340B Brand

August 11, 2021

340B Brand

340B Program Has a Branding Problem

Quick – without giving it too much thought – estimate the percentage of the people you know who can correctly identify the purpose of the 340B program? If the answer you came up with is higher than 25%, count me a skeptic, unless you only hang out with 340B program coordinator types during your non-working hours. In my personal professional experience, even fellow colleagues who work for 340B participating safety-net provider organizations were not entirely clear on the intent or value of the program.Consider how that might compare with other, similarly complex, regulatory and entitlement programs. If you casually reference programs or terms such asAccountable Care Organizations, Patient Centered Homes, Value Based Care,Alternative Payment Models, or even Meaningful Use, I will bet that you will get a thoughtful nod of recognition from a surprising portion of the general public. Must be because those programs and their associated terminology has been around longer, right? The reality is that the origin of the 340B program can be traced to legislation going all the way back to 1992 – whereas the other programs mentioned, also designed to right size the equitable delivery of quality care, were initiated in 2011 as part of the Affordable Care Act (ACA) or what has become commonly known as Obama Care.

It is not my intention to guide this discussion towards the endless dissection of pricing trends and practices of the pharmaceutical industry. There are reams of literature on the topic and most of us have experience with that reality ourselves. However, it is important for us to remember why the 340B program exists in the first place, why it is important, and who it impacts the most. According to an article in HealthcareFinance and the sources they cite, “Drug prices rose three times faster than inflation over the last decade, even after discounts.” This means that even those of us lucky enough to have excellent insurance coverage experience bouts of sticker shock at the local pharmacy. This reality is increasingly true even for drug therapies that have been around for decades and are no longer under patent.What is hidden in this overall inflationary trend is the fact that these price increases are often uneven, sudden, and without any apparent rationale. The prices of drugs can fluctuate at levels that would be deemed completely irrational if it was any other consumable. Imagine the national outcry if a $5 gallon of milk rose to $50 overnight, with no obvious changes in any immediately apparent economic drivers. What this can mean for those who are less fortunate, people who are uninsured or underinsured, is that sudden and irrational price appreciation is often a barrier to obtaining crucial therapies, reducing health and quality of life.

Section 340B of the Public HealthService Act (under Section 602 of the Veterans Health Care Act of 1992) was passed to help uninsured and low-income individuals afford crucial drug therapies. A legitimate concern in 1992, it has become only more imperative over the subsequent decades as already discussed. The 340B program has been a game-changer for countless safety-net providers, low-income communities, and families across the US. And yet, the program has been demonized and attacked from its very inception. Today, the program is under more existential threat than ever before. Pharmaceutical companies are spending billions on lawsuits and lobbing efforts to dismantle a program that has shown to be effective, costs taxpayers nothing, does not pose a threat to big pharma’s double digit profit margins, and has the support of just about every provider association. Increasingly, pharmaceutical companies are simply making the business decision to not follow the law and use their deep pockets to litigate the program. A classic example of how “might makes right” and the fact that big Pharma is the proverbial Goliath.

The Pharma industry is helped along in their efforts to dismantle 340B by the very fact that there is little public knowledge about, or emotional connection with the program. Not only is 340B rarely mentioned in popular media, but it’s typically little more than a side note even in healthcare specific publications. The program and its impact may very well be the “best kept secret” in the industry, with the greatest amount of positive impact on the most people while staying almost completely under the radar. Few people have an emotional and/or intellectual connection with the program beyond those who are directly involved in the field. To make matters worse, those few people who are aware of the 340B but are not program insiders often have a rather negative perspective. Perhaps at the very root of the problem is the naming convention itself, making it hard for people to get overly invested in something that is named after a section number of an esoteric piece of legislation.A significant part of the challenge is that the pharmaceutical industry has successfully funded the “opinions” of many impressive sounding people, who use their credentials and platforms to disparage the value of the program. It is often cynically portrayed as a greedy money grab by safety-net provider organization executives who are funding their jet-setting lifestyles. This would be a laughable anti-340B stance, especially for those of us who have spent our professional lives serving and seen the reality, were it not clearly such an effective strategy.

Perhaps the root of the issue is the fact that program advocates and champions typically take an intellectual stance when defending the value of the program – sharing facts, figures, and diving into the policy itself. The reality is that while the delivery of equitable and highly quality clinical care depends on sound science and effective fiscal policy, selling the value of the program needs to focus on the human element. My personal position is that it’s not facts, figures, political arguments, or policy intricacies that move the needle of public perception. Rather, it is the ability to help people understand that for a large portion of the American public - typically the most vulnerable amongst us, people who might are our neighbors, friends, our family – access to 340B drugs can be the difference between a long and healthy life or premature death.  It is the responsibility of each one of us to take up the advocacy mantle, share our stories, recount our professional and personal experiences, and relay the very real human benefits of 340B. I personally belief this is the only way we will be able to rise above the "branding problem" of 340B and save this crucial program so that it can continue to benefit people for years to come.

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