Viewpoint: Placing the health and well-being of patients first
Every day many Americans have to weigh how they will spend each dollar.
Food or rent? Electric bill or healthcare? For those who are uninsured and underinsured, medication is often sacrificed to cover the basic costs of day-to-day life.
The consequences of skipping a prescription? More emergency room visits, declining health and a poorer quality of life.
Ministry Saint Mary’s Hospital believes it is our responsibility to ensure that those we serve have access to the prescription medications they need to maintain or improve their health. Our mission has always been to serve the poor and underserved, to provide healthcare that truly leaves no one behind.
Last year, Ministry Saint Mary’s provided $1,751,000 in charity care for persons living in poverty, and as a member of Ascension Health, the nation’s largest nonprofit health system, this contributed to the total $1.5 billion the organization provided in charity care for those living in poverty in 2013.
For vulnerable individuals, a program called 340B is vital to their ability to obtain medications and services to keep them out of the hospital by best managing their medical conditions. This is especially important for patients with chronic diseases like hypertension and diabetes.
The 340B Drug Pricing Program was enacted by Congress in 1992 to help safety-net providers – those who provide care to the most poor and vulnerable among us – afford the rising cost of outpatient drugs. The problem that drove Congress to address this issue – the rising and unaffordable costs of drugs – has not disappeared or abated.
The cost of pharmaceuticals continues to rise at alarming rates for providers across the country.
At Ascension Health we have seen non-340B drug prices rise by $36 million just over the past 12 months. For example, the price for Ofirmev, an injectable form of acetaminophen that is commonly prescribed for post-surgical pain, increased by 140 percent over the past 12 months. Santyl, an ointment prescribed to remove dead skin from wounds to promote healing, increased by 97 percent over the same period of time.
Price increases are not limited to top branded medications. Generic medications have increased at even more dramatic rates. Methotrexate is a tablet prescribed for patients with psoriasis, cancer and severe rheumatoid arthritis. In the past 12 months, its price increased by a whopping 488 percent. Close behind is Prednisone, a steroid this is prescribed for a variety of medical conditions, including multiple sclerosis, lupus and arthritis. Its price went up by 460 percent, and morphine increased by 99 percent.
The increase in cost for pharmaceuticals is a complex problem for Ministry Saint Mary’s Hospital as the number of poor and vulnerable patients we treat continues to grow. However, the 340B law is simple and effective. By allowing us to pay less for high-priced outpatient prescription drugs, as a safety-net provider, we have more resources to help our patients.
When the program was enacted, 340B was limited to governmental-funded health centers and certain safety-net hospitals. But with the success of the program, Congress added cancer hospitals, children’s hospitals and rural hospitals in 2010. Ministry Saint Mary’s is able to participate in 340B because we are a sole community hospital. In fact, about half of the newly eligible hospitals are small, rural hospitals serving poorer, more disadvantaged populations – patients less likely to have prescription drug coverage, and less likely to be covered by Medicaid benefits than their urban counterparts.
Unfortunately, large pharmaceutical companies – in search of padding their bottom lines – have started to question the success of the program. A recent study funded by the pharmaceutical companies suggested that 340B hospitals provide only a minimal amount of charity care. That report told only half of the story. Using the same data source, when bad debt and Medicaid payment short falls were added to the calculation, 340B hospitals provided consistently more uncompensated care than non-340B hospitals.
I can tell you how our hospital uses its drug discount savings:
Patients in need are identified either because they have expressed concern about being able to pay for services or, when working with hospital associates, it becomes clear that they are not taking needed medications or have other unmet healthcare needs. The patient is then referred to programs such as Ministry Sacred Heart-Saint Mary’s Hospital’s Community Link Program for help in identifying assistance options.
The Community Link Program works in collaboration with the Discharge Planning staff for patients leaving the hospital without the ability to purchase needed medications. Recently, a patient in our emergency department was unable to purchase needed antibiotics so the Emergency Department staff connected the patient with the Community Link Program to help them obtain their medication.
The Medication Assistance Coordinator and RN Case managers in Ministry Medical Group clinics work in collaboration with the Community Link Coordinator to help meet the unmet needs of diabetic patients to monitor and treat their diabetes. Monitoring and controlling diabetes is critical to avoiding hospital stays and improving quality of life.
The bottom line: 340B is a successful and critical program that allows hospitals to help underserved patients with the high cost of prescription drugs. Rolling back the 340B program will only add to pharmaceutical industry profits while leaving our most vulnerable citizens with less access to the medication and quality healthcare they desperately need.
Monica Hilt, President
Ministry Howard Young Health Care
Ministry Sacred Heart-Saint Mary’s Hospital
System Director – 340B Drug Discount Program
Ministry Health Care