340B Health president was a recent guest on Monitor Monday. The following are edited remarks of her presentation.
2019 was another very busy year for people involved in the 340B drug pricing program. And it marked the end of a remarkable decade of progress and challenges.
One of the most important developments of this past year was the creation of a new, secure website for use by 340B covered entities to check the ceiling prices that they should be charged for all drugs covered by 340B. This is the first time such a resource has been available, and it introduced some much-needed price transparency. We are already seeing evidence of this working well. More than a dozen pharmaceutical companies have had to revise their pricing, and in many cases, pay refunds to hospitals, health centers, and clinics that had been charged too much. The Health Resources and Services Administration deserves tremendous credit for the creation of this valuable website tool.
We also saw the beginning of a national debate over drug pricing. President Trump and the leaders of both political parties on Capitol Hill have put some important ideas on the table for debate. While there are many differences in how they approach this issue, the key point is that patients need relief from the high cost of prescription drugs, and so do the safety-net providers that care for them. It is my hope that in 2020, our leaders can come together on a common-sense set of reforms that slow the rise in prices, protect patients from financial pain, and protect the vital safety net.
We also saw a continuation of the fight over how much Medicare pays 340B hospitals for drugs. Beginning in 2018, Medicare has been paying these hospitals nearly 30 percent less than it pays all other hospitals. A lawsuit challenging those cuts has led to a federal court ruling them to be unlawful. But the government is appealing that decision, and the cuts remain in place for now. These cuts are harming hospitals and their patients, and the sooner they are ended, the better. We must see a resolution to this issue early in 2020 so that we can get things back on an even keel.
I’d also like to call attention to a very important initiative that President Trump announced nearly one year ago in his State of the Union address to Congress. The President called for dramatic action to reduce the number of infections with the human immunodeficiency virus (HIV) that causes AIDS. In fact, the President set an ambitious goal to reduce infections by 90 percent by the end of the new decade.
To achieve this, we must make sure that people who are at risk of acquiring HIV have access to prevention treatment, known as PrEP, that reduces their risk by more than 90 percent. And we must make sure people living with HIV have access to treatment that provides longer lives and reduced risk. A key part of that effort is the lower prices for these drugs that 340B guarantees.
Finally, I will note that states have grown more active in 340B policymaking. In previous years, states focused primarily on how much their Medicaid programs were paying for drugs covered by 340B. But in 2019, we saw several states adopt legislation putting limits on private payors so that they cannot set discriminatory payment levels for 340B hospitals and pharmacies. This is an important issue for 340B. Paying 340B providers less just because they are in 340B undermines the purpose of the program because it transfers the benefits from safety-net providers to insurers who are not in the business of treating low-income patients. State action to prevent this from happening is definitely a move in the right direction. I expect states will remain active in 2020 on 340B-related issues.
We start this new year and new decade with cautious optimism. It’s easy to focus on what divides us, but at this point in our national debate over healthcare, it will serve us well to focus on what can bring us together.
Here’s the uncomfortable truth: many hospitals and state Medicaid plans, under pressure from HR1 data analysis needs, are paying eye-watering markups to for-profit CPA and
As discussed last week, payments to Medicare Advantage (MA) plans are adjusted to account for expected healthcare resource consumption by enrollees. Higher risk scores increase
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