In the coming weeks, the Missouri General Assembly will hear legislation related to the federal 340B Drug Pricing Program. The program requires pharmaceutical manufacturers to sell drugs at a discount to eligible healthcare providers that serve large numbers of low-income patients. Drug manufacturers and insurance companies have worked to undermine the program. These changes influence hospitals’ and other eligible 340B program participants’ ability to deliver essential services in communities throughout the state and place locally owned pharmacies at risk.
Attacks on the program are happening in several ways. Drug manufacturers are working to limit the number of contract pharmacies patients and hospitals can use. This restricts the volume of discounts — saving Big Pharma dollars while reducing patients’ access to needed medication. At the same time, insurers are attempting to keep the discounts and restrict patients from accessing healthcare providers that participate in the 340B program.
When manufacturers define who can partner with hospitals and providers through the program, patients lose access. For example, Golden Valley Memorial Healthcare (GVMH) has facilities in Clinton, Warsaw, Windsor and Osceola. Drugmakers’ unethical contract pharmacy restrictions limit GVMH’s ability to partner with local pharmacies in favor of only the highest volume big-box pharmacies in our service area. The result is that a patient who lives in Warsaw might have to travel nearly 30 miles to Clinton to access their low-cost medication. It also means we are not able to contract with many locally owned pharmacies and patients are steered away from their local pharmacy. There is only one pharmacy in Windsor and it is locally owned. If that pharmacy goes away — which is possible with these attacks on 340B — the entire community could lose local access to prescriptions and a vital part of the local care team.
The savings from 340B participation allow hospitals to provide services that many could otherwise not. For example, GVMH uses the 340B program to support reduced-cost cancer drugs and care. These savings allow us to provide generous financial assistance, while helping patients access cancer care, locally. Absent this access, many of our patients would go without care.
GVMH uses 340B to subsidize 100% of our diabetes program. This includes diabetes care and medication, but also extends to patient education and counseling. Diabetes is a leading chronic condition in Missouri and is prevalent in rural communities. Controlling diabetes controls healthcare costs.
Missouri, which has one of the highest rates of maternal mortality and morbidity in the nation, is increasingly home to maternity deserts. The 340B program supports high-quality maternity care in Clinton and obstetric services in our region. In the past year, we have reduced the number of available maternity beds at GVMH due to operating losses associated with the service. The savings we receive from the 340B program help to offset those losses and support our birthing services.
GVMH provides ambulance services to all of Henry County and assists in mutual aid for surrounding ambulance districts. We are one of the few hospitals in the state that continues to provide ambulance services. If the 340B program continues to erode, ambulance services for Henry County will require tax-based support.
The 340B program does not cost the state or federal government a thing. The initial intent of the program was to ask that all healthcare entities, including Big Pharma, assist in caring for the uninsured and underinsured. Hospitals like GVMH provide care below cost on a daily basis.
There is an old saying in the hospital community: If you have seen one hospital, you have seen one hospital. I have shared how GVMH uses 340B to support the work we do to improve individual and community health. Every hospital will have a different story. However, every eligible 340B hospital is dependent on the program as a tool to maintain services and ensure their financial stability, so they can fulfill their missions.
Missouri has lost 12 rural hospitals throughout the last decade. I have seen firsthand what it has done to Osceola, Mo., to lose its rural hospital. When a rural community loses a hospital the economic and health outcomes for those communities become diminished. According to the Missouri Rural Health Association, 43% of rural hospitals are at risk of closure. When rural hospitals close, people die.
In 2024, we have a chance to join other states that have pushed back on these attempts to subvert the program. Senate Bill 751 sponsored by Sen. Justin Brown, and House Bill 2267 sponsored by Rep. Tara Peters, would rein in these violations of the letter and spirit of the program. We have a chance to protect health outcomes and economic vitality for rural Missouri.
Missouri’s hospitals are under significant financial pressure. Allowing these raids on the 340B program will limit patient access to care and divert money away from safety-net hospitals. The federal program is clear that insurers cannot keep these discounts. That has not kept them from trying.
This program matters to Missouri communities and the hospitals and other healthcare providers that help keep them healthy. We can, and should, say no to these attacks on 340B.
CEO of Golden Valley Memorial Healthcare
