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J Lee MD PhD's avatar

This is a disturbing eye-opener. Thanks for posting bad but necessary news about a rather obscure, truly sleazy, but "not-so-little" pipeline for more cash to flow silently and electronically from Gubment right into the coffers of "healthcare systems". Al Capone himself could not have invented a slicker fund-raising gimmick. This off-the-rails drug pricing program conveniently creates a tempting modus operandi for steadily sucking up more *fungible moolah* that can support stuff like [wait for it. . . .] the outlandish salaries & benefits accruing to the wankers who nowadays populate the carpeted, clean, nicely furnished, and very quiet "Administrative Suites" found inside most every medical center. We are now an "Industry" and you know exactly who the people are that I'm talking about here -- those folks with the fixed smiles and the capped teeth, and sometimes the Botoxed faces; they often wear the tasseled loafers; the folks who have now enshrined the putrid idea that "being smart" amounts simply to having an ability to sling the bull and the creativity to fashion animated Power Point slides that can be used to "show leadership" during talks that they give periodically to hospital employees (we the serfs), and most especially talks that are accompanied by the intense use of a set of peculiar hand-waving motions and finger gestures that oddly are now everywhere common for this class of cretins; folks who often have creatively and self-consciously changed their professional names from "John B. Smith" to "J. Brandon Smith" because well. . . . . . . gosh, it just sounds more important; folks who literally don't do shit except for *creating the impression of being busy* with all their important decision-making, all their going to meetings in the Board Room, and of course dodging diligently anything at a hospital that might ever involve even a minuscule risk of their custom-fitted shirtings and Hermes ties and 900-dollar blazers being sprayed with blood or stool or emesis, etc. God forbid! As far back as 1985, during my early academic surgery career, I predicted in plain language during invited lectures given at various major academic medical centers that the well-intentioned, but misguided and hijacked, Healthcare Quality Movement (thanks Don Berwick but you did not see this coming) would more likely than not eventuate in the rise of what I have called "The Big Pee-Pees", a new species of greedy, self-important, buzzword-spouting Power Players who do NOT take care of patients. Instead, they prance about as if they are the CEOs at General Motors or Amazon, etc. And that, my colleagues, is exactly what has happened to us. It's a disaster. Good luck.

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Brandon's avatar

Speaking as a pharmacist at a Critical Access Hospital I do have a few critiques for this piece. It makes some arguments that I have seen quite a bit recently. I take issue with the framing that the intention of this program is solely to provide cheap outpatient drugs for patients, as noble as that is. Another critical (no pun intended) component of the 340b program is to provide some additional source of revenue for our Critical Access Hospitals (CAH's) and other potentially financially challenged health systems by collecting the spread between the 340b price and the typical reimbursement rate from insurance. Without such additional revenue, there is a high likelihood that even more small hospitals and health systems would have to dramatically reduce their services or even close- like we've seen many CAH's do in the past 10 years.

I would also like to highlight the additional frustration that 340b participants have with drug manufacturers deciding to unilaterally "opt-out" of their 340b drug pricing, charging 340b hospitals the standard price for now- and fighting the legal battle that will inevitability ensue later. It's unclear if our 340b-eligible facilities will ever be able to claw back that overcharging that has occurred. It's also unclear if HRSA has any interest in doing anything to remediate this situation- which I find troubling. (If you want to read more- https://www.statnews.com/2022/06/10/pursuit-of-profits-is-driving-drug-companies-to-break-the-340b-law/)

Altogether- I do feel like the current implementation of the 340b Program has serious issues, and I would be in favor of significant restrictions on eligibility for the large chains (CVS, Walgreens, etc.) that are very much abusing the system, and at the end of the day are NOT what these programs are for. But also, at the end of the day, our smaller independent pharmacies and CAH's rely on these programs to survive financially- and it doesn't feel like there are many advocates for us out there. I would love to see some accountability for the manufacturers that have decided to illegally "opt-out", but we will have to wait and see. Appreciate the piece, hope the context that I mentioned is also considered in the 340b conversation.

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