
womp womp, in our state. We took a little bit of a different pathway
00:01:09.981 --> 00:01:11.121
from some of the other states.
00:01:11.281 --> 00:01:14.521
Most states have started with protections, and we started with transparency.
00:01:14.961 --> 00:01:18.941
We were a little bit different there, too, where we started more along the lines
00:01:18.941 --> 00:01:22.141
of the American Hospital Association, good stewardship principles,
00:01:22.141 --> 00:01:27.321
more with a narrative and a calculation that focused on, you know,
00:01:27.341 --> 00:01:28.981
what was that true 340B savings?
00:01:29.161 --> 00:01:33.501
So the difference between what we would have paid on 340B and what we would
00:01:33.501 --> 00:01:35.661
have paid if we bought the drug at a traditional price.
00:01:35.761 --> 00:01:40.521
So a little bit unusual, but we've had an evolution that we'll talk about during the conversation.
00:01:40.761 --> 00:01:45.621
Ohio actually is going to end up following the same pathway.
00:01:45.941 --> 00:01:50.101
We originally had a contract pharmacy bill in the last session,
00:01:50.101 --> 00:01:51.881
but it didn't go anywhere.
00:01:52.061 --> 00:01:59.301
And then a unique thing happened, and I think this is a great topic to talk about within advocacy.
00:01:59.581 --> 00:02:06.441
It's a place people don't think about. We didn't have a provider transparency bill that was passed.
00:02:06.641 --> 00:02:13.141
As part of our budget process, our House version had nothing involving 340B transparency.
00:02:13.481 --> 00:02:18.321
Then, the Senate version came out with language for hospitals only.
00:02:18.761 --> 00:02:19.801
It went to conference committees,
00:02:20.042 --> 00:02:23.842
and that's when they take both versions
00:02:23.842 --> 00:02:27.122
of the bill, the Senate version and House version, and they blend them together.
00:02:27.302 --> 00:02:33.642
When they did that at like 11 o'clock at night, they changed hospital to covered
00:02:33.642 --> 00:02:35.882
entity. So it now applies to everyone.
00:02:36.162 --> 00:02:41.042
We're in a similar boat where we're starting with transparency that starts next July,
00:02:41.362 --> 00:02:47.382
but we still have a contract pharmacy bill live and will possibly pass this session.
00:02:47.382 --> 00:02:52.802
We're hoping that we can get it passed and that I'm kind of viewing this
00:02:52.802 --> 00:02:59.022
in glass half full and that these transparency requirements can actually help
00:02:59.022 --> 00:03:04.802
us in where there's less accusations that the 340B program is opaque.
00:03:04.802 --> 00:03:08.822
Yeah, we definitely have had success with that in Maine.
00:03:08.842 --> 00:03:14.002
It was funny, our experience was that we passed the transparency legislation.
00:03:14.302 --> 00:03:19.942
Then the following year, we were working on our contract pharmacy protections
00:03:19.942 --> 00:03:23.582
and did not anticipate this.
00:03:23.582 --> 00:03:28.242
As we were doing our testimony for moving forward with the contract pharmacy
00:03:28.242 --> 00:03:33.822
protections, we had calls for more transparency, more transparency.
00:03:33.822 --> 00:03:37.522
We had not gotten through that. We haven't even got a report yet.
00:03:37.782 --> 00:03:42.022
We had not gotten through our first reporting, so it was well played.
00:03:42.022 --> 00:03:46.922
They did get more transparency added to our transparency reporting.
00:03:47.102 --> 00:03:53.072
They'll be updating now. Now ours looks both like Maine did originally,
00:03:53.092 --> 00:03:55.032
but adding some of the Minnesota measures.
00:03:55.412 --> 00:03:59.412
So looking at not just what the true savings are on what we're purchasing,
00:03:59.612 --> 00:04:03.232
but also adding in that margin that any retail pharmacy would have.
00:04:03.232 --> 00:04:04.852
So what did you sell the drug for?
00:04:04.972 --> 00:04:09.532
And then minusing your 340B cost from that. So it does inflate the 340B savings
00:04:09.532 --> 00:04:14.032
to add in a retail pharmacy margin, but then do reporting with those numbers.
00:04:14.052 --> 00:04:18.292
We were able to move the contract pharmacy protection process.
00:04:18.917 --> 00:04:23.417
A lot of it had to do with the fact that we were both protecting the state's
00:04:23.417 --> 00:04:26.937
safety net providers and also being transparent about what was going on.
00:04:27.337 --> 00:04:31.897
You mentioned Minnesota. That's the one transparency
00:04:31.897 --> 00:04:35.737
report that we've actually seen come out.
00:04:35.797 --> 00:04:40.037
So let's talk about that a little bit, and what we saw ther,e and the nuances
00:04:40.037 --> 00:04:46.517
with 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 --> 00:04:51.877
I personally refer to a lot of what's coming out of these state transparency
00:04:51.877 --> 00:04:55.517
bills as state-funded pharma research, which is unfortunate, right?
00:04:55.597 --> 00:04:59.617
We do want to be transparent with what's happening in our 340B Program,
00:04:59.617 --> 00:05:03.277
but many of the states are not asking for narratives.
00:05:03.357 --> 00:05:08.397
They are asking about the numbers, but they don't tell the full story.
00:05:08.537 --> 00:05:12.617
Minnesota is one of those states where they've gotten lots of numbers,
00:05:12.617 --> 00:05:17.317
but no actual information from the covered entities coming back about the true
00:05:17.317 --> 00:05:19.457
importance of their 340B Programs.
00:05:19.637 --> 00:05:24.137
I think that's challenging for state legislators and administrators because
00:05:24.137 --> 00:05:29.657
they're dealing with so many topics. They don't understand the nuances
00:05:29.657 --> 00:05:34.137
of 340B, so getting the information from the
00:05:34.419 --> 00:05:37.839
the numbers is not going to make sense to them.
00:05:37.999 --> 00:05:42.539
I think that I'd much rather see when these bills go through,
00:05:42.599 --> 00:05:46.839
I'd much rather see a narrative be added to it if it's going to be there.
00:05:47.439 --> 00:05:52.199
When we see these come out, I think that's important when you're talking
00:05:52.199 --> 00:05:57.579
to legislators that you have a bill that's proposed, that you explain that this
00:05:57.579 --> 00:05:59.759
data doesn't mean much without context.
00:05:59.759 --> 00:06:02.739
It's very much like healthcare, right? What are we testing for?
00:06:03.299 --> 00:06:06.619
What are the results that we need to see, right?
00:06:06.699 --> 00:06:10.359
If you want to understand what the 340B Program is doing,
00:06:10.779 --> 00:06:13.039
numbers aren't going to tell the whole story.
00:06:13.379 --> 00:06:16.559
You have to have the narrative to go with it.
00:06:16.559 --> 00:06:21.519
In those transparency bills, it's really important that we have an opportunity
00:06:21.519 --> 00:06:26.919
to explain along with the numbers so that the legislators can understand,
00:06:27.119 --> 00:06:30.359
so that it becomes something meaningful and usable, right?
00:06:30.419 --> 00:06:35.199
If you just get a list of lab tests coming back, and you don't have the report
00:06:35.199 --> 00:06:39.479
that comes back from the doctor to go with it, it's not meaningful to you as a patient.
00:06:39.479 --> 00:06:43.179
That's very much what we're seeing in the states that are getting their reports
00:06:43.179 --> 00:06:47.979
back, that aren't having that narrative coming in from the covered entities
00:06:47.979 --> 00:06:49.919
to help with that explanation.
00:06:50.219 --> 00:06:53.379
We're really thinking about that.
00:06:53.519 --> 00:06:58.299
The other piece that we're thinking about, too, is that there are other stakeholders
00:06:58.299 --> 00:07:02.359
in the 340B Program who have opportunities to be transparent.
00:07:02.359 --> 00:07:09.859
Big kudos to Michigan, who introduced in their transparency bill this
00:07:09.859 --> 00:07:14.899
year, some manufacturer transparency and something for us all to think about, right?
00:07:15.039 --> 00:07:19.159
Because as the manufacturers are restricting the 340B Program,
00:07:19.159 --> 00:07:23.719
as they are pulling back those savings from the safety net in each of our states,
00:07:23.959 --> 00:07:27.379
where are they reinvesting? Where are those dollars going?
00:07:27.659 --> 00:07:30.479
I think that's
00:07:31.106 --> 00:07:36.526
only fair. We are equal, covered entities are equal stakeholders with manufacturers.
00:07:36.786 --> 00:07:40.326
So what's good for the goose is good for the gander. Yeah, we would love to
00:07:40.326 --> 00:07:44.506
see states having transparency measures to get explanations of,
00:07:44.586 --> 00:07:49.766
what is that savings now going towards? How are you supporting our communities?
00:07:50.006 --> 00:07:53.526
How are you expanding care for our patients? Letting us know,
00:07:53.706 --> 00:07:58.486
what are you now spending in our state to create access for our communities?
00:07:58.486 --> 00:08:01.286
Also, what are you spending on your marketing?
00:08:01.526 --> 00:08:07.466
What does it cost to manufacture these drugs, right? So let's have transparency all around.
00:08:07.686 --> 00:08:10.346
We're very much in support of transparency,
00:08:10.346 --> 00:08:13.506
but we think that it's important to have it for both parties.
00:08:14.407 --> 00:08:18.927
To build on that, what we've seen is that with the data from the Office of Pharmacy
00:08:18.927 --> 00:08:21.647
Affairs and the audits that they've been doing,
00:08:22.127 --> 00:08:27.127
manufacturers actually have a three times higher rate of repayment on audits
00:08:27.127 --> 00:08:32.927
to the covered entities than the covered entities do to manufacturers when there are audit findings.
00:08:33.607 --> 00:08:38.207
We recently just saw a manufacturer that was overcharging for the entire
00:08:38.207 --> 00:08:39.987
length of the 340B Program.
00:08:40.147 --> 00:08:44.287
Yeah, and that's disheartening, right? So from the very beginning of their participation
00:08:44.287 --> 00:08:47.167
in the program for the medications that they were supplying,
00:08:47.387 --> 00:08:50.667
they did not calculate the 340B price correctly.
00:08:51.107 --> 00:08:53.907
They had major repayments that they had to do.
00:08:54.027 --> 00:08:58.147
They went back just a little over a decade. For the rest of the time,
00:08:58.307 --> 00:09:00.987
which we've been in the 340B program for over three decades,
00:09:01.387 --> 00:09:05.687
it was, if you would like the rest of this money, please calculate it yourself and let us know.
00:09:06.087 --> 00:09:11.027
We, as covered entities, are held to a very high threshold.
00:09:11.027 --> 00:09:17.787
We believe that the transparency measures are important and should go all around.
00:09:18.027 --> 00:09:22.467
I would say another area that could be included in that would be the pharmacy benefit
00:09:22.467 --> 00:09:28.187
managers or PBM, because we're hearing more and more about their participation
00:09:28.187 --> 00:09:30.687
in the program and taking those savings.
00:09:30.907 --> 00:09:34.827
I think that would be fair as well to add.
00:09:34.947 --> 00:09:39.047
We hear a lot of stories about PBMs coming in and saying what the program will
00:09:39.047 --> 00:09:42.787
cost if the contract pharmacy restrictions are lifted.
00:09:42.947 --> 00:09:48.247
Every time we ask the question, has the state seen savings
00:09:48.247 --> 00:09:51.607
in the last few years when the restrictions have been in place?
00:09:51.607 --> 00:09:56.607
Every time we ask that question, the answer has been no. It's curious that
00:09:56.607 --> 00:10:01.747
it will cost us more if we remove them, but we didn't save one when they were
00:10:01.747 --> 00:10:04.007
in place. So how does that work?
00:10:04.187 --> 00:10:08.567
That's the same for employers, too. They're using that same argument
00:10:08.567 --> 00:10:13.027
with employers that 340B makes your costs go up because you get less
00:10:13.027 --> 00:10:16.387
rebates, but we haven't seen their costs go down in the last five years with
00:10:16.387 --> 00:10:18.207
contract pharmacy restrictions.
00:10:18.449 --> 00:10:22.669
It's been significant if you look at our contract pharmacy savings that
00:10:22.669 --> 00:10:24.149
covered entities are noticing.
00:10:24.469 --> 00:10:28.569
I do think that there's opportunities for transparency for all of the
00:10:28.569 --> 00:10:29.829
participants in the program.
00:10:30.209 --> 00:10:34.169
I think this is something to explore as you work on your advocacy.
00:10:34.569 --> 00:10:40.349
I do think it's good for us just to talk a little bit about advocacy in general,
00:10:40.609 --> 00:10:48.729
It's an ongoing conversation, and it's really important to be prepared when you go in.
00:10:49.089 --> 00:10:54.629
Yeah, exactly. What would you say if a state is coming up with advocacy
00:10:54.629 --> 00:11:00.909
or with a provider reporting bill, what would the advocacy discussion points,
00:11:00.949 --> 00:11:02.849
would you go and talk about it?
00:11:02.949 --> 00:11:08.429
I think what comes to mind for me is what transparency do we already have in
00:11:08.429 --> 00:11:15.089
place as covered entities? Yeah, and so that is something we really leveraged in Maine.
00:11:15.677 --> 00:11:19.297
We talked a lot about that, right? We were able to keep the federally qualified
00:11:19.297 --> 00:11:23.017
health centers out of the reporting requirements because we talked about what
00:11:23.017 --> 00:11:26.957
we were reporting in UDS, and with our fiscal audits that we have to do annually.
00:11:27.257 --> 00:11:32.277
Also thinking about what is meaningful and really articulating that,
00:11:32.777 --> 00:11:36.537
making sure that you have the narrative in there as well, creating a strong
00:11:36.537 --> 00:11:39.577
coalition without creating division, right?
00:11:39.657 --> 00:11:43.897
We worked with the health centers and the other grantees, who work closely with the hospital.
00:11:44.097 --> 00:11:49.237
Even though we were able to articulate the nuances of the health centers,
00:11:49.457 --> 00:11:55.177
it was never in a conversation that was disparaging to another covered entity
00:11:55.177 --> 00:11:56.717
type. They weren't throwing them under the bus.
00:11:56.957 --> 00:12:02.317
This makes us unique, but no, never that this makes somebody else,
00:12:02.317 --> 00:12:07.757
you know, less a participant of this program, right?
00:12:08.117 --> 00:12:11.817
It's just that this is our federal obligation, so this is why we're doing
00:12:11.817 --> 00:12:15.757
this and helping others highlight how they show as well.
00:12:15.937 --> 00:12:21.057
I think that fiscal audit, that was something I didn't think about at first.
00:12:21.057 --> 00:12:28.617
I always bring up UDS, but our fiscal audit is reported to the federal government. It's published.
00:12:29.057 --> 00:12:33.337
Anyone can go pull up a fiscal audit from a health center,
00:12:33.357 --> 00:12:37.137
and it's proving that we're using the funds to meet the mission of the health center.
00:12:37.137 --> 00:12:40.217
We, as health centers, have a lot of transparency already.
00:12:40.217 --> 00:12:46.297
We have been successful in a number of states by articulating that to be able to
00:12:46.657 --> 00:12:51.917
support transparency, but say that we already have extensive transparency reporting,
00:12:51.917 --> 00:12:54.617
so we have been able to be exempted from the state requirements.
00:12:54.617 --> 00:12:57.477
Because again, like you said, we're already publicly published.
00:12:57.817 --> 00:13:02.577
Then from there, just making sure that as we're having these conversations,
00:13:02.577 --> 00:13:06.757
that there is a focus on yes, okay, we're having transparency, but if
00:13:07.125 --> 00:13:10.345
we don't have protections in the state for the contract pharmacy,
00:13:10.505 --> 00:13:13.245
how does this feed into that conversation as well?
00:13:13.365 --> 00:13:17.725
Using every moment of advocacy to help move things forward as well.
00:13:17.845 --> 00:13:20.285
We are fully in support of transparency.
00:13:20.865 --> 00:13:24.125
Here's how we're doing it. Here's what the program means to our community.
00:13:24.325 --> 00:13:29.225
Also, here's what the contraction of the program has meant to the community.
00:13:29.385 --> 00:13:31.825
How do we continue to work together?
00:13:32.065 --> 00:13:36.685
I think if you have one of these bills coming up, talking about the transparency
00:13:36.685 --> 00:13:41.865
that we already do, being supportive of transparency is a good thing.
00:13:42.085 --> 00:13:45.765
We see that benefit, but we're already doing it.
00:13:45.885 --> 00:13:50.545
So talking about the workforce requirements, but then also talking about how
00:13:50.545 --> 00:13:57.265
if we're transparent, then we should be able to open that contract pharmacy access back up.
00:13:57.265 --> 00:14:04.645
So really talking about the impact there and how it's hurting your patients,
00:14:04.785 --> 00:14:05.645
which are their constituents.
00:14:06.756 --> 00:14:12.296
I think that's all, the whole thing is talking about how it affects the constituents.
00:14:12.576 --> 00:14:16.116
At the end of the day, it's the patients who are missing out.
00:14:16.256 --> 00:14:19.296
One of the things that was most disheartening to me,
00:14:19.416 --> 00:14:23.276
just as we're wrapping up, is when we were down in the state house doing
00:14:23.276 --> 00:14:27.176
testimony, people from different groups who were coming
00:14:27.176 --> 00:14:30.076
in and saying that this hasn't hurt patients.
00:14:30.756 --> 00:14:38.076
I was flabbergasted, and I have no poker face, so I was told not to sit in front of the camera.
00:14:38.256 --> 00:14:42.996
That was for a reason, because I'm sure I was all sorts of everything.
00:14:43.356 --> 00:14:46.956
I can't tell you, how many patients and we're,
00:14:47.116 --> 00:14:53.756
a step removed as consultants, how many calls we receive as the consultant,
00:14:54.056 --> 00:14:58.396
from our covered entities saying, we can't get this medication for our
00:14:58.396 --> 00:15:02.296
patients, even those from contract pharmacies, for the covered entities we work with.
00:15:02.376 --> 00:15:08.456
What are we supposed to do about a regular restriction
00:15:08.456 --> 00:15:11.936
comes in, how are we supposed to deal with this? How are we supposed to deal with this?
00:15:12.056 --> 00:15:17.656
Patients are being impacted because, yes, the medication is at the pharmacy,
00:15:17.836 --> 00:15:21.796
but especially with where we work, which is with the FQHCs.
00:15:22.348 --> 00:15:27.028
We were previously passing on that 340B price to the patients.
00:15:27.028 --> 00:15:32.368
If that's not at the pharmacy, we can't pass that on, which means the patient's
00:15:32.368 --> 00:15:36.948
not able to afford their medication. They're having to make hard choices
00:15:36.948 --> 00:15:41.668
about what will they afford that month, or will they even take that medication home with them?
00:15:41.788 --> 00:15:45.968
So lots of changes, lots of impact.
00:15:45.968 --> 00:15:52.668
To hear people come in and testify that this has not had harm was so
00:15:52.668 --> 00:15:58.788
disheartening and one of the reasons that we worked so hard as our coalition to move this forward.
00:15:59.028 --> 00:16:04.968
I think that's a great point to end on, and that if you're getting started with advocacy,
00:16:05.348 --> 00:16:09.808
one of the easiest ways to do it is to just go in, talk about your patients,
00:16:10.048 --> 00:16:14.748
talk about the impact of whatever the bill is and how it's going to affect your
00:16:14.748 --> 00:16:16.128
patients, because that's easy.
00:16:16.328 --> 00:16:18.728
That's what covered entities do so well.
00:16:19.328 --> 00:16:22.128
That's why we're doing this. Yeah, it's a great way to start.
Meet Logan Yoho, PharmD, BCACP, 340B ACE, and co-host of the 340Banter Podcast. With nearly a decade of experience in the 340B industry, Logan is dedicated to helping health centers optimize and maintain successful, compliant 340B Programs. As Director of Advocacy and Education at FQHC 340B Compliance, he focuses on implementing entity-owned pharmacies and guiding advocacy efforts for 340B. Logan’s extensive background includes leading the pharmacy and 340B programs at Hopewell Health Centers, serving as Apexus 340B University Faculty, and chairing the Ohio 340B FQHC Consortium. Logan’s leadership and expertise have earned him multiple awards, and he brings a wealth of knowledge to every episode of 340Banter.
Meet Chelsea Violette, PharmD, BCACP, 340B ACE, and your co-host for the 340Banter Podcast. With over a decade of experience in pharmacy and 340B Program management, Chelsea brings a wealth of knowledge to the table. As Chief Operating Officer at FQHC 340B Compliance, she works tirelessly to support health centers across the country, ensuring they have the tools and strategies they need to succeed. Chelsea’s hands-on experience as a 340B Consultant and Pharmacy Manager, combined with her expertise as a subject matter expert for the Apexus 340B Prime Vendor Program, makes her a trusted voice in the world of 340B compliance. Tune in for her practical insights, guidance, and lively discussions on all things 340B.
00:00:00.017 --> 00:00:05.377
Today on 340 Banter, we're live from the 340B Midwest Regional Conference.
00:00:05.777 --> 00:00:10.457
I'm joined by Felicity. Chelsea couldn't be with us today, but today we want
00:00:10.457 --> 00:00:15.377
to talk a little bit about what we've been seeing in the states around provider reporting.
00:00:15.797 --> 00:00:21.117
I know both of our states, Maine and Ohio, have seen quite a bit of changes
00:00:21.117 --> 00:00:24.897
here recently. Let's talk about what we're really seeing with that.
00:00:45.041 --> 00:00:49.121
Awesome. Thank you for having me here. It has been wonderful to make the
00:00:49.121 --> 00:00:53.521
trip from Maine, and I did not have any trouble with my flight. So that was amazing.
00:00:53.801 --> 00:00:59.421
We have had a lot of work around 340B lately in Maine.
00:00:59.641 --> 00:01:03.921
We were a little bit late starting, and we started with transparency,
00:01:04.221 --> 00:01:09.981
womp womp, in our state. We took a little bit of a different pathway
00:01:09.981 --> 00:01:11.121
from some of the other states.
00:01:11.281 --> 00:01:14.521
Most states have started with protections, and we started with transparency.
00:01:14.961 --> 00:01:18.941
We were a little bit different there, too, where we started more along the lines
00:01:18.941 --> 00:01:22.141
of the American Hospital Association, good stewardship principles,
00:01:22.141 --> 00:01:27.321
more with a narrative and a calculation that focused on, you know,
00:01:27.341 --> 00:01:28.981
what was that true 340B savings?
00:01:29.161 --> 00:01:33.501
So the difference between what we would have paid on 340B and what we would
00:01:33.501 --> 00:01:35.661
have paid if we bought the drug at a traditional price.
00:01:35.761 --> 00:01:40.521
So a little bit unusual, but we've had an evolution that we'll talk about during the conversation.
00:01:40.761 --> 00:01:45.621
Ohio actually is going to end up following the same pathway.
00:01:45.941 --> 00:01:50.101
We originally had a contract pharmacy bill in the last session,
00:01:50.101 --> 00:01:51.881
but it didn't go anywhere.
00:01:52.061 --> 00:01:59.301
And then a unique thing happened, and I think this is a great topic to talk about within advocacy.
00:01:59.581 --> 00:02:06.441
It's a place people don't think about. We didn't have a provider transparency bill that was passed.
00:02:06.641 --> 00:02:13.141
As part of our budget process, our House version had nothing involving 340B transparency.
00:02:13.481 --> 00:02:18.321
Then, the Senate version came out with language for hospitals only.
00:02:18.761 --> 00:02:19.801
It went to conference committees,
00:02:20.042 --> 00:02:23.842
and that's when they take both versions
00:02:23.842 --> 00:02:27.122
of the bill, the Senate version and House version, and they blend them together.
00:02:27.302 --> 00:02:33.642
When they did that at like 11 o'clock at night, they changed hospital to covered
00:02:33.642 --> 00:02:35.882
entity. So it now applies to everyone.
00:02:36.162 --> 00:02:41.042
We're in a similar boat where we're starting with transparency that starts next July,
00:02:41.362 --> 00:02:47.382
but we still have a contract pharmacy bill live and will possibly pass this session.
00:02:47.382 --> 00:02:52.802
We're hoping that we can get it passed and that I'm kind of viewing this
00:02:52.802 --> 00:02:59.022
in glass half full and that these transparency requirements can actually help
00:02:59.022 --> 00:03:04.802
us in where there's less accusations that the 340B program is opaque.
00:03:04.802 --> 00:03:08.822
Yeah, we definitely have had success with that in Maine.
00:03:08.842 --> 00:03:14.002
It was funny, our experience was that we passed the transparency legislation.
00:03:14.302 --> 00:03:19.942
Then the following year, we were working on our contract pharmacy protections
00:03:19.942 --> 00:03:23.582
and did not anticipate this.
00:03:23.582 --> 00:03:28.242
As we were doing our testimony for moving forward with the contract pharmacy
00:03:28.242 --> 00:03:33.822
protections, we had calls for more transparency, more transparency.
00:03:33.822 --> 00:03:37.522
We had not gotten through that. We haven't even got a report yet.
00:03:37.782 --> 00:03:42.022
We had not gotten through our first reporting, so it was well played.
00:03:42.022 --> 00:03:46.922
They did get more transparency added to our transparency reporting.
00:03:47.102 --> 00:03:53.072
They'll be updating now. Now ours looks both like Maine did originally,
00:03:53.092 --> 00:03:55.032
but adding some of the Minnesota measures.
00:03:55.412 --> 00:03:59.412
So looking at not just what the true savings are on what we're purchasing,
00:03:59.612 --> 00:04:03.232
but also adding in that margin that any retail pharmacy would have.
00:04:03.232 --> 00:04:04.852
So what did you sell the drug for?
00:04:04.972 --> 00:04:09.532
And then minusing your 340B cost from that. So it does inflate the 340B savings
00:04:09.532 --> 00:04:14.032
to add in a retail pharmacy margin, but then do reporting with those numbers.
00:04:14.052 --> 00:04:18.292
We were able to move the contract pharmacy protection process.
00:04:18.917 --> 00:04:23.417
A lot of it had to do with the fact that we were both protecting the state's
00:04:23.417 --> 00:04:26.937
safety net providers and also being transparent about what was going on.
00:04:27.337 --> 00:04:31.897
You mentioned Minnesota. That's the one transparency
00:04:31.897 --> 00:04:35.737
report that we've actually seen come out.
00:04:35.797 --> 00:04:40.037
So let's talk about that a little bit, and what we saw ther,e and the nuances
00:04:40.037 --> 00:04:46.517
with 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 --> 00:04:51.877
I personally refer to a lot of what's coming out of these state transparency
00:04:51.877 --> 00:04:55.517
bills as state-funded pharma research, which is unfortunate, right?
00:04:55.597 --> 00:04:59.617
We do want to be transparent with what's happening in our 340B Program,
00:04:59.617 --> 00:05:03.277
but many of the states are not asking for narratives.
00:05:03.357 --> 00:05:08.397
They are asking about the numbers, but they don't tell the full story.
00:05:08.537 --> 00:05:12.617
Minnesota is one of those states where they've gotten lots of numbers,
00:05:12.617 --> 00:05:17.317
but no actual information from the covered entities coming back about the true
00:05:17.317 --> 00:05:19.457
importance of their 340B Programs.
00:05:19.637 --> 00:05:24.137
I think that's challenging for state legislators and administrators because
00:05:24.137 --> 00:05:29.657
they're dealing with so many topics. They don't understand the nuances
00:05:29.657 --> 00:05:34.137
of 340B, so getting the information from the
00:05:34.419 --> 00:05:37.839
the numbers is not going to make sense to them.
00:05:37.999 --> 00:05:42.539
I think that I'd much rather see when these bills go through,
00:05:42.599 --> 00:05:46.839
I'd much rather see a narrative be added to it if it's going to be there.
00:05:47.439 --> 00:05:52.199
When we see these come out, I think that's important when you're talking
00:05:52.199 --> 00:05:57.579
to legislators that you have a bill that's proposed, that you explain that this
00:05:57.579 --> 00:05:59.759
data doesn't mean much without context.
00:05:59.759 --> 00:06:02.739
It's very much like healthcare, right? What are we testing for?
00:06:03.299 --> 00:06:06.619
What are the results that we need to see, right?
00:06:06.699 --> 00:06:10.359
If you want to understand what the 340B Program is doing,
00:06:10.779 --> 00:06:13.039
numbers aren't going to tell the whole story.
00:06:13.379 --> 00:06:16.559
You have to have the narrative to go with it.
00:06:16.559 --> 00:06:21.519
In those transparency bills, it's really important that we have an opportunity
00:06:21.519 --> 00:06:26.919
to explain along with the numbers so that the legislators can understand,
00:06:27.119 --> 00:06:30.359
so that it becomes something meaningful and usable, right?
00:06:30.419 --> 00:06:35.199
If you just get a list of lab tests coming back, and you don't have the report
00:06:35.199 --> 00:06:39.479
that comes back from the doctor to go with it, it's not meaningful to you as a patient.
00:06:39.479 --> 00:06:43.179
That's very much what we're seeing in the states that are getting their reports
00:06:43.179 --> 00:06:47.979
back, that aren't having that narrative coming in from the covered entities
00:06:47.979 --> 00:06:49.919
to help with that explanation.
00:06:50.219 --> 00:06:53.379
We're really thinking about that.
00:06:53.519 --> 00:06:58.299
The other piece that we're thinking about, too, is that there are other stakeholders
00:06:58.299 --> 00:07:02.359
in the 340B Program who have opportunities to be transparent.
00:07:02.359 --> 00:07:09.859
Big kudos to Michigan, who introduced in their transparency bill this
00:07:09.859 --> 00:07:14.899
year, some manufacturer transparency and something for us all to think about, right?
00:07:15.039 --> 00:07:19.159
Because as the manufacturers are restricting the 340B Program,
00:07:19.159 --> 00:07:23.719
as they are pulling back those savings from the safety net in each of our states,
00:07:23.959 --> 00:07:27.379
where are they reinvesting? Where are those dollars going?
00:07:27.659 --> 00:07:30.479
I think that's
00:07:31.106 --> 00:07:36.526
only fair. We are equal, covered entities are equal stakeholders with manufacturers.
00:07:36.786 --> 00:07:40.326
So what's good for the goose is good for the gander. Yeah, we would love to
00:07:40.326 --> 00:07:44.506
see states having transparency measures to get explanations of,
00:07:44.586 --> 00:07:49.766
what is that savings now going towards? How are you supporting our communities?
00:07:50.006 --> 00:07:53.526
How are you expanding care for our patients? Letting us know,
00:07:53.706 --> 00:07:58.486
what are you now spending in our state to create access for our communities?
00:07:58.486 --> 00:08:01.286
Also, what are you spending on your marketing?
00:08:01.526 --> 00:08:07.466
What does it cost to manufacture these drugs, right? So let's have transparency all around.
00:08:07.686 --> 00:08:10.346
We're very much in support of transparency,
00:08:10.346 --> 00:08:13.506
but we think that it's important to have it for both parties.
00:08:14.407 --> 00:08:18.927
To build on that, what we've seen is that with the data from the Office of Pharmacy
00:08:18.927 --> 00:08:21.647
Affairs and the audits that they've been doing,
00:08:22.127 --> 00:08:27.127
manufacturers actually have a three times higher rate of repayment on audits
00:08:27.127 --> 00:08:32.927
to the covered entities than the covered entities do to manufacturers when there are audit findings.
00:08:33.607 --> 00:08:38.207
We recently just saw a manufacturer that was overcharging for the entire
00:08:38.207 --> 00:08:39.987
length of the 340B Program.
00:08:40.147 --> 00:08:44.287
Yeah, and that's disheartening, right? So from the very beginning of their participation
00:08:44.287 --> 00:08:47.167
in the program for the medications that they were supplying,
00:08:47.387 --> 00:08:50.667
they did not calculate the 340B price correctly.
00:08:51.107 --> 00:08:53.907
They had major repayments that they had to do.
00:08:54.027 --> 00:08:58.147
They went back just a little over a decade. For the rest of the time,
00:08:58.307 --> 00:09:00.987
which we've been in the 340B program for over three decades,
00:09:01.387 --> 00:09:05.687
it was, if you would like the rest of this money, please calculate it yourself and let us know.
00:09:06.087 --> 00:09:11.027
We, as covered entities, are held to a very high threshold.
00:09:11.027 --> 00:09:17.787
We believe that the transparency measures are important and should go all around.
00:09:18.027 --> 00:09:22.467
I would say another area that could be included in that would be the pharmacy benefit
00:09:22.467 --> 00:09:28.187
managers or PBM, because we're hearing more and more about their participation
00:09:28.187 --> 00:09:30.687
in the program and taking those savings.
00:09:30.907 --> 00:09:34.827
I think that would be fair as well to add.
00:09:34.947 --> 00:09:39.047
We hear a lot of stories about PBMs coming in and saying what the program will
00:09:39.047 --> 00:09:42.787
cost if the contract pharmacy restrictions are lifted.
00:09:42.947 --> 00:09:48.247
Every time we ask the question, has the state seen savings
00:09:48.247 --> 00:09:51.607
in the last few years when the restrictions have been in place?
00:09:51.607 --> 00:09:56.607
Every time we ask that question, the answer has been no. It's curious that
00:09:56.607 --> 00:10:01.747
it will cost us more if we remove them, but we didn't save one when they were
00:10:01.747 --> 00:10:04.007
in place. So how does that work?
00:10:04.187 --> 00:10:08.567
That's the same for employers, too. They're using that same argument
00:10:08.567 --> 00:10:13.027
with employers that 340B makes your costs go up because you get less
00:10:13.027 --> 00:10:16.387
rebates, but we haven't seen their costs go down in the last five years with
00:10:16.387 --> 00:10:18.207
contract pharmacy restrictions.
00:10:18.449 --> 00:10:22.669
It's been significant if you look at our contract pharmacy savings that
00:10:22.669 --> 00:10:24.149
covered entities are noticing.
00:10:24.469 --> 00:10:28.569
I do think that there's opportunities for transparency for all of the
00:10:28.569 --> 00:10:29.829
participants in the program.
00:10:30.209 --> 00:10:34.169
I think this is something to explore as you work on your advocacy.
00:10:34.569 --> 00:10:40.349
I do think it's good for us just to talk a little bit about advocacy in general,
00:10:40.609 --> 00:10:48.729
It's an ongoing conversation, and it's really important to be prepared when you go in.
00:10:49.089 --> 00:10:54.629
Yeah, exactly. What would you say if a state is coming up with advocacy
00:10:54.629 --> 00:11:00.909
or with a provider reporting bill, what would the advocacy discussion points,
00:11:00.949 --> 00:11:02.849
would you go and talk about it?
00:11:02.949 --> 00:11:08.429
I think what comes to mind for me is what transparency do we already have in
00:11:08.429 --> 00:11:15.089
place as covered entities? Yeah, and so that is something we really leveraged in Maine.
00:11:15.677 --> 00:11:19.297
We talked a lot about that, right? We were able to keep the federally qualified
00:11:19.297 --> 00:11:23.017
health centers out of the reporting requirements because we talked about what
00:11:23.017 --> 00:11:26.957
we were reporting in UDS, and with our fiscal audits that we have to do annually.
00:11:27.257 --> 00:11:32.277
Also thinking about what is meaningful and really articulating that,
00:11:32.777 --> 00:11:36.537
making sure that you have the narrative in there as well, creating a strong
00:11:36.537 --> 00:11:39.577
coalition without creating division, right?
00:11:39.657 --> 00:11:43.897
We worked with the health centers and the other grantees, who work closely with the hospital.
00:11:44.097 --> 00:11:49.237
Even though we were able to articulate the nuances of the health centers,
00:11:49.457 --> 00:11:55.177
it was never in a conversation that was disparaging to another covered entity
00:11:55.177 --> 00:11:56.717
type. They weren't throwing them under the bus.
00:11:56.957 --> 00:12:02.317
This makes us unique, but no, never that this makes somebody else,
00:12:02.317 --> 00:12:07.757
you know, less a participant of this program, right?
00:12:08.117 --> 00:12:11.817
It's just that this is our federal obligation, so this is why we're doing
00:12:11.817 --> 00:12:15.757
this and helping others highlight how they show as well.
00:12:15.937 --> 00:12:21.057
I think that fiscal audit, that was something I didn't think about at first.
00:12:21.057 --> 00:12:28.617
I always bring up UDS, but our fiscal audit is reported to the federal government. It's published.
00:12:29.057 --> 00:12:33.337
Anyone can go pull up a fiscal audit from a health center,
00:12:33.357 --> 00:12:37.137
and it's proving that we're using the funds to meet the mission of the health center.
00:12:37.137 --> 00:12:40.217
We, as health centers, have a lot of transparency already.
00:12:40.217 --> 00:12:46.297
We have been successful in a number of states by articulating that to be able to
00:12:46.657 --> 00:12:51.917
support transparency, but say that we already have extensive transparency reporting,
00:12:51.917 --> 00:12:54.617
so we have been able to be exempted from the state requirements.
00:12:54.617 --> 00:12:57.477
Because again, like you said, we're already publicly published.
00:12:57.817 --> 00:13:02.577
Then from there, just making sure that as we're having these conversations,
00:13:02.577 --> 00:13:06.757
that there is a focus on yes, okay, we're having transparency, but if
00:13:07.125 --> 00:13:10.345
we don't have protections in the state for the contract pharmacy,
00:13:10.505 --> 00:13:13.245
how does this feed into that conversation as well?
00:13:13.365 --> 00:13:17.725
Using every moment of advocacy to help move things forward as well.
00:13:17.845 --> 00:13:20.285
We are fully in support of transparency.
00:13:20.865 --> 00:13:24.125
Here's how we're doing it. Here's what the program means to our community.
00:13:24.325 --> 00:13:29.225
Also, here's what the contraction of the program has meant to the community.
00:13:29.385 --> 00:13:31.825
How do we continue to work together?
00:13:32.065 --> 00:13:36.685
I think if you have one of these bills coming up, talking about the transparency
00:13:36.685 --> 00:13:41.865
that we already do, being supportive of transparency is a good thing.
00:13:42.085 --> 00:13:45.765
We see that benefit, but we're already doing it.
00:13:45.885 --> 00:13:50.545
So talking about the workforce requirements, but then also talking about how
00:13:50.545 --> 00:13:57.265
if we're transparent, then we should be able to open that contract pharmacy access back up.
00:13:57.265 --> 00:14:04.645
So really talking about the impact there and how it's hurting your patients,
00:14:04.785 --> 00:14:05.645
which are their constituents.
00:14:06.756 --> 00:14:12.296
I think that's all, the whole thing is talking about how it affects the constituents.
00:14:12.576 --> 00:14:16.116
At the end of the day, it's the patients who are missing out.
00:14:16.256 --> 00:14:19.296
One of the things that was most disheartening to me,
00:14:19.416 --> 00:14:23.276
just as we're wrapping up, is when we were down in the state house doing
00:14:23.276 --> 00:14:27.176
testimony, people from different groups who were coming
00:14:27.176 --> 00:14:30.076
in and saying that this hasn't hurt patients.
00:14:30.756 --> 00:14:38.076
I was flabbergasted, and I have no poker face, so I was told not to sit in front of the camera.
00:14:38.256 --> 00:14:42.996
That was for a reason, because I'm sure I was all sorts of everything.
00:14:43.356 --> 00:14:46.956
I can't tell you, how many patients and we're,
00:14:47.116 --> 00:14:53.756
a step removed as consultants, how many calls we receive as the consultant,
00:14:54.056 --> 00:14:58.396
from our covered entities saying, we can't get this medication for our
00:14:58.396 --> 00:15:02.296
patients, even those from contract pharmacies, for the covered entities we work with.
00:15:02.376 --> 00:15:08.456
What are we supposed to do about a regular restriction
00:15:08.456 --> 00:15:11.936
comes in, how are we supposed to deal with this? How are we supposed to deal with this?
00:15:12.056 --> 00:15:17.656
Patients are being impacted because, yes, the medication is at the pharmacy,
00:15:17.836 --> 00:15:21.796
but especially with where we work, which is with the FQHCs.
00:15:22.348 --> 00:15:27.028
We were previously passing on that 340B price to the patients.
00:15:27.028 --> 00:15:32.368
If that's not at the pharmacy, we can't pass that on, which means the patient's
00:15:32.368 --> 00:15:36.948
not able to afford their medication. They're having to make hard choices
00:15:36.948 --> 00:15:41.668
about what will they afford that month, or will they even take that medication home with them?
00:15:41.788 --> 00:15:45.968
So lots of changes, lots of impact.
00:15:45.968 --> 00:15:52.668
To hear people come in and testify that this has not had harm was so
00:15:52.668 --> 00:15:58.788
disheartening and one of the reasons that we worked so hard as our coalition to move this forward.
00:15:59.028 --> 00:16:04.968
I think that's a great point to end on, and that if you're getting started with advocacy,
00:16:05.348 --> 00:16:09.808
one of the easiest ways to do it is to just go in, talk about your patients,
00:16:10.048 --> 00:16:14.748
talk about the impact of whatever the bill is and how it's going to affect your
00:16:14.748 --> 00:16:16.128
patients, because that's easy.
00:16:16.328 --> 00:16:18.728
That's what covered entities do so well.
00:16:19.328 --> 00:16:22.128
That's why we're doing this. Yeah, it's a great way to start.
Don’t miss out on critical updates and game-changing strategies. Subscribe to 340Banter today and ensure your FQHC is always a step ahead in 340B compliance.
340Banter is brought to you by FQHC 340B Compliance, a trusted partner in optimizing 340B Programs for Federally Qualified Health Centers nationwide. Their mission is to provide tailored resources to help health centers secure and optimize their 340B Programs, improving compliance and oversight. For more information, contact us!
.jpg)
