340B Insight

Providing care beyond hospital walls is a growing trend for 340B hospitals. One service that health systems provide outside of the hospital setting is home infusion care. On our first episode of 2023, we are joined by David Klinger and Seth Gazes from Geisinger Health to hear how 340B hospitals can establish home infusion care and the 340B considerations they should keep in mind. Prior to the interview, we provide an update on the 19th drug company to restrict 340B discounts for drugs dispensed at community and specialty contract pharmacies. We also recap drug manufacturer 340B overcharge notices in 2022.

Establishing a Home Infusion Program

Dave and Seth share the challenges that historically underserved patients face accessing infusion treatments and how this motivated Geisinger to start a home infusion program. They discuss how home infusion helps the health system provide comprehensive care, detail how the program assists patients with navigating their treatment, and share patient feedback about the program.  

340B Considerations 

Dave and Seth explain the 340B considerations for operating a home infusion program. These include understanding patient eligibility and the type of pharmacy that will support the home infusion program. Our guests also share how Geisinger uses the 340B savings it receives from discounts on home infusion drugs.  

Home Infusion Program Trends 

One of the challenges operating a home infusion program is the availability of nurse staffing. Geisinger is responding to this challenge by establishing home infusion treatment in a clinic format outside of the hospital. Seth also discusses opportunities for more infusion drugs to be administered outside of the hospital. 

Check out all of 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’d like us to cover in this podcast, email us at [email protected].

Resources 

1. Statement on Biogen Restricting 340B Discounts Through Community-Based Pharmacies
2. Drug manufacturer overcharge notices on HRSA Website
3. 340B Coalition Winter Conference 2023  

340B professionals are not the only hospital staff who need to know about 340B. That is why it is important that 340B professionals educate their colleagues about the program and what it means for clinical care and patient care operations. For our final episode of the year, 340B professional Ryan Atherton joins us to share the strategies he has deployed to help his colleagues better understand 340B’s role in the patient care mission. Ryan formerly was the 340B program manager at Yakima Valley Memorial Hospital in Washington State. He improved understanding of 340B among the hospital’s staff, which led to a more efficient program. Before the interview, we share a news update on HRSA’s new proposed rule for 340B administrative dispute resolution (ADR).  

How to Engage With Provider Colleagues 

When Ryan first started at Yakima, he saw that a lack of knowledge about 340B was limiting the program’s ability to operate as effectively as possible. He explains how he worked with his team to identify the best methods to educate providers about 340B, including through newsletters and staff onboarding. 

Overcoming Education Challenges

One challenge of educating non-340B hospital professionals is that it can be overwhelming for them due to the large amount of complex information to learn. Ryan shares best practices in keeping education tailored to each staff member’s role and using different approaches depending on the audience.

Streamlined Communication 

Ryan discusses the benefits of making the time to educate hospital colleagues about 340B. This includes more streamlined communication between the 340B team and providers, better understanding among providers of how their roles affect 340B, and improved knowledge of how 340B advances the patient care mission. 

Check out all of 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. New 340B Dispute Resolution Proposed Rule Addresses Several 340B Health Concerns 
2. Statement on Biogen Restricting 340B Discounts Through Community-based Pharmacies 

The recent election results have implications for the future of U.S. health policy and the 340B program. Health policy experts Debbie Curtis and Rodney Whitlock join us this week to discuss how the new Congress will affect 340B and how individuals can best engage in educating and advocating for the program. Debbie and Rodney are vice presidents at McDermott + Consulting and previously were congressional staffers. Before the interview, we provide an update on the litigation process in the 340B contract pharmacy dispute, and we recap HRSA audit results of drug companies. 

What Divided Government Means for Health Policy 

Rodney and Debbie recap the election results, including some of the 340B congressional champions who are returning to Congress. They explain how a divided government will affect health policy issues that 340B hospitals care about, such as the COVID-19 public health emergency and disproportionate share hospital payments. 

340B’s Spot on the New Congress’s Agenda 

Leadership changes in U.S. House and Senate committees that focus on health policy could affect whether lawmakers prioritize 340B issues in the new Congress. Our guests also discuss the importance of monitoring health policies the Biden administration is implementing that could affect 340B, such as the Inflation Reduction Act. 

Prepare to Educate Members of Congress about 340B 

As the year ends, hospitals and health systems need to prepare to engage with new and returning members of Congress. Rodney, Debbie, and interviewer Tom O’Donnell, 340B Health’s senior vice president of government relations, discuss the keys to educating members of Congress about the value of 340B.  

Check out all of 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’d like us to cover in this podcast, email us at [email protected].

Resources 

1. Judges Mulling Decisions in Cases on Drug Company 340B Restrictions 
2. HRSA FY 2022 Manufacturer Audit Results
3. 340B Health Impact Profile Guide  

Nov. 17 is National Rural Health Day, which is an opportunity to celebrate the importance of rural hospitals to patients living in remote communities. We are joined by Karen McCombs, 340B program manager for Wills Memorial Hospital in Georgia. Karen shares her tips for managing her critical access hospital’s 340B program in a compliant and efficient manner to support patient care initiatives. Before the interview, we provide updates on the 2023 Medicare payment rate for 340B drugs and on the status of 340B contract pharmacy litigation pending in federal appeals courts. 

Where Everyone Knows Your Name 

Karen provides her perspective on the unique elements of working in a rural hospital and discusses her hospital’s extensive history in its community.   

Filling in the Gaps 

Karen explains how 340B savings help her hospital offset its costs to help ensure the hospital remains open for the community. She describes one of Wills Memorial’s greatest 340B success stories and shares how the hospital has used 340B to support all its patients.

Advice for Rural Hospitals 

Rural hospitals often have smaller staffs. Karen discusses how she is the only employee at her hospital whose sole focus is 340B. She shares her framework, “Build, Research, Audit, Ask” as a model professionals can deploy to operate a successful 340B program. 

Check out all of 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 topics you’d like us to cover in this podcast, email us at [email protected].

Resources 

1. CMS Rule Provides Clarity on 2023 Pay Rates and Modifiers but Puts Off Remedies for Past Cuts
2. Appeals Court Judge Suggests HHS Might Need to Fine Drugmaker Before Lawsuit Over 340B Pricing Refusals Can Proceed
3. HRSA Events for National Rural Health Day 
4. 340B Insight Episode 61: Congressman Henry Waxman Reflects on 30 Years of 340B 

On Nov. 4, 1992, President George H.W. Bush signed the 340B drug pricing program into law.  To celebrate 30 years of 340B, we speak on today’s episode with former Congressman Henry Waxman, who was one of the principal architects of the 340B program. Congressman Waxman served in Congress for 40 years from 1975-2015. During part of that time, he chaired the influential U.S. House Energy & Commerce Committee and U.S. House Government & Oversight Committee. 

Chairman Waxman shares why Congress created 340B, explains the need for a strong health care safety net, discusses 340B’s achievements, and remarks on why the program is just as important today as it was 30 years ago.  

Supporting the Health care Safety Net

Chairman Waxman prioritized building and protecting the health care safety net throughout his time in Congress. He discusses why this was a priority for him. He also explains the origins of the bipartisan legislation that created 340B.  

340B’s Legacy 

Throughout its history, 340B has had bipartisan support. Chairman Waxman shares his perspective on the major developments for 340B over its three decades and whether 340B has achieved what he envisioned when he wrote the law. 

Check out all of 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’d like us to cover in this podcast, email us at [email protected].

Resources 

1. Chairman Henry Waxman’s Bio 
2. Section 340B of the Public Health Service Act
3. 340B Health Statement on Final Medicare 2023 OPPS Rule
4. Merck Referred for Penalties for Refusal to Follow Federal Law on 340B Pricing 
5. HRSA Directs AbbVie and Amgen to Restore 340B Pricing to Safety-net Hospitals  

When Hennepin Medical Center saw that some of their patients were frequently visiting the emergency department for all their health care needs, they recognized how vital it was to find a better way to care for them. Our guest this week is Christene Jolowsky, senior director of pharmacy at Hennepin Healthcare. Christene shares how Hennepin has used 340B savings to operate a coordinated care clinic that meets the health and social needs of their patients. Prior to the interview, we provide news updates on the restoration of full Medicare payment rates for 340B drugs and details about another drug company that is attempting to block the federal government from requiring 340B discounts on drugs dispensed at contract pharmacies.

A One-Stop Shop for Care

Chris shares how the coordinated care clinic determines which patients are eligible for its services. She then describes a typical patient experience at the clinic and how this experience meets the clinic’s mission to provide comprehensive care. This includes addressing social determinants of health such as transportation and food insecurity. 

Keys to the Clinic’s Success 

Many patients come into the clinic with distrust of the medical system and providers. Chris explains how Hennepin’s providers build trust with patients and provide personalized care. 

The Role of 340B

340B savings have supported every aspect of the coordinated care clinic. Chris discusses how the clinic’s presence has reduced emergency department visits and shares a story of how the clinic significantly reduced the number of prescribed medications for one of its patients.  

Check out all of 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’d like us to cover in this podcast, email us at [email protected].

Resources 

1. Medicare 340B Payment Cut Ending for the Remainder of 2022
2. UCB Sues HHS Over 340B Contract Pharmacy Violation Letter 
3. Report on Hennepin Healthcare’s Coordinated Clinic: 340B Hospitals Are Directing Savings Toward Their Communities’ Unique Needs

All this year we are reflecting on the approaching 30th anniversary of the 340B program and celebrating the patient care successes the program has enabled over the past three decades. This week, we are joined by Andrew Lowe, clinical director of pharmacy at Arrowhead Regional Medical Center in California. Arrowhead has participated in 340B since the first days that hospitals were eligible for the program. Andy has had a front-row seat the entire time to see the difference 340B has made in the lives of patients in need and the health care safety net’s ability to care for them. He shares how Arrowhead navigated health care in a pre-340B world and what the program has allowed his hospital to accomplish in patient care over the past 30 years. Prior to the interview, we share several news updates on new developments on Medicare cuts for 340B drugs, the release of new 340B research, and more. 

The Ability to Serve More Patients 

Arrowhead was one of the first hospitals to participate in 340B. Andy shares about the challenges the hospital had faced when caring for low-income patients prior to 340B and what changed once the hospital started receiving 340B discounts. 

Improved Patient Health Outcomes 

With its 340B savings, Arrowhead expanded treatment programs to more patients. Andy discusses how the hospital used 340B savings to help fund hepatitis C and cancer treatment services and how patient health outcomes have improved. 

Advice to Other 340B Professionals

Andy has nearly 30 years of experience in 340B, so we had to ask him his most important piece of advice to other professionals operating their hospitals’ 340B programs. Andy also shares how his career brought him to the world of safety-net hospitals and 340B. 

Check out all of 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’d like us to cover in this podcast, email us at [email protected].

Resources 

1. Report: 340B DSH Hospitals Serve Higher Share of Patients with Low Incomes
2. Report Infographic: 340B DSH Hospitals Serve Higher Share of Patients with Low Incomes
3. Federal Judge Reiterates that Medicare 340B Cuts Must End Immediately  
4. Bipartisan Letter from Senators Joe Manchin and Mike Braun to HHS Regarding the 340B Contract Pharmacy Dispute 

It has been an eventful summer for 340B, and we are checking in this week with 340B Health President and CEO Maureen Testoni to hear her analysis on the top 340B developments. Maureen provides updates on issues that include the contract pharmacy dispute, Medicare payment cuts, and the new drug pricing law. She also shares a preview of what may occur in the fall. 

340B Contract Pharmacy Dispute Continues 

The number of companies currently restricting 340B discounts has grown. Maureen discusses the impact of these unlawful restrictions on 340B hospitals and patient care, how Congress is responding to advocacy efforts, and where the issue stands in the courts. She also explains how 340B Health is taking a multi-pronged approach to address the dispute. 

Progress Toward Ending Medicare Cuts 

The U.S. Supreme Court decided in June that Medicare cuts for 340B drugs that have been in place since 2018 are unlawful. Maureen recaps how the Centers for Medicare & Medicaid Services (CMS) has responded to the court’s decision and predicts when hospitals might expect to be repaid for the cuts they received.  

New Drug Pricing Law 

Major federal drug pricing legislation became law in August, and the new law will have significant ramifications that are difficult to predict. Maureen describes the key drug pricing provisions and what they could mean for 340B.

Celebrating 340B’s Big Upcoming Anniversary 

Maureen shares her key takeaways from the 340B Coalition Summer Conference. Amid the challenges covered entities face, she believes it is important to recognize the 30th anniversary of the 340B program in November by celebrating the difference 340B has made in patients’ lives. 

Check out all of 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’d like us to cover in this podcast, email us at [email protected].

Resources 

1. Survey Results: Contract Pharmacy Restrictions Represent Growing Threat to 340B Hospitals and Patients 
2. Hospitals Say Medicare Must End 340B Cuts, Repay Harmed Facilities
3. Research Shows 340B Meeting Its Mission
4. Maureen Testoni’s 340B Coalition Summer Conference 2022 Recap Blog Post
5. Upcoming 340B Health Webinars 

Drug shortages occurring throughout the U.S. health system can lead to delays for patients receiving the medications they need. 340B hospitals face unique challenges with avoiding and managing drug shortages. We are joined by Cescilly Smith-Jenkins, 340B program director at Ascension Wisconsin, to find out how 340B hospitals can address shortage problems effectively. 

Why Drug Shortages Happen

There are several factors behind drug shortages. Cescilly explains how drug shortages are affected by other supply shortages, outlines drug shortage trends in the U.S., and notes which drugs are most prone to being in short supply.

340B Challenges to Managing Shortages 

340B compliance adds additional complexity to drug shortages. Cescilly discusses how regulatory policies create challenges for avoiding shortages on 340B-eligible drugs. She also shares an example of how her health system overcame a recent drug shortage.   

Approaches to Stay Ahead of Shortages  

Cescilly has a unique way to think about 340B that can help hospitals operate their program in a way that stays ahead of drug shortages. She also explains risks that can occur when the 340B team is unaware of hospital operational changes, and she provides practical tips on maintaining communications with key stakeholders. 

Check out all of 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’d like us to cover in this podcast, email us at [email protected].

Resources

1. Annual Hospital Recertification Closes Sept. 19 
2. 340B Insight Episode 55: Are You Ready for 340B Recertification?

Pharmacy technicians play key roles in hospital 340B program operations, but pharmacy technician staffing shortages are occurring in hospitals throughout the nation. We’re joined by Dr. Tyffani Wingfield with the American Society of Health-System Pharmacists (ASHP) to discuss how the shortages are affecting hospitals, the pharmacy technician workforce, and 340B. Tyffani also shares potential solutions. Before the interview, we discuss recently enacted federal drug pricing legislation and the start of the annual 340B hospital recertification process.  

Factors Contributing to the Pharmacy Tech Shortage

Pharmacy technician vacancy rates are high. Tyffani shares results from a pair of ASHP surveys that provide insights into the most prominent challenges hospitals face in recruiting and retaining technicians as well as potential solutions.

How Pharmacy Tech Shortages Affect Hospitals  

Tyffani explains the vital roles pharmacy technicians fill, the strain on the health care system when there aren’t enough technicians, and how hospital organization structures can be modified to support techs. She also provides advice for how pharmacy technicians can have a satisfying career.

What the Pharmacy Tech Shortage Means for 340B 

The staffing shortage has affected technicians operating 340B programs and pharmacy services. Tyffani describes how the staffing shortage affects 340B professionals in their day-to-day work. 

Check out all of 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. Medicare Drug Price Negotiation Bill Becomes Law 
2. 340B Health Webinar: Inflation Reduction Act Drug Pricing Provisions and 340B 
3. 340B Insight Episode 55: Are You Ready for 340B Recertification?
4. ASHP’s Executive Summary for the Pharmacy Technician Shortage Survey Findings