What is 340B?
As part of a bipartisan bill, the 340B Federal Drug Pricing Program was created in 1992 with the congressional intent to assist safety-net providers “to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services” (H.R. Rep. No. 102-384(II), at 12 (1992)). If drug manufacturers wish to participate in the Medicaid Drug Rebate Program (MDRP), the 340B program mandates that they provide discounted 340B pricing on Covered Outpatient Drugs to eligible safety-net entities. As such, although it is a federal program, the 340B program is not funded by taxpayers.
Community Health Centers (CHCs) are one of those eligible entities, and since 1992 the 340B program has become vitally important to CHCs and their patients. The 340B program permits CHCs to save on drug costs by purchasing outpatient 340B medications at a reduced/discounted price for eligible patients. Thereby, CHCs can provide affordable discounted or free medications to low-income patients. The CHC also can generate savings that are reinvested into services that meet the unique needs of their vulnerable communities.
Columbus Neighborhood Health Center, Inc. dba PrimaryOne Health (P1H), is an excellent example of this. P1H has served low-income residents of Columbus and Franklin County, Ohio, since 1997, and is the oldest and largest federally qualified health center (FQHC) system in central Ohio. P1H operates 11 health center sites in the medically underserved neighborhoods of Columbus, Ohio, one rural health center site in Pickaway County, and four mobile health centers.
In 2021, P1H provided over 144,500 visits to >42,000 unique patients during the pandemic. P1H provides integrated, comprehensive, affordable healthcare services to those in need, including primary care, adult medicine, integrated behavioral health, obstetrics and gynecology, pediatrics, dental, vision, clinical pharmacy, substance use disorder, nutrition, and physical therapy services.
While P1H’s services are open and available to all, P1H targets services towards those who are low-income, those who lack affordable access to care, and/or those who are underserved by safety net providers including people experiencing homelessness and public housing residents. P1H provides care to more than 13,450 patients (32%) whose income is 100% and below the poverty level and more than 15,500 patients (37%) who are uninsured. 38% of P1H’s patient population is best served in a language other than English.
How does PrimaryOne Health Use the 340B Program to Meet the Unique Needs of its Vulnerable Communities?
P1H uses all savings resulting from its participation in 340B to expand our patients’ ability to access to medication and other services. Section 330(e)(5)(D) of the Public Health Service Act, as well as the regulations governing our Federal grant, require that every penny of savings resulting from our participation in 340B is used for purposes that expand access to care for our patient population.
P1H provides discounted medication pricing to all uninsured patients with incomes at 200% or less of the Federal Poverty Level. In 2021 we saved our patients millions on prescription medications through the 340B program. On average our low-income patients saved $1,200 last year, and the great impact of the program for our patients attracted media coverage showcasing one of our 340B patient’s stories. PrimaryOne Health uses the remaining 340B savings to expand access to the following services that we would otherwise not be able to provide or only in limited capacity: substance use disorder and addiction services, language assistance / interpreter services, physical therapy, dental care, clinical pharmacy, vaccines, and nutrition.
P1H has continued to work to build a cohesive, consistent, and quality system of health center sites throughout the medically underserved areas of central Ohio in Franklin and Pickaway counties. P1H has developed strong community pharmacy partnerships (i.e., 340B Contract Pharmacies) across the area to ensure patient access to medications. Our mission is to serve the healthcare needs of vulnerable, uninsured, under-insured, and insured residents within the community. The 340B Pharmacy Program provides an opportunity to invest in a holistic practice serving the physical and mental well-being for our patients.
How Important Are 340B Contract Pharmacies to PrimaryOne Health and Its Patients?
At PrimaryOne Health, we do not have our own in-house pharmacy but instead we administer 100% of our 340B program solely through Contract Pharmacy partners throughout the area. We chose this method because it is the best way to ensure access to life-saving and affordable medications for our patients who are spread across more than 200 zip codes. We would be unable to serve all our patients without the 340B Contract Pharmacies who partner with us. The Contract Pharmacy program is vital to ensuring affordable access to prescription medications for our patients, but also essential to supporting and sustaining services within our health centers. We are also intentional about contracting with local independent pharmacies to promote and support small businesses, especially in underserved rural and urban areas of our service area.
Simply put, we would not be able to fulfill our 330 Grant requirements for thousands of residents without our 340B contract pharmacy program. In these unprecedented times, contract pharmacies are playing a significant role in serving our patients during the COVID-19 Pandemic, ensuring safe access to affordable medications in the places where our patients live, work, worship, and play.
About the Guest Writer
Jangus B. Whitner, PharmD, MHA, BCACP, 340B ACE, is Director of Pharmacy Services at PrimaryOne Health, the oldest and largest community health center in central Ohio. He is the Founder and Past Chair of the Ohio 340B FQHC Consortium, a 340B Apexus Certified Expert, and has served as a subject matter expert for Apexus through webinars and workshops. After receiving his PharmD degree from The University of Toledo, Jangus went on to complete two years of post-graduate pharmacy residency training and then pursued a Master of Healthcare Administration (MHA) degree.