FAIRMONT — After Craig Blair lost the GOP primary for his seat in the West Virginia Senate, he set out to make one thing clear.
“The reasons I lost are evident to anyone on the ground here in West Virginia,” Blair wrote in an op-ed submitted to the Dominion Post. “One reason you will not find among them is my support for a federal drug discount program that costs taxpayers nothing and disproportionately benefits rural, working-class voters — you might even call the MAGA supporters — in places like my district.”
Blair is a champion of a federal program known as the 340B Drug Pricing Program. Its name is a reference to section 340B of the Public Health Service Act, which requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to health care organizations that care for uninsured and low-income patients. Rural populations particularly benefit from the program.
“We very much keep a very close eye on what’s happening at both the federal and state level with regards to 340B,” Todd Karpinski, chief pharmacy office for WVU Medicine, said. “There’s a group within pharma who would like the 340B program to be scaled back dramatically. Essentially, they’re the ones taking the loss but as you know, major pharma companies aren’t losing money. They make billions and billions of dollars.”
Karpinski said the 340B program does not cost the federal or state government a dime. The program is supported and funded by pharma based on legislation from the mid 1990s.
The program has been in place since 1992, according to Adam Croglia, managing director of Washington, D.C.-based Trysail Strategies. The company is working to get the word out about 340B. Croglia said the point of the program was to figure out how to enable better health care for people who need it but can’t afford it.
“This is not health care for the rich,” he said. “This is health care for the poor and the people who need it.”
Croglia said by participating in the 340B program, pharmaceutical companies reap the benefits of having their drugs covered by state Medicaid, an enormous marketplace. Since pharma funds the 340B program, they see 340B as a cost that reduces the profits they can make on medicines.
PhRMA, the pharmaceutical trade agency, spent $28 million on lobbying in 2023, according to opensecrets.org.
Emily Blaiklock, vice president of Pharmacy at Positive Impact Health Centers and Bill Keeton, chief advocacy officer for Vivent Health, are both strong proponents of the program. They are also both part of the Ryan White Clinics, a national organization that tries to elevate the importance of 340B issues as it relates to HIV care providers.
Blaiklock explained that through her current role at Ryan White Clinics, she gets to see the direct benefit that the 340B program provides to patients through wraparound services and medication they wouldn’t otherwise be able to receive. Ryan White Clinics receives federal dollars through a grant for the service. This gives Blaiklock the ability to participate in the 340B program.
The clinic can purchase medications at a discounted price, which she then bills to insurance through the clinic’s pharmacy programs.
“The margin that I make on those medications, that has to go back into the services that I provide to underserved patients,” Blaiklock said. “It allows me to stretch these scarce federal dollars much farther without an additional burden on the taxpayers to do so.”
Keeton said individuals who are in rural areas like Wisconsin, Georgia or West Virginia may not have access to infectious disease physicians who would be able to provide high quality care for people with HIV. He said the money freed up by lower drug costs helps provide wraparound services needed to effectively treat all the needs of rural patients.
“This program was meant to buttress existing programs already in the space taking care of these folks,” Keeton said. “It allows us to generate the resources to have comprehensive services for these folks. It’s doctors, dentists, nurses, behavioral health and mental health providers. It’s social service providers and programs like food pantries and housing programs and case management. We’re able to do all of that with the investment that’s being made in us through the federal programs, and the 340 B program.”
The 340B program provides the flexibility health care providers need to target their care effectively, Blaiklock said. In a more rural setting, she can allocate money to transportation to help rural residents reach their appointments. In an urban area, because transportation is more available, her focus might shift to more mental health programs.
There is a multifaceted debate about the effectiveness of 340B. According to an article by Vox explaining the debate, pharma argues the savings are not passed along to patients. A 2018 report published in the New England Journal of Medicine found no measurable difference in “safety-net or inpatient care for low income groups or in mortality among low-income residents of the hospitals’ local service area,” Vox quoted.
However, according to Lindsay Conway, managing director of the Advisory Board, a healthcare research organization, the report published by the New England Journal comes with important caveats. Conway argues there’s insufficient data on care provided by 340B hospitals, and that the cancer metric the study used to determine efficacy is questionable at best.
Regardless, West Virginia is a strong 340B state. Joseph Letnaunchyn, president and CEO of the West Virginia Hospital Association, published a letter in 2020 strongly supporting the 340B program.
“The program, which also benefits Federally Qualified Health Centers and other safety net providers in our state, is currently under attack by several of the largest U.S. drug manufacturers,” Letnaunchyn wrote. “One by one, these drug companies have unilaterally taken a series of actions to restrict and undermine the 340B program – all in the wake of a global pandemic, and as hospitals remain on the frontlines of care. Their actions will affect access to health services and prescription drugs for all West Virginians.”
Karpinski said the program plays a big role for WVU Medicine. All but one of the hospitals it owns throughout the state qualify for the program. It allows the hospital system to purchase medicine at 20-40% than wholesale acquisition cost. By saving money on those drugs, the organization can provide scarce resources to a lot of underinsured patients.
“We have several preventative cancer screening programs that we fund,” Karpinski said. “We have diabetes education programs.”
Karpinski added the 340B program allows WVU Medicine to keep the rural hospitals it has bought, open.
Gov. Jim Justice is a champion of 340B, Blair said in his piece for the Dominion Post. Justice signed West Virginia Senate Bill 325 which protects 340B at the state level. Senators Shelley Moore Capito and Joe Manchin are both supporters of 340B.
Blair argued that the notion W340B is somehow unconservative or problematic is wrong, given its support by Republican state leaders. West Virginia joins fellow red states Arkansas, Louisiana, Mississippi and Kansas in protecting 340B.
Croglia said nationally, his organization can go tit for tat on pharma’s complaints about the program. They have rebuttals to all of them. What’s important is illuminating the motive of the group doing the critique, which is profit driven, he said.
Keeton put the role 340B plays when it comes to providing health care in the rural population he serves, simply.
“I can tell you that there would be a lot of patients that would not receive any form of of health care in our areas in Georgia,” he said, “if we did not have continued access to 340B program.”
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