Placing the Health and Well Being of Patients First | Commentary
Every day many Americans have to weigh how they spend each dollar.
Food or rent? Electric bill or healthcare? For those who are uninsured and underinsured, medication is often sacrificed to cover the basic costs of day-to-day life.
The consequences of skipping a prescription? More emergency room visits, declining health and a poorer quality of life.
As the nation’s largest nonprofit health system, Ascension believes it is our responsibility to ensure that those we serve have access to the prescription medications they need to maintain or improve their health. Our mission has always been to serve the most poor and vulnerable of society, to provide healthcare that truly leaves no one behind, and that is why we, along with leaders from Safety Net Hospitals for Pharmaceutical Access, are on Capitol Hill Wednesday.
Last year, Ascension provided $1.5 billion in charity care for persons living in poverty at our 101 acute care hospitals in 23 states and D.C. For many of those vulnerable people, a program called 340B is vital to their ability to obtain medications and services to keep them out of the hospital by best managing their medical conditions. This is especially important for patients with chronic diseases like hypertension and diabetes.
The 340B Drug Pricing Program was enacted by Congress to help safety-net providers — those who provide care to the most poor and vulnerable among us — afford the high cost of outpatient drugs.
At the time of the law’s enactment in 1992, prescription drug costs were increasing at a rate of 14 percent each year. The situation remains dire for patients today, as mediation costs are once again skyrocketing at the same clip. In many cases, price jumps are far higher. For instance, the cost of an EpiPen, which treats allergic reactions, rose 222 percent in the last seven years. One industry survey found that diabetics are struggling with the cost of some insulin injections that have increased at least 160 percent just since 2007.
The 340B law is simple and effective: By paying less for high-priced outpatient prescription drugs, safety-net providers have more resources to help their patients.
When the program was first enacted, 340B was limited to government-funded health centers and certain safety-net hospitals. But with the success of the program, Congress added cancer hospitals, children’s hospitals and rural hospitals in 2010.
In fact, about half of the newly eligible hospitals are small, rural hospitals serving poorer, more disadvantaged populations – patients less likely to have prescription drug coverage, and less likely to be covered by Medicaid benefits than their urban counterparts.
Unfortunately, large pharmaceutical companies – in search of padding their bottom lines – have started to question the success of the program. A recent study funded by the pharmaceutical companies suggested that 340B hospitals provide only a minimal amount of charity care. That report told only half of the story. Using the same data source, when bad debt and Medicaid payment short falls were added to the calculation, 340B hospitals provided consistently more uncompensated care than non-340B hospitals
I can tell you how our hospitals use their drug discount savings:
•The Joshua Max Simon Primary Care Center is a private, nonprofit clinic run by St.Vincent Hospital in Indianapolis. The clinic serves more than 19,000 patients each year, 95 percent of whom are uninsured, underinsured or have Medicaid. Roughly 82,000 prescriptions are filled at the clinic each year, either free of charge or at 20 percent of the already discounted 340B price.
•Saint Thomas Hickman Hospital in Centerville, Tenn., was the first critical access hospital in Tennessee. The population of Hickman County is impoverished, the next nearest hospital is 40 miles away, and the county has one of the highest suicide rates in the state. Without 340B, the area’s rural patients would not have access to affordable medications to manage their mental illness and promote recovery.
•St. Mary’s Outpatient Infusion Clinic in Boonville, Ind., provides access to outpatient infusion medications prescribed when a condition is so severe that the patient cannot be treated effectively at home. At St. Mary’s clinic, a 55-year-old woman suffering from multiple sclerosis found she was no longer able to help out on her small family farm or take care of her children. She was prescribed a monthly infusion to slow the progression of her disease and reduce flare-ups. Normally, the drug costs $2,000 per treatment, but the 340B discount reduced the drug’s cost by 72 percent.
The bottom line: 340B is a successful and critical program that allows hospitals to help underserved patients with the high cost of prescription drugs. Rolling back the 340B program will only add to pharmaceutical industry profits while leaving our most vulnerable citizens with less access to the medication and quality healthcare they desperately need.
Robert J. Henkel is the president and CEO of Ascension Health, the nation’s largest Catholic and nonprofit health system. He also serves as an executive vice president of Ascension.