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April is National Cancer Control Month, and this week we are joined by Dr. Gerold Bepler, president and CEO at the Barbara Ann Karmanos Cancer Institute in Detroit. Dr. Bepler discusses the unique role cancer centers play in preventing and treating cancer, the importance of 340B to Karmanos and its patients, how Karmanos is addressing racial and ethnic disparities in cancer treatment, and the partnership it has formed to expand access to cancer research and treatment in rural communities. Before the interview, we recap 340B Health’s recent virtual Hill Day. 

The Karmanos Comprehensive Approach to Cancer Research and Treatment

The Karmanos Cancer Institute is one of 51 National Cancer Institute (NCI)-Designated Comprehensive Cancer Centers. Karmanos has a comprehensive integrated organization that conducts research to evaluate how cancer grows and progresses, develops new targets, provides access to new drugs, and leverages early detection and prevention programs. Karmanos also has developed a genetic counseling program and a clinical trial program. Dr. Bepler shares that 15-20% of Karmanos patients are uninsured or underinsured and another third rely on Medicare.  

340B Is Improving Access to Cancer Treatment

Karmanos’s main Detroit location is a disproportionate share hospital (DSH). 340B helps it to purchase highly effective cancer drugs that often can be $10,000-$15,000 per month. Dr. Bepler explains that Karmanos has established a specialty pharmacy that uses 340B savings to provide direct financial assistance to help patients in need cover the gap between what their insurer pays and the cost of the medication to the patient. In 2020, Karmanos provided $1.7 million in patient assistance through this specialty pharmacy. 340B also helps fund follow-up support that Karmanos pharmacists provide patients on the medications they need for their cancer treatment. 

Ongoing 340B Issues Affect Cancer Treatment 

Drug manufacturers’ refusals to provide 340B discounts on drugs dispensed at community pharmacies have had a detrimental effect on cancer patients. Karmanos has had to help some rural patients find alternative medications to replace the ones they have lost access to, and this risks a reduction in medication adherence. Dr. Bepler also discusses how cancer and rural hospitals are unable to access 340B discounts on orphan drugs when they are used for off-label purposes or to treat common conditions. 

How Cancer Centers Advocate for 340B

Karmanos collaborates with several associations to advocate for 340B, including the Association of American Cancer Institutes (AACI). Dr. Bepler discusses that it is critical to be part of a larger organization that has power to affect and understand legislative action regarding 340B compliance. 

Addressing Disparities in Cancer Prevention and Treatment 

Dr. Bepler explains that different racial and ethnic groups have unique risks in developing cancer and that cancer may behave in different ways biologically. Karmanos conducts research to understand these biological differences and investigate if they require new drug development. Karmanos also has established an Office of Cancer Health Equity and Community Engagement to communicate directly with community leaders and understand the priorities of the communities it serves. They then match these needs to the development of screening, treatment, and early detection programs to reduce cancer risk and improve outcomes for diagnosed patients.

Bringing World-Class Cancer Research and Treatment to Rural Communities 

Because NCI-Designated Comprehensive Cancer Centers are usually in metropolitan areas, more effort is required to reach rural patients with the latest treatments. Karmanos partnered with McLaren Health, a community-based health network. They work together to improve the quality of cancer care in rural communities and provide expedited access to newer treatments. Dr. Bepler shares that quality of care has improved and enrollment in clinical trials has increased five-fold in recent years in the rural communities they serve together. 

Check out all our episodes on the 340B Insight podcast website. You also can stay updated on all 340B Health news and information by visiting our homepage. If you have any questions you would like us to cover in this podcast, email us at [email protected].

Resources

1. 340B Health Virtual Hill Day Video 
2. 340B Health’s Staffing 340B Webinar