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340 B covered entities are opposed to moving drugs to FFS only in NY (carving rx out of managed care).
ALBANY — 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.”