This week we are joined by Danielle Sestito, system director for the 340B program at Northwell Health in New York. Northwell Health is New York’s largest health system and was one of the systems most affected by the initial COVID-19 outbreak last spring. Danielle shares how Northwell responded to the initial outbreak and how it has prepared for a resurgence. She also discusses how the health system has avoided drug shortages while maintaining 340B compliance and the importance of HRSA’s 340B regulatory flexibilities during the public health emergency. Prior to the interview, we share updates on how some of the Trump administration’s final health care actions could affect 340B. 

Clinical Challenges in the Pharmacy

During Northwell’s treatment of 3,500 inpatients for COVID-19 in April, providers grappled with the lack of evidence-based therapeutics and FDA-approved medications. Danielle shares how Northwell responded by developing a clinical guidelines committee and expanding clinical privileges to pharmacists, both of which resulted in improved patient health outcomes.

The Scramble to Purchase Drugs

Like all providers, Northwell was tasked with creating processes to ensure they avoided drug shortages. HRSA’s regulatory flexibilities for the 340B program allowed hospitals to purchase drugs at 340B pricing for new surge locations if they maintained program eligibility. In certain cases, drugs also could be purchased via GPO accounts, something that could not be possible prior to the pandemic. Thanks to the best practices they implemented, Northwell has avoided drug shortages. 

340B Supporting Patients Under Financial Duress

Danielle explains that 340B savings are critical for helping patients during the pandemic. 340B enables Northwell to offer medication therapy management services, including follow-up calls, to ensure patients are adhering to their medications. The need for these programs has increased during the pandemic. Northwell also provides discounts on medications to qualified patients who have become uninsured or have low incomes.

Lessons Learned

Pharmacists need a very calculated approach in preparing for the winter COVID-19 surge. Danielle recommends frequent calls with drug procurement buyers and pharmacy directors in outlining plans for purchasing drugs, as well as constant communication with buyers on how many COVID and vented patients are in the hospital. Leveraging data analytics and estimating the run rates of drugs is crucial to avoid drug shortages. Danielle also discusses how Northwell is preparing for distribution of COVID-19 vaccines.  

Telemedicine is Here to Stay

Danielle praises the role telemedicine and mail-order pharmacies have played in helping patients with chronic diseases access health care services and medications. Hospitals still will receive 340B credit for telemedicine visits if the visit meets 340B eligibility standards. Mail-order pharmacies will help patients with chronic diseases access medications even it they cannot leave their homes due to the pandemic or other health challenges.  

Check out all of our episodes on the340B 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.     Most Favored Nation Pricing Could Trigger 340B Medicare Rate Cuts Starting in 2022

2.     Final PBM Rebate Rule Has Uncertain 340B Implications 

3.     United Therapeutics is Fifth Drug Maker to Restrict 340B Contract Pharmacy  

4.     Northwell Health