The future of 340B, my perspective

The snippets below are taken from a recent article in Pharmacy Times: The Future of 340B: It’s All About Perspective

“Established more than 20 years ago [the 340B Drug Discount Program], this legislation was enacted to assist different health care settings in providing excellent care for indigent and vulnerable patients. To allow this to happen, safety net providers have access to discounted outpatient drugs from manufacturers. By being able to purchase the discounted medications, these qualifying organizations are able to utilize the savings to provide care for those uninsured and underinsured patients. “ – The 340B Drug Discount Program can be a great thing for healthcare systems that care for a lot of ‘uninsured’ or ‘underinsured’ patients. These are often time indigent patients.

“Unfortunately, some of the safety net providers have been targeted with intimations that they have inappropriately taken advantage of opportunities that allow for beneficial financial terms. This money ends up benefitting organizations and executives, not the people it was intended to serve, suggest the critics. I am aware of these concerns as I am employed by an organization that qualifies for the 340B Drug Discount Program.” – People aren’t “targeting” systems, per se. People are questioning some of the, shall we say, creative 340B practices. The problem here is really quite simple. It’s not the facilities that everyone is worried about, but rather the big businesses that have come in with promises to managing the 340B program for the healthcare system; for a slice of the pie, of course.  

“If you can strip away all of the politics that lead to the tension around the topic, there are 2 things that everyone needs to remember—there are underserved patients among us, and the illegality of these activities. Anybody who gets sick in our country should be able to receive the best care available, even if they cannot afford it.” – Absolutely, I agree with this 100%. It’ should be about providing the healthcare system with resources to care for the underserved patients in the area. Definitely, no doubt about it. You will not get any argument from me over the authors thoughts on this.

“One way to stretch our limited resources is to subsidize those who have an expressed mission to care for those less fortunate. If they can do that while legitimately and legally following the regulations that are currently in place, these organizations should not be pressured to operate any differently or be highlighted in the popular press. They should not be made to feel guilty for doing what is allowed under the law and improving care for the less fortunate. Let these organizations utilize the opportunities to provide high-level care to the unfortunate, as none of us want to be in that situation.” – Ah, there’s the rub, “legally following the regulations that are currently in place”. Unfortunately that creates a lot of gray area. Legally following the regulations and following the spirit of the regulations are two totally different things. You can legally do something that is wrong, you know it and I know it.

I haven’t come across anyone begrudging a healthcare system for utilizing the 340B program to the fullest extent legally allowed when used to serve their patients. What I have found are people within certain circles that have started to question the involvement of big business in procuring “additional savings” within the 340B Drug Discount Program for a piece of the action. The 340B program wasn’t designed to make lots of money for big businesses, it was designed to help healthcare systems care for their underserved patients.

No program can ever be written to possibly cover all potential use cases. In this case it’s opened up the 340B system to abuse secondary to loopholes and gray areas. This has led to big business coming in from all different angles looking for a big score. Like sharks they can smell blood in the water from miles away.

Don’t kid yourself about what some businesses are willing to do to make money. Would they take advantage of a system designed to help the less fortunate? In the blink of an eye. Oh it’s all perfectly legal, but it’s a moral and ethical quagmire for some.

The problem arises from the complexity of the system. Like all government programs the 340B Drug Discount Program require a team of dedicated people to manage. It’s not easy. Simplifying the program to ensure that the entire benefit of the 340B program goes directly to the healthcare systems caring for patients in need would be a good place to start.

As the article says, it’s all about perspective. There’s a difference between taking advantage of the opportunity and taking advantage of the system. It’s kind of like “taking advantage of being at a party to meet a girl” and “being at a party to take advantage of a girl that’s had a bit too much to drink”. Both are “technically legal”, but the latter makes anyone with a conscience cry foul. 

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