Tuesday, March 21, 2023

Play

Texas lawmakers consider legislation to prevent cities from self-governance, Connecticut considers policy options to alleviate an eviction crisis, and Ohio residents await community water systems.

Play

Gov. Ron DeSantis breaks his silence on Trump's potential indictment and attacks Manhattan prosecutors, President Biden vetoes his first bill to protect socially conscious retirement investing, and the Supreme Court hears a case on Native American water rights.

Play

The 41st state has opted into Medicaid which could be a lifeline for rural hospitals in North Carolina, homelessness barely rose in the past two years but the work required to hold the numbers increased, and destruction of the "Sagebrush Sea" from Oregon to Wyoming is putting protection efforts for an itty-bitty bunny on the map.

States Take Action Against PBM's 340b Workarounds

Play

Tuesday, December 27, 2022   

With Community Health Centers' funding facing challenges from pharmacy benefit managers, some state lawmakers are getting involved.

The centers are a nonprofit safety net created by Congress in 1965 to provide health care services to medically underserved communities both urban and rural. They are the medical home for 600,000 Missourians.

They are funded by private insurance and Medicaid, federal government grants, and the 340b drug-pricing program. Under 340b, drug manufacturers agree to discount drugs to safety-net providers in exchange for their drugs being covered by Medicare and Medicaid.

Until recently, insurance companies and pharmacy benefit managers reimbursed the retail price, and the health centers were able to pocket the difference with the mandate they use the money to reach more eligible patients and provide more comprehensive services.

Colleen Meiman, a national policy adviser for state associations of Community Health Centers, said in recent years, the benefit managers have changed their approach.

"What has happened in the past five to 10 years or so is that the PBMs have figured out, 'Wait a second, you're a health center. You're eligible for 340b, we know you're paying less for drugs than everybody else, so we're going to reimburse you less for drugs,' " Meiman explained.

Meiman pointed out 22 states have passed laws against 340b workarounds. A bill to make these practices illegal died in committee in the Missouri Legislature last term.

Meiman noted for decades, the financial stability of Community Health Centers has relied in part on 340b savings, and pharmacy benefit managers are exploiting a loophole.

"Just because you just recently figured out that there's this loophole in the law, and you can get your hands on our savings, does not negate the fact that those savings are critical to keeping the primary-care infrastructure safety net in this country running," Meiman contended.

She added over time, the benefit managers' tactics have evolved to avoid providing 340b drug access in the first place.

"You'll see 'Oh you dispense 340b drugs, pharmacy? We're not going to let you into our preferred network,' is a favorite approach," Meiman stressed. "'We're not going to cover 340b drugs anymore', so there's many different ways of instead of just paying them less, just keep the patients from getting the 340b drug in the first place."

Community health centers serve as the medical home for more than 30 million Americans of all ages.


get more stories like this via email
At least 124 bills have been introduced nationwide this year targeting LGBTQ rights in schools and educational settings, freedom of speech and expression, and access to medically necessary health care for transgender people, according to the American Civil Liberties Union. (Adobe Stock)

Social Issues

Educators in New Hampshire say a proposed "parental bill of rights" before lawmakers discriminates against LGBTQ students. The legislation requires …


Social Issues

Leaders of the Wabanaki Nations are asking Maine lawmakers to recognize tribal sovereignty and help ensure a better economic future for their youth…

Social Issues

American democracy is in mortal danger as the 2024 election approaches, according to experts at a conference held at the University of California…


New Mexico has followed Texas' lead by passing preemptive legislation to ban the storage of high-level radioactive waste in the state. (Tiero/AdobeStock)

Environment

Like Nevada, New Mexico has rejected a proposed interim storage facility for spent nuclear fuel. Responding to the Federal Nuclear Regulatory …

Social Issues

New Mexico's LGBTQ community will soon have additional protections after existing language in state law was updated by the Legislature. Sen…

Environment

Thousands of lives are cut short every year because of air pollution from coal-fired power plants in Wyoming and across the United States, according …

Social Issues

New data from the Centers for Disease Control and Prevention show another increase in the nation's maternal mortality rate, and a Minnesota expert …

 

Phone: 303.448.9105 Toll Free: 888.891.9416 Fax: 208.247.1830 Your trusted member- and audience-supported news source since 1996 Copyright 2021