Point of View: Put vulnerable patients before profit
Article originally featured on Palm Beach Post.
The federal 340B program, which provides cheaper drugs to community health centres and nonprofit hospitals, is past due for re-evaluation.
Nearly 27.4 million people across the country have no health insurance, and about 147 million more have inadequate health insurance, according to an analysis by the Kaiser Family Foundation in 2017. This means that more than half of the American population experiences some form of healthcare insecurity and therefore may not be receiving proper medical care. To alleviate this problem, the 340B program was created in 1992 to aid vulnerable and uninsured Americans by reducing healthcare costs.
The 340B drug discount program provides cheaper drugs to community health centers and nonprofit hospitals. According to the National Institutes of Health (NIH), 16% of our nationwide epilepsy population does not have health insurance. Vulnerable patients are more likely to skip medications and end up in the emergency room for a seizure that could have been prevented with proper medication adherence. People with epilepsy often experience other chronic illnesses making it difficult to manage their health and access various medications.
Constant oversight of programs and policies is necessary and at 27-years-old, the 340B program is past due for re-evaluation. While this program was designed with honourable intentions, like any program, it can easily have negative outcomes if not monitored properly. What started as a way for low-income patients to receive less expensive healthcare has turned into entities, such as disproportionate share hospitals (DSH) and contract pharmacies, taking advantage of the benefits of the program at the cost of vulnerable patients.
In 1992, there were about 50 participating 340B healthcare facilities. This number increased to 583 in 2005, and then to almost 13,000 in 2017, according to a report by the U.S. House Energy and Commerce Committee. However, this growth is not necessarily indicative of success when many of these DSH hospitals are actually providing lower levels of charity care.
Why are decreased levels of charity care happening? Because 340B DSH hospitals receive drug manufacturer discounts ranging from 20-50% off regular drug prices, but regulations do not strictly outline how the drug savings are then utilized. The savings are often not passed down to uninsured patients and instead may go towards hospital construction, employee bonuses and other hospital interests. 340B DSH hospitals do not even have to disclose how these savings are being used. When a program has such lax oversight, one can see why it can be so easily and widely exploited.
It’s time for us to stand up for vulnerable patients and get this program back on track by prioritizing vulnerable patients over profit. Enforcing stricter guidelines and establishing clearer definitions for participating facilities will protect these patients and ensure the program is not abused. We need to bring the 340B program back to its true intentions— our epilepsy community deserves better.
KAREN BASHA EGOZI AND JULIE MARTIN, MIAMI
Editor’s note: Egozi is president and CEO of Epilepsy Florida and Julie Martin is executive director of Epilepsy Alliance Louisiana, both members of the Epilepsy Alliance America.