How to use 340B program for vulnerable and low-income patients?

The 340B drug discounted program requires pharmaceutical companies to sell covered entities (CEs) with a discounted price for outpatient drugs. These covered entities can include safety-net hospitals, children’s hospitals, disproportionate share hospitals, sole community hospitals, rural referral centers, and many more.

Providers working for the CEs can use the savings to provide services for those vulnerable and low-income patients and allow patients to access medications at low or no cost at all.

340B CEs are made aware that they must use the earnings from the 340B program to give back to the communities that they serve in one way or another.

The following is an example of how a 340B CE can use the savings to serve their patients.

A CE draws a draft of an income-based sliding scale that is like the Federal Poverty Guideline. In the draft, patients have the right to get the application form from their doctors. If qualified, they can be provided with financial assistance to pay for certain expensive drugs or medical bills. It is noted that CEs can decide how they spend the 340B savings and how much discount each patient receives depending on their situation.

Here we show how we can help qualified uninsured, under-insured, and low-income patients to get discounted drugs by making full use of 340B drug discounted program.

First, as we mentioned above, the outpatient facility that the patients go to is part of the CE that is listed on the Health Resources and Services Administration (HRSA) website. The current CEs can be found at here. The list is updated on a regular basis. The CEs need to complete an annual online recertification to keep their eligibility status.

Second, an eligible provider must work for a CE when seeing patients.

Third, the relationship between the patient and provider cannot be just prescription based. To be considered as an eligible patient, the patient needs to have had a visit with an eligible provider to receive the 340B drug.

Fourth, drug manufactures that participate in Medicaid and other CMS programs are required to provide outpatient drugs to 340B CEs at significantly reduced prices. Wholesalers maintain a complete list of 340B drugs and prices. The information is not open to the public as only 340B CEs can access their accounts.

Finally, there are some types of drugs that we would like to mention specifically due to the complicity when dealing with 340B program compliance and policies. Some patients may not be able to get discount from 340B drugs although they are eligible.

Narcotic medications are usually 340B eligible drugs, but many CEs choose to carve out while implementing 340B program. This is primarily due to the complexity of various policies while replenishing this type of drugs.

Some generic drugs can also be excluded by CEs because they do not usually get as high discount as those brand drugs. Including generic drugs may have a negative effect on their overall 340B savings. It is also noted that some CEs choose to carve out Medicaid patients to avoid duplicative discount from drug manufacturer.

Orphan Drugs are a class of medications for treating rare conditions or diseases. Vaccines and Orphan Drugs are generally excluded from 340B eligible drugs. However, there are some exceptions for Orphan Drugs. The orphan drug exclusion does not apply to some CEs such as children’s hospitals and disproportionate share hospitals (DSHs). It is also important to know that some orphan drugs can be used to treat a common condition. In this case, CEs can get discounts on orphan drugs if they are not used to treat rare diseases. To search if a specific drug has been designated as an orphan drug, go to FDA Database.

We aim to illustrate more about orphan drugs in our future articles or blogs. We will also help patients get more resources from the healthcare organization that they have patient-provider relationship with. Feel free to contact us if you need more help regarding how to obtain eligible 340B drugs or would like to know more about some specific drugs.

For more information regarding 340B drug pricing program, please check Health Resources and Services Administration (HRSA) website.