Who Is Deciding the Fate of 340B Funding?

All three arms of the federal government continue to struggle over the fate of the 340B Drug Pricing Program for Hospitals. In July, a Circuit US Court of Appeals dismissed the suit brought by the American Hospital Association, the Association of American Medical Colleges, and America’s Essential Hospitals because it was filed when the “new regulation had not yet even become effective.” On September 11, these plaintiffs were joined by 340B Heath and three major hospital systems in asking a federal court to order DHHS – within 30 days – to issue a final ruling that requires drug companies to “disclose the ceiling price for 340B outpatient drugs”. Congress originally required this disclosure in 2010. According to the plaintiffs, DHHS has postponed deadlines for this disclosure five times to date.

Congress held hearings on 340-B last Spring. In the Administrative branch, the Centers for Medicare and Medicaid Services (CMS) has included a cost cutting measure in their 2019 plan that will reduce access to drugs provided in some off-campus hospital clinics. According to Politico, this “proposed rule would slash by nearly 30 percent Medicare Part B drug payments to 340B hospital outpatient facilities offsite.”

Fortunately, the new rule is subject to public comment and those comments must be available for public inspection. The Washington Post reports that CMS received some 1,400 public comments on CMS’ intention to cut the 340B program. Of those, “hundreds appeared to come from patients across the country – pleas from average Americans whose treatments for diseases such as cancer depend on costly medicines.”

After examining the responses posted online by CMS, Kaiser Health News (KHN) noticed that “of the 1,406 comments that specifically mentioned 340B… about half included the same or similar wording and were submitted anonymously.” These messages also generally “lamented ‘abuse’ of the drug discounts, faulted hospitals for being ‘greedy’ and used phrasing such as ‘quality, affordable, and accessible.” KHN also found two messages, “that were duplicated hundreds of times and made the very same grammatical mistake.”

Changes in the Rate of Uninsured Americans

Census data released last Wednesday indicated that 8.8% of Americans (28.5 million people) were uninsured in 2018 – the same rate as occurred in 2016. A significant drop in the uninsured rate started in 2014, with ACA implementation, but now appears to have “flattened out”, The Hill reports, “with almost 30 million people still lacking coverage.”

The Hill adds that these numbers “contrast to data released in January from Gallup, which showed three million additional people without health insurance in President Trump’s first year”. The Kaiser Family Foundation posits that this contrast may simply reflect a time-lag and that “the uninsured rate could increase in 2018 or 2019, as the Trump administration’s changes to ObamaCare take effect.”

The 84% funding reduction (from $63 million to $10 million) for ACA Navigators to help people enroll in insurance plans are also expected to reduce participation this year (see 7/12/18 WA). The uninsured rate will also likely increase following 2019 implementation of the GOP tax law repealing of mandatory coverage.

Politico adds that the rates differ widely between states that have Medicaid expansion and those that don’t. “In the 32 states, including the District of Columbia, that expanded Medicaid as of Jan. 1, 2017, the average uninsured rate was 6.5 percent, about half the 12.2 percent rate in states that haven’t expanded.”

Finally, the Federal Register announced last August 2 that a Final Rule change will be implemented on October 2, 2018 to “lengthen the maximum duration” of short-term limited duration (STLD) insurance policies from the current three months maximum to up to 364 days. These policies are very limited in scope and inappropriate for people at high risk or living with HIV for a variety of reasons. This major expansion in the STLD policies market will likely affect future census figures on the number of insured and unassured Americans, despite the fact that STLD policies are woefully deficient in the coverage they offer their consumers.

View the latest HIV Policy Update here.