This post is part of NACHC’s 340B Blog Series. The 340B Drug Pricing Program is an essential source of support for Community Health Centers, allowing them to stretch increasingly scarce federal resources and reinvest in patient care. Learn more about 340B and read other blogs in the series.
Elizabeth Linderbaum is NACHC’s Deputy Director of Regulatory Affairs.
Celebrating 51 years as a federally qualified health center, El Rio Health has long been a trusted institution in Tucson, Arizona. Starting their health center journey with a building donated by the local county and federal grant money set aside by then-President Lyndon B. Johnson, they have grown to serve around 125,000 people. Currently, El Rio serves 1 in 12 Tusconians. Beyond providing comprehensive primary care services, El Rio has been able to further expand their services and enhance the quality of care for their patients because of the 340B drug pricing program.
El Rio’s Advanced Practice Pharmacy Team supported by 340B
The 340B program has existed since 1992, allowing certain safety-net health care providers that already operate on razor-thin margins, like health centers, to buy specific medications at a discount. Participation in the program produces savings that help health centers, like El Rio, support services that benefit the overall health and wellbeing of their patients.
One of the biggest services the 340B program helps fund is their Advanced Practice Pharmacy Team, which began in 2002. An Advanced Practice Pharmacist splits their time between an outpatient pharmacy and the clinic, spending four days in the outpatient pharmacy and one day at the clinic. Because clinical pharmacists are not a billable provider under Medicare and Medicaid, 340B savings help El Rio fund this crucial service that helps enhance health literacy and improve care coordination for their patients.
These pharmacists play a key role on the collaborative care team and participate in their successful Pharmacy-Based Diabetes Management Program. It has expanded to a total of nine other clinics within El Rio Health’s system. Through a collaborative agreement with physicians, these pharmacists help patient manage their medication regimen. Given their understanding of medication therapy, the pharmacists can recommend treatment changes as necessary and monitor for any potential drug reactions.
Pharmacists also serve as a friendly resource for patients, answering questions and concerns, educating patients, and identifying/resolving any medication adherence or therapy related issues. They can also refer the patient to other specialty providers such ophthalmologists, podiatrists, nutritionists, or behavioral health providers, depending on the patient’s needs. Above all, the pharmacists strive to improve outcomes through constantly monitoring their patients’ condition.
Diabetes management is a significant focus of the pharmacy program
Over 34 million people in the United States have diagnosed diabetes, and in Arizona around 10.7% of their adult population have diagnosed diabetes. The Pharmacy-Based Diabetes Management Program has yielded significant improvements in patients’ blood sugar levels, systolic blood pressure, cholesterol, and body mass index. One of the prescriptions the 340B program helps lower the cost most for patients is insulin. Given the huge difference in what the drug retails for—newer versions of insulin can cost between $175 and $300 a vial—versus the price the patient gets, the 340B program can help alleviate patients’ preoccupation about one less burdensome health care cost.
Unfortunately, most medications being restricted by pharmaceutical manufacturers under the 340B program include insulin for diabetes care. Given that health center patients with diabetes rely on 340B-priced medications more than any other patient population, as documented in NACHC’s recent report, these manufacturer restrictions take a toll on patients’ wellbeing.
El Rio uses savings from 340B to help patients address social and economic factors affecting their health
El Rio credits 340B program savings for helping them address the social determinant of health needs for their patients and making a direct impact on their access to equitable care. One of those patients is a 26-year-old currently on a ventilator. The patient needed a new ventilator but due to lack of insurance and few family resources and support, that ventilator seemed out of reach financially. Because of their 340B savings, El Rio stepped in and paid for a new ventilator, alleviating that financial burden for their patient.
Another patient came into El Rio complaining of severe back pain. Providers could not figure out why, despite multiple treatments, the pain persisted. After digging deeper and establishing a trusted relationship with that patient, the patient mentioned that she sleeps on her floor. El Rio’s team bought her a complete bed set; after that, her back pain began to subside. The 340B program enables health centers like El Rio, time and time again, to address key social drivers of health and ultimately help improve their patients’ lives.
Health centers have long stood as a pillar of support within their communities, helping connect patients to necessary resources to ensure people can live as healthily as possible. El Rio’s story shows how 340B savings have helped further their reach and positively impact their patients as well as overall community.
Thank you to Josh Carzoli, Chief Operating Officer, and Ocie Wilson, Pharmacy Director, for speaking with us about El Rio Health.