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340B Press Round up:Politico - Health Care Union Joins Coalition Opposing Medicaid Drug Carve-Out
Health Care Union Joins Coalition Opposing Medicaid Drug Carve-Out By Shannon Young
December 17, 2020
Opponents of a Medicaid drug carve-out included in the state budget have picked up another important ally, with 1199 SEIU adding its lobbying power to a coalition of community health groups, providers and others seeking to reverse the policy before it takes effect next spring.
The union, which represents 2,500 federally qualified health center workers, formally joined Save New York’s Safety Net on Thursday in urging the state to reverse the policy that would move the Medicaid retail pharmacy benefit from managed care to fee-for-service.
The union and other coalition members argued that, if implemented on April 1 as planned, the policy would hurt safety net providers that rely on the federal 340B drug pricing program to purchase prescription drugs at significantly reduced prices and use the savings to provide services for uninsured New Yorkers.
“At this moment, in a pandemic where we’re trying to get everybody vaccinated, to cut hundreds of millions of dollars from this safety net provider group does not make any sense,” Helen Schaub, the union’s New York State director for policy and legislation, said in an interview.
Gov. Andrew Cuomo’s administration has stood by the Medicaid Redesign Team II-backed policy, saying it will save taxpayers millions by “increasing transparency, ensuring Medicaid pays the best price for medications, and eliminating unnecessary administrative costs to health plans, all while ensuring that consumers continue to have access to needed medications.”
Cuomo, meanwhile, announced earlier this month that the state would allocate more than $100 million in savings achieved through the carve-out directly to 340B providers to address changes in the reimbursement and ensure continuation of critical services. And “340B entities will still be able to purchase medications at reduced 340B prices,” Department of Health spokesperson Jonah Bruno said in an email on Wednesday.
The MRT II, which recommended the pharmacy benefit carve-out from Medicaid managed care to fee-for-service as part of a series of proposals presented to state lawmakers as they finalized the state budget last spring, projected the policy would save the state $125 million in FY 2022.
But, Schaub said, there are “real questions” about whether the predicted savings will actually transpire.
Opponents have pointed to a recent Menges Group report, prepared for the New York Health Plan Association and Coalition of New York State Public Health Plans, which estimated that the pharmacy carve-out could cost New York $1.5 billion over five years. State health officials have questioned those findings.
“We appreciate that the state wants to make sure that various parties in the Medicaid program are not taking too much of a profit, but the collateral damage to the safety net providers here is really too much to bear,” Schaub said.
The coalition, which includes dozens of community health groups, has further raised concerns that the expected funding losses would require federally qualified health center and community health centers to lay off staff and scale back programs for New Yorkers who need them most. That, they argued, is at odds with the Cuomo administration’s push to prioritize minority and low-income communities that have been disproportionately affected by Covid-19 – in the state’s response to the pandemic.
“Just at the time when the vaccine is going to be coming available to community residents, is going to be the time when providers are going to have the rug pulled out from underneath them in terms of their ability to ensure that the vaccination efforts are successful,” said Rose Duhan, president and CEO of the Community Health Care Association of New York State.
She added that the $100 million announced by the governor for 340B providers “doesn’t come close to filling the gap” for what will be lost and, at best, represents only a “one-year fix.”
Dr. Peter Meacher, the chief medical officer for Callen-Lorde, said his clinic alone stands to lose 14 percent of its revenue under the planned carve-out. Such a cut, he said, would likely force Callen-Lorde to scale back the services — like housing supports and HIV-related counseling — that have allowed it to make inroads with historically hard-to-reach communities and treat patients before they are in crisis.
“Even if you’re just making an economical argument, it’s ridiculous, let alone the ethical argument that this is a program for people who we know are disconnected from health care — people of color, poor communities. These are the very people where we’re told, ‘Oh we must prioritize them to get vaccinated,’” he said in an interview. “And at the same time, you’re going to pull away everything that connects them to the health system? That makes no sense.”
The coalition has offered support for legislation NY S8948 (19R) / NY A10960 (19R) — sponsored by Assembly Health Committee Chairman Richard Gottfried (D-Manhattan) and Senate Health Committee Chairman Gustavo Rivera (D-Bronx) — that would delay the budget language’s implementation by three years.
Schaub, who recently issued a memo in support of the legislation, said beyond that, 1199 SEIU and the coalition are pushing to change the 340B policy through budget negotiations ahead of the April implementation date.
“We do have a budget between now and then, [when] I think we can have that conversation,” she said.
Drug Program Cuts Threaten COVID Vaccine Effort By Tat Bellamy-Walker
December 15, 2020
As New York begins COVID-19 vaccinations, health officials say looming cuts to the states’s 340B drug discount program could make it even more challenging to vaccinate the city’s most vulnerable populations.
Under the 340B program, managed Medicaid providers receive discounted drugs for underserved clients. COVID-19 outreach is among the many types of services funded under this program. Officials told Gay City News that outreach is a costly yet effective part of slowing the spread of the virus. But, looming state budget cuts slated for next spring could threaten these services.
In the past, non-profits were able to apply the difference between the discounted drug price and the Medicaid reimbursement they received to carry out other services. But under the planned cuts, that amount, estimated at roughly $250 million annually, would be diverted back to the state under a fee-for-service model. Governor Andrew Cuomo’s plan to offset a portion of the reduced funding by providing an additional $100 million to such healthcare providers is widely viewed as “just giving with one hand while you take much more with the other,” in the words of Patrick McGovern, chief business development and policy officer at Amida Care, a not-for-profit health plan serving people living with HIV/AIDS.
Charles King, the CEO of Housing Works, a non-profit focused on HIV/ AIDs and homelessness, said the 340B funding is necessary in dispelling misinformation about the COVID-19 vaccine and vaccines in general.
“If we had to spend 20 minutes walking them through why the vaccines important [and] why it’s safe, we wouldn’t be able to afford to take that time,” King said. “It would really undermine our efforts to ensure the people we serve get vaccinated.”
Developing trusting relationships, he said, is critical for follow-ups and helping patients stick with treatment.
“If you’re serving a population that is suspicious of the healthcare system, doesn’t have a lot of education around healthcare issues, and particularly has reason to be suspicious about drugs, you’ve got to take the time to work with people, to listen to them, to encourage them, to hear them out,” King said.
Years of discrimination from doctors make it even more difficult for marginalized people, including people of color and LGBTQ communities, to trust the medical system. A recent study from the Pew Research Center found that while Black Americans are more likely to know someone who has died as a result of COVID-19, they’re still less likely to seek a vaccination when compared to other ethnic groups.
Another study published last month from the Community Health Care Association of New York State shows clinicians are reporting similar concerns.
“We know that a lot of the staff at health centers have a lot of questions. And this is because the vaccine is so new,” said Rose Duhan, the organization’s CEO. “There’s reimbursement for administering the vaccine, but there’s not reimbursement for the clinicians’ time to be spent in conversations… amongst the other clinicians or with the staff.”
But, it’s not just outreach and education that’s at stake. Anthony Fortenberry, the director of nursing at the Callen-Lorde Community Health Center, which specializes in LGBTQ-focused care, said staffing is also at risk.
“Our nurses are funded through 340B dollars,” Fortenberry said. “The lack of 340B [funding] would mean that we would not be able to have the amount of nurses that we would need to be able to meet community demand.”
Slashing these resources from health centers is “bad policy” and “bad timing,” said Amida Care’s McGovern.
“When the state is determined to try to overcome resistance within communities of color to take these vaccines and then trying to figure out how to distribute vaccines in an unprecedented scale,” he said. “You need to rely upon these very institutions that you’re draining all of this support from.”
Non-Profits Blast Cuomo for ‘Misleading’ on HIV Funding by Matt Tracy
December 8, 2020
Several health organizations have lashed out at Governor Andrew Cuomo after his team celebrated the allocation of $100 million into services for people living with HIV/ AIDS at a time when the state is separately planning to divert crucial funding away from programs serving those same individuals.
“The $100 million grant is just giving with one hand while you take much more with the other,” Patrick McGovern, chief business development and policy officer at Amida Care, a not-for-profit health plan serving people living with HIV/AIDS, told Gay City News on December 7.
Those groups and others were already outraged because of looming changes to the federal 340B program, which requires drug manufacturers participating in Medicaid to distribute medication at discounted rates to managed care providers with underserved clients. Those providers are then able to use the remaining funds they receive to pay for those drugs to carry out other services.
Safety net hospitals, which provide care to patients regardless of financial status, as well as community health non-profits and homeless shelter providers are among those benefiting the most from the 340B programs — for now.
But that program is in limbo in New York after the state passed a budget slated to go into effect April 1 that would carve out that program in a way that would shift funding away from service providers to the state in a fee-for-service model. In turn, the non-profit groups have warned that they would collectively lose out on as much as $250 million in one year, forcing some providers to shutter while generally impeding the fight to end the HIV/ AIDS epidemic in the state.
That outrage boiled over when the governor’s World AIDS Day press release said the state “will provide more than $100 million in Medicaid Redesign savings directly to 340B providers in the upcoming year to mitigate changes in reimbursement and ensure continuation of critical services.”
The press release described that as a “step the state has taken to bolster the state’s progress in fighting to end the epidemic.”
That was not the first time the Cuomo administration pointed to the $100 million plan — the state’s Health Department told Gay City News about the plan in November — but the way in which it was mentioned on World AIDS Day was especially irritating to community groups and prompted them to put the 340B program cutbacks back into the spotlight yet again. The Health Department pointed to the $100 million in response to Gay City News’ inquiry last month about the 340B cutbacks.
“This is a deeply flawed view of the reality to be faced by our most vulnerable neighbors as a result of the governor’s actions,” Harlem United’s CEO, Jacquelyn Kilmer, said in a written statement.
Aiming her comments directly at the governor, Kilmer added, “Governor Cuomo, this plan to mitigate the damage caused by these changes is a slap in the face to all of New York’s most vulnerable communities and an insult to those working on their behalf. Touting such a plan in the World AIDS Day press release as a solution sadly demonstrates a lack of empathy and compassion for those indigent New Yorkers who will languish and likely not survive without being able to access the life-saving medications and services they need. It is shameless thievery from those whom your office swore to protect.”
Housing Works, which serves clients living with HIV/ AIDS and experiencing homelessness, could lose $10 million in annual 340B rebates beginning in April, the organization wrote in a press release on December 2.
Among other compounding concerns, some groups are warning that the state is withholding 20 percent of funding contracts with non-profit organizations.
“On World AIDS Day (WAD) 2020, Governor Andrew Cuomo released a statement that was misleading at best and on some points frankly dishonest,” Housing Works noted in a press release. “We have a right to expect clear and honest public health statements from our New York leaders, not the wishful thinking and unsupported boasts, half-truths, and falsehoods we’ve come to expect at the national level from the Trump Administration. We are saddened that the Governor tried to use World AIDS Day to mask and divert attention from deep cuts to our State’s HIV response that signal the Governor’s abandonment of his own historic plan for Ending the Epidemic (EtE) in NYS.”
Even some of the parties quoted by Cuomo in his press release were unhappy with it, such as GMHC, whose CEO, Kelsey Louie, had praised the governor in that release “for his leadership on groundbreaking programs and services created by New York’s Blueprint to End the Epidemic.”
“GMHC was pleased to provide a quote for Gov. Cuomo’s World AIDS Day statement last week remembering those we have lost and praising the collaborative efforts of government and community to advance EtE efforts,” GMHC noted in a December 7 release. “However, we were dismayed to see it included in a press release that justified the Medicaid Carve-Out Plan that will devastate the State’s healthcare safety net. GMHC does not support the governor’s Medicaid Carve-Out Plan.”
Callen-Lorde Community Health Center, which provides healthcare and related services targeted to the city’s LGBTQ community, also took aim at the governor in a separate press release entitled “ENOUGH IS ENOUGH.”
“We are at a crossroads,” Wendy Stark, the organization’s executive director, said in a written statement. “Our ability to provide care would be irreparably damaged and, likewise, the health of the state would be devastated by the impact of the carve out. The announcement by the governor flew in the face of the task that we have been charged with as safety net providers and goes against what we have been recommending to the administration for months. It will cost jobs and ultimately, cost lives.”
Callen-Lorde is slated to lose $12 million, or 14 percent of its overall budget, if the 340B changes go into effect, the organization noted.
Community Health Centers Fear They May Lack Funding to Vaccinate the Most Vulnerable By Jennifer Henderson
December 7, 2020
Community health centers have spent decades building trust with the 2.3 million patients across the state deemed the most vulnerable. Such patients often have felt slighted or stigmatized when seeking care elsewhere. Now as federal, state and local officials prioritize Covid-19 vaccine distribution for those very individuals, health centers fear they may lack critical dollars to do so.
In recent months health centers have maintained that the state’s plan to carve the Medicaid pharmacy benefit out of managed care would decimate essential services for those most in need by making changes to the 340B program. It allows safety-net providers to purchase deeply discounted drugs and use the savings to provide such services. Now, they say, vaccine distribution—including important outreach and education in local communities—would be especially affected.
When it comes to addressing the health disparities brought to greater light as a result of the pandemic and prioritizing vaccine distribution for those most at risk, support that would enable that to happen is being slashed, said Dr. Peter Meacher, chief medical officer at Callen-Lorde, which operates health centers in Manhattan, the Bronx and Brooklyn and specializes in LGBTQ heath care.
Meacher saw one of his patients last week and began thinking even more about the issue. The patient—who has been coming to Callen-Lorde for care and support for seven years—is a 30-year-old, HIV-positive Hispanic man. Through the health center, the patient was able to navigate benefits and get the care he needed to keep his HIV levels suppressed and be cured of hepatitis C. When the pandemic hit the region, the man contracted Covid, and Callen-Lorde counseled him to keep him safe at home while he recovered. And when the man lost his three delivery jobs as a result of the crisis, the health center connected him to temporary housing.
“This is someone who should be a top priority for getting a Covid vaccine when it comes out—he’ll take it from us,” Meacher said. Now is not the time to pull the rug out from a part of the health system that this population trusts, he added.
Rose Duhan, president and CEO of the Community Health Care Association of New York State, concurred that the timing of the impending loss of 340B dollars couldn’t be worse.
Having funding in place for services that occur outside of the traditional patient visit, such as reaching out to the community, educating patients and staff about the vaccine, and tracking patients who need a second dose, is paramount, Duhan said, because the effort is more than just putting a shot in a person’s arm.
Achieving immunity in vulnerable communities through a vaccine is critical, Duhan said, noting that the very areas health centers serve have been most affected economically by the crisis. The loss of 340B dollars is going to make the situation last longer than it needs to, she added.
“We do not anticipate 340B reforms to have any impact on Covid-19 vaccine distribution in New York State,” said Jonah Bruno, director of public information for the state Department of Health, in a statement provided to Crain’s. “In the upcoming fiscal year, we will allocate more than $100 million dollars in savings achieved through the carve-out directly to 340B providers.”
November 23, 2020
A federal program requiring drug manufacturers to distribute medication to certain providers at discounted prices could undergo sweeping changes here in New York, prompting local nonprofits to raise concerns about the looming impact those changes could have on vulnerable populations — including individuals living with HIV/ AIDS as well as homeless folks.
Under the 340B program — named after Section 340B of the Public Health Service Act — pharmaceutical companies participating in Medicaid sell discounted drugs to managed care providers with underserved clients, which allows the providers to then utilize remaining funds to facilitate other services. The organizations that benefit from the program include community health non-profits, homeless shelter providers, and safety net hospitals, which serve patients regardless of their ability to pay.
However, those crucial organizations are fearing the worst after the state passed a budget in April calling for the program to be carved out on April 1 of next year in such a way that would divert the savings from providers serving vulnerable populations to the state as part of a fee-for-service model.
Nonprofits say altering 340B could hinder efforts to end the HIV/ AIDS epidemic in New York
“The state is saying, ‘No, we’re going to take it,’” Matt Bernardo, the president of Housing Works, told Gay City News in an interview. Housing Works serves many New York City residents living with HIV/ AIDS and experiencing homelessness, and the organization is among the groups slated to be impacted by the changes.
“It’s something that is not just an administrative change,” Bernardo said. “It’s a massive impact for safety net providers and for efforts to end the epidemic here in New York.”
The robust coalition working to halt the impending changes includes dozens of groups such as the AIDS Healthcare Foundation, Gay Men’s Health Crisis, Planned Parenthood, the Latino Commission on AIDS, the LGBT Community Center, the Callen-Lorde Community Health Center, Harlem United, and the Treatment Action Group.
Bernardo and others are underscoring the ripple effect the changes would have on both providers and the clients they serve. He predicted that some service organizations would be shuttered entirely, clients would lose access to the ongoing care they need, and the compounding consequences of those realities would eventually mean hospitals would be overwhelmed with folks who couldn’t afford their routine healthcare.
At Harlem United, which works to provide housing, healthcare, testing, vocational services, and other offerings to more than 10,000 clients per year, CEO Jacqui Kilmer stressed that the changes would have a disproportionate impact on low-income New Yorkers, the LGBTQ community, and people of color.
Harlem United currently uses savings from the 340B program to conduct outreach in communities, transport individuals to clinics and other facilities, and connect individuals who are not virally suppressed to case management services as part of a broader goal of ending the HIV/ AIDS epidemic, Kilmer explained.
“People will get sicker, hospitalizations and emergency room visits will go up, and service providers will lay staff off,” Kilmer said. “In many cases they will have to shut their doors.”
In October, more than 100 organizations penned a letter to Governor Andrew Cuomo expressing “strong opposition” to the changes and noted that up to 70 percent of the clients served by 340B hospitals, clinics, and organizations are covered under a Medicaid managed care plan.
The coalition is pointing to a report published by the Menges Group — a strategic health policy and care coordination consulting firm — that estimates the changes will cost taxpayers $154 million in one year.
When reached for comment on November 23, the state’s health department characterized the forthcoming changes much differently.
“The Medicaid Redesign Team II proposal to move the Medicaid pharmacy program from managed care plans saves taxpayers millions of dollars by increasing transparency, ensuring Medicaid pays the best price for medications, and eliminating unnecessary administrative costs to health plans, all while ensuring that consumers continue to have access to needed medications,” Jonah Bruno, a spokesperson for the State Health Department, said in a written statement to Gay City News. “In the upcoming fiscal year, we will allocate more than $100 million dollars in savings achieved through the carveout directly to 340B providers. Additionally, 340B entities will still be able to purchase medications at reduced 340B prices.”
The state health department also noted that in accordance with state law, the department convened a 340B advisory group to figure out how the state should distribute the funding directly to 340B entities. That group has met three times so far and a fourth meeting will be scheduled soon.
The service providers, however, are foreshadowing a far more disastrous scenario under which the interruption in services they provide could create dire healthcare realities for many communities that have already faced hardship during the coronavirus pandemic.
“We are going to be loud and do the advocacy that the HIV/AIDS community and community health organizations have been known for,” Bernardo added. “We are calling on the governor, who has the power to stop this, and the health department, to rethink this.”
Bernardo and Kilmer said there are efforts underway to engage lawmakers with the hopes that they can step in and help stop the changes from being implemented in April. A pending bill proposed by State Assemblymember Richard Gottfried of Manhattan and State Senator Gustavo Rivera of the Bronx, who chair their respective chamber’s Health Committee, calls for delaying the 340B changes for three years.
Kilmer added that the coalition has also facilitated conversations with government agencies, underscoring the sense of urgency on the part of the service providers who are likely to be impacted.
“For many people, this seems to be a very complex issue when you start talking about the 340B program,” Kilmer said. “But the bottom line is this: If this change in the budget goes through, it would devastate people’s health.”
November 10, 2020
A growing coalition of health care groups and providers are outraged over an impending change to Medicaid funding for prescription drugs in the Empire State.
The groups are pleading with the Department of Health to not follow through on changes to the 340B drug discount program, which allows safety net hospitals catering to underserved and low-income communities to purchase deeply discounted prescription drugs.
A provision tucked into the budget this year, based on a recommendation by the state’s Medicaid Redesign Team, would “carve out” the discount and shift payment to a fee-for-service reimbursement starting next April.
That means hospitals that care for large numbers of people with Medicare, Medicaid or those without insurance would lose out on the savings and the state would instead capture the rebate, a move that could decimate essential services for communities hardest hit by the coronavirus pandemic, opponents argue.
“It’s essential to maintain the safety net for our state’s most vulnerable populations,” said Guillermo Chacon, president of the Latino Commission on AIDS and founder of the Hispanic Health Network. “The State’s budget changes to ‘carve-out’ Medicaid prescription drugs will devastate the 340B drug discount program for the poorest New Yorkers in need of health services.”
Sen. Gustavo Rivera (D-Bronx) and Assemblyman Dick Gottfried (D-Manhattan), the health chairs in both the Senate and Assembly, have proposed a bill that would delay the transition for three years.
As per the current law, the state Department of Health has convened an advisory group, which is exploring the impact of the change. The work group has met three times and is scheduled to reconvene soon, according to agency spokesman Jonah Bruno.
Bruno said the proposal “saves taxpayers millions of dollars by increasing transparency, ensuring Medicaid pays the best price for medications, and eliminating unnecessary administrative costs to health plans, all while ensuring that consumers continue to have access to needed medications.”
More than 35 groups have so far joined the Save NY’s Safety Net: 340B Saves Lives coalition, including the Drug Policy Alliance, the Alcoholism & Substance Abuse Providers of New York State, and Community Healthcare Network, a non-profit network of 14 federally-qualified health centers serving 85,000 patients annually in the five boroughs.
“We provide high-quality, affordable primary care and specialty support services, regardless of patient ability to pay,” said Robert Hayes, president and CEO of the the health care provider. “The 340B carve-out threatens our most essential programs. The carve-out is reverse Robin Hood, taking efficient, life and health preserving care from New Yorkers most in need.”
New coalition urges state to reverse Medicaid drug carve-out By Jennifer Henderson
Community health groups across New York today are launching a coalition aimed at urging the state to reverse the Medicaid drug carve-out and resulting changes to the 340B drug discount program.
The coalition—called Save New York’s Safety Net: 340B Saves Lives—says that carving the Medicaid pharmacy benefit out of managed care and adding it into a fee-for-service model will decimate essential services for those most in need. Though the state’s plan—scheduled to take effect April 1—is intended to save Medicaid money, the group is steadfast in its belief that it will cause widespread and disastrous health consequences and actually cost the state large sums of money instead.
The 340B program allows safety-net providers, including community health centers and hospitals, to purchase deeply discounted drugs and use the savings to provide essential services for low-income New Yorkers.
“This is not about one organization and its particular issues and survival,” said Wendy Stark, executive director of Callen-Lorde, which operates health centers in Manhattan, the Bronx and Brooklyn, and specializes in LGBTQ heath care. “This is about access to health care for the most vulnerable communities across the state.”
For Callen-Lorde, the negative impact would equate to about $12 million, or about 14% of its overall budget.
“We are starting to plan for that now,” Stark said. “That planning is devastating.”
She said the loss of 340B revenues will affect patients and staff should the carve-out not be reversed.
Stark shared the story of one of Callen-Lorde’s nurses and a patient whose health was deteriorating before care was sought at the organization. The patient was a Black, transgender woman with substance-use issues who was also living with HIV. She was living in a shelter and did not have a health care provider because she had been treated poorly when attempting to access care in the past.
The nurse was able to have the patient diagnosed with a staph infection and treated the same day, get her blood drawn, establish an HIV medication regimen and enroll her in health coverage as well as ongoing primary care, mental health care and substance-use services. Her HIV is now undetectable, and she is living in supportive housing.
Stark quotes the nurse as saying, “The patient is now healthy, thriving and living her best life.” The nurse’s salary is paid for by 340B dollars.
Perry Junjulas, executive director at Albany Damien Center, which provides behavioral health, housing, meals, employment, pharmacy and other services to people living with HIV/AIDS, concurred that the need for 340B revenues is critical.
“If allowed to go forward, we’re going to see a number of people going hungry again, homeless and not able to access the medications they need,” Junjulas said.
He said he is fearful the outcome could mirror the early days of the HIV/AIDS epidemic, when treatment wasn’t available.
“Some people are not going to have access to medication that we actually have this time,” he said.
The issue will predominately affect Black and brown communities, he said. The financial impact to the Damien Center is some $1.4 million, or about 25% of its annual operating budget.
Rose Duhan, president and CEO of the Community Health Care Association of New York State, noted that the loss of 340B revenues couldn’t come at worse time because of the pandemic.
Community health centers are more critical than ever, in part because of their work to address all the factors that affect an individual’s health, Duhan said.
Though some directors of community health centers were included in a state advisory council to determine ways to mitigate the impact of the carve-out on 340B dollars, more than a handful recently stepped away from the process.
“While we understand the agreement called for recommendations by Oct. 1, we believe the process is in need of further deliberations and a more concerted effort to explore alternative solutions to achieve savings without severely disrupting safety-net providers’ ability to render quality and appropriate care,” they wrote in a letter to the state. “As it stands today, the majority of this advisory council simply cannot support a recommendation on how to mitigate the harm caused by this policy decision.”
Jonah Bruno, director of public information at the state Department of Health, said in a statement: “The Medicaid Redesign Team II proposal to move the Medicaid pharmacy program from managed care plans saves taxpayers millions of dollars by increasing transparency, ensuring Medicaid pays the best price for medications, and eliminating unnecessary administrative costs to health plans, all while ensuring that consumers continue to have access to needed medications.”
But members of the coalition simply don’t agree.
“We need to have this carve-out reversed and reversed in total right now,” Junjulas said. “We’re going to be asking the poorest people to pay the highest price.”
October 14, 2020
Finalizing a budget can be chaotic in the best of times. This year, we hammered out the last details of the state’s $177 billion spending plan as the COVID-19 crisis was approaching its peak in New York State.
It was in this context that the Legislature agreed to a little-noticed recommendation from the Governor’s Medicaid Redesign Team II (MRT II) that strips a critical federal benefit from health-care providers and patients in New York. Luckily, we have until April 1, 2021 to undo this mistake. I will be working non-stop over the next seven months to do just that, along with a coalition of advocates and Medicaid patients as part of the Protect the Safety Net campaign.
The MRT II pushed through a provision in the budget that would “carve out” a pharmacy benefit from the state’s Medicaid managed-care program and shift payment to a fee-for-service reimbursement. The commission claimed its goal was to lower costs and increase transparency, but in reality this provision would devastate Ryan White Clinics, federally-qualified health centers, safety net hospitals, and other safety net providers in the 340B drug discount program. In Monroe County, for example, Trillium Health, Jordan Health, and the University of Rochester Medical Center all rely on 340B to provide essential services to families in our community.
The federal 340B Drug Discount Program protects safety net providers from drug price increases and gives them access to pharmaceuticals at discount prices. This includes HIV/AIDS clinics that receive support under the Ryan White CARE Act as well as community health centers that have been on the frontlines of fighting COVID-19. 340B providers rely on this funding to operate food pantries, provide transportation assistance, STI screenings, mental health and wellness programs, and run harm reduction programs – services that are often grossly underfunded by the state.
If the carveout is not reversed, many patients across New York State will simply have nowhere to turn. These are not savings that should be made on the backs of those who can ill afford these cuts.
The 340B Program is under constant threat from Big Pharma, which has tried to distort and undermine the program since it was established with broad, bipartisan support back in 1992. For the pharmaceutical industry, a discount program for Medicaid patients just means less profit. For short-sighted bureaucrats in Albany, it’s a chance for accounting gimmicks that allow them to claim “savings” that would actually harm the vulnerable New Yorkers they are supposed to be serving.
The Medicaid commission chose the worst possible time to experiment with changes to New York State’s safety net. 340B providers care for patients in communities that have been hardest hit by the COVID-19 pandemic. If these providers are forced to eliminate services, more patients will be forced to go to hospital emergency rooms for care – swamping our hospital system and driving up costs while leading to poor health outcomes.
This would also threaten the progress we’ve made in fighting the HIV/AIDS epidemic. Ryan White Clinics have built comprehensive models of health care and social services to address the diverse needs of their patients. This comprehensive model of care is only possible because of the clinics’ participation in the 340B program.
In the weeks and months ahead, New Yorkers will be hearing a lot more about this issue. The New York chapter of Ryan White Clinics for 340B Access recently launched a campaign to Protect the Safety Net, led by advocates and Medicaid patients. We’re going to keep fighting until the state reverses course and restores this critical benefit for the most vulnerable New Yorkers.
October 20, 2020
A newly-formed coalition of community health groups is urging Albany lawmakers to reverse the Medicaid drug carve-out included in the state budget, arguing that changes to the 340B drug discount program could “decimate essential services for the poorest New Yorkers.”
Impact: Save New York’s Safety Net seeks to repeal the Medicaid Redesign Team II-backed carve-out, which is set to take effect on April 1, 2021. The coalition contends the policy will devastate 340B drug discount program providers who rely on the program’s savings to support other essential services they offer to New Yorkers.
What they said: Peter Grisafi, president and CEO of Damian Family Care Centers, which is part of the coalition, said if the pharmacy carve-out takes effect as scheduled, his organization would “no longer be able to provide free medications to uninsured and underinsured individuals.”
Housing Works President Matthew Bernardo, another coalition member, said changes to the 340B benefit “would limit client access to lifesaving services and force Housing Works to close sites and eliminate key outreach and retention programs.”
The Cuomo administration has stood by the policy. Department of Health spokesperson Jonah Bruno told POLITICO earlier this month that the “proposal to move the Medicaid pharmacy program from managed care plans saves taxpayers millions of dollars by increasing transparency, ensuring Medicaid pays the best price for medications, and eliminating unnecessary administrative costs to health plans, all while ensuring that consumers continue to have access to needed medications.”
Details: Other coalition members include: Trillium, RWC-340B, iHealth, Harlem United, GMHC, Evergreen Health Services, CHCANYS, Callen-Lorde Community Health Center, Alliance for Positive Change, Albany Damien Center and AIDS Healthcare Foundation.
Background: The MRT II, which was reconvened to identify cost-savings and efficiencies in the state’s Medicaid program, recommended the pharmacy benefit carve-out from Medicaid managed care to fee-for-service as part of a series of proposals presented to state lawmakers as they finalized the state budget last spring. The MRT II projected the policy would save the state $125 million in FY 2022.
But a recent Menges Group report, prepared for the New York Health Plan Association and Coalition of New York State Public Health Plans, suggested the pharmacy carve-out could cost New York $1.5 billion over five years. State health officials have questioned those findings.