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 the 340B Drug Pricing Program.
Elizabeth Linderbaum is NACHC’s Deputy Director of Regulatory Affairs.
Sixteenth Street Community Health Centers (SSCHC or Sixteenth Street) began as a medical clinic in 1969, providing a medical home model of care in Milwaukee, Wisconsin. Since then, they have expanded their services drastically by offering OBGYN, behavioral health, substance use disorder, pharmacy, physical and occupational therapy services, and more, thanks in part to 340B – a critical program now under threat.
Sixteenth Street Community Involvement
Spread across the Milwaukee-Waukesha area, Sixteenth Street has five major clinic locations within a 25-mile radius. They serve over 43,000 patients – over half of whom (55 %) rely on Medicaid. After one of the major behavioral health clinics in their community closed, SSCHC opened a new dedicated behavioral health center to help mitigate any potential gaps in care. The staff at Sixteenth Street, like other health centers, are proud of their work meeting patients where they live, learn, work and play. Over the years, SSCHC has developed numerous partnerships with local schools and send providers to campuses to promote primary care, behavioral health, and to increase access to affordable health care for students and their families. SSCHC further participates in their community by hosting events such as Bike Day, where hundreds of bikes and helmets are given for free to local youth each year.
SSCHC credits the 340B program with helping to provide the resources needed to make an impactful difference in their community.
The 340B program just marked its 30-year anniversary and over the course of that time has provided vital resources to covered entities, like health centers, that operate on razor thin margins. Through access to discounted medications, health centers reinvest their medication savings back into services that positively impact the health and wellbeing of their patients.
A crucial part of Sixteenth Street’s whole-person care model is expanding services offered by clinical pharmacists, who help develop treatment protocols to help patients with diabetes, hypertension, smoking cessation, and lipid management. SSCHC pharmacists also conduct comprehensive medication reviews, preventative health screenings, and ensure providers are educated on updated treatment guidelines as well as new medications. Despite their significant role, there are limited reimbursement models to support their time with patients. As manufacturers continue to place restrictions on the 340B program, patients across the country are in jeopardy of losing access to clinical pharmacists in their community.
Manufacturer Restrictions Hit Patients the Hardest
Both patients and staff at SSCHC continue to grapple with the broad and far-reaching impact of restrictions imposed by pharmaceutical manufacturers. Employees spend over 750 hours of staff time identifying, informing, and triaging their 1,500 uninsured patients who are impacted by pharmaceutical restrictions on 340B. Critical patient services are at risk of being cut back and facility improvements have been delayed because of decreased 340B savings.
Before, SSCHC’s uninsured patients were able to get access to a 3-month supply of brand name diabetes medications, including insulin, for $8. Now, however, they must choose between three options if the drug company who makes their medication restricted 340B access: pay hundreds of dollars for the same medication, drive to a distant pharmacy to get the medication for a discount, or switch to a potentially less effective medication.
Like most health centers, Sixteenth Street relies on contract pharmacies located in areas convenient to their patients. Thus, pharmaceutical restrictions on contract pharmacies have hit patients particularly hard. Contract pharmacies also serve as an extension of health centers; they boost patient access to services and medications with convenient locations in rural and urban areas. Over 86% of health centers have contract pharmacies.
With a 45% decrease in annual 340B savings due to manufacturer restrictions, SSCHC confronts a host of challenges as they try to expand patient services. The health center has had to limit new staffing positions, particularly those historically funded by 340B savings at a time when as COVID-19 pandemic has exacerbated a nationwide workforce shortage at health centers. The 340B restrictions have reduced funds that would be invested recruiting and hiring staff. A case in point is SSCHC’s need for Medication Access Specialists, who help low-income patients reduce their medication costs (approximately 70% of SSCHC patients are under 100% of the Federal Poverty Level). The restrictions on 340B have made it challenging to find the resources to expand this valuable service to patients in need.
The Path Forward for 340B
Sixteenth Street continues to reinvest their 340B savings into services such as their clinical pharmacist program, expanding facilities to meet patient needs, and Medication Access Specialists, to meet patient needs and enhance overall access. There is no end in sight for these restrictions, which underscores the immediate need for legislation to provide a national solutions. Congress needs to act now to resolve the contract pharmacy restrictions and alleviate patient suffering caused by these unlawful cuts made to the 340B program.
A special thank you to Sixteenth Street’s Jason Jenders, PharmD, AAHIVP, Director of Pharmacy, for speaking with us about Sixteenth Street Community Health Centers.