Drug Company 340B Discount Refusals Harm Patients

It is the one-year anniversary of 340B Insight, and this week we are joined by Anne Webster, a nurse practitioner for UnityPoint Health Methodist in Peoria, Ill. Anne discusses how drug company restrictions on 340B pricing on drugs dispensed at community pharmacies have directly affected her patients living with diabetes and their ability to access the insulin and other medications they need to manage their conditions. Please note that the episode was recorded prior to the Health Resources & Services Administration (HRSA) announcing on May 17, 2021, that drug companies refusing 340B discounts to safety-net hospitals and providers on drugs dispensed at community pharmacies are in violation of the law and that they must offer 340B pricing and pay refunds. We will discuss this news in future episodes.340B Increases Patient Access to Insulin  Anne works in an endocrinology clinic, and her patients are living with complex cases of type 1 and type 2 diabetes. Her patients usually have several comorbidities and are underinsured. As one of the few 340B providers in the area, her clinic treats patients who travel up to two hours one way to receive care from Anne and access the insulin they need at the community pharmacy on the hospital campus. Through the community pharmacy partnership, Anne’s uninsured and underinsured patients were accessing highly concentrated insulin, reducing the frequency of injections per day. She explains that 340B pricing has helped patients obtain high-quality insulin and other medications at a price they could only afford with a discount. Anne says her uninsured and underinsured patients saved $1.2 million in out-of-pocket expenses per year by receiving their medications at UnityPoint Health Methodist’s community pharmacy. Patients Are Losing Access to Insulin and Other Medications  After drug company refusals to provide 340B discounts on drugs dispensed at community pharmacies, Anne had to switch patients to lower-quality, less-concentrated insulin. This resulted in patients with worse glycemic control who were injecting a large volume of fluid under their skin, which can lead to health complications. Anne’s patients were very upset about the changes to their insulin and other medications. The insulin they often had to switch to must be injected through a vial and syringe setup. This is challenging for patients with vision and dexterity problems. Higher Costs for Patients In addition to taking insulin that is ill-suited for them, patients had higher costs due to the inability to access insulin at the community pharmacy. Anne shares that through the community pharmacy partnership, patients could access a month’s supply of insulin for less than $40. The insulin they often switched to can cost them up to $150 per month out of pocket.  Patient Stories Anne also explains the stress the drug manufacturers’ actions have placed on her patients. She shares the stories of two patients who are living with diabetes and fall into the Medicare coverage gap. The first patient, a retired factory worker, has had his insulin prescription switched multiple times over the past year. The first time was when Eli Lilly refused to provide 340B discounts and the second time was when Novo Nordisk followed suit. Even though he since has gained access to insulin through a drug company patient assistance program, this took a long time. During that process, he experienced significant stress from the uncertainty about whether he could access the insulin he needs. The second patient is a retired police officer. He was accessing a medication from AstraZeneca for blood sugar and weight control that reduced the amount of insulin he needed. AstraZeneca’s decision to refuse 340B pricing on drugs dispensed at community pharmacies resulted in the patient losing access to the drug for a long time until a patient assistance program decided it would cover it. Check out all our episodes on the 340B Insight podcast website. You also can stay updated on all 340B Health news and information by visiting our homepage. If you have any questions you would like us to cover in this podcast, email us at [email protected] 340B Health and Allied Organizations Brief in AstraZeneca vs. HHS Federal Court Case About HHS Advisory Opinion Regarding 340B Community Pharmacies HHS Brief in AstraZeneca vs. HHS Federal Court Case About HHS Advisory Opinion Regarding 340B Community Pharmacies More States Acting To Protect 340B Safety-Net HospitalsRising Insulin Prices Impact Patients’ Diabetes Management, Holistic WellnessEpisode One: HRSA’s OPA Response to COVID-19 with Rear Admiral Krista Pedley– May 18, 2020