State regulators, drug makers pose new threats to operations of Valley health centers

The patients begin arriving at 7:30 a.m. when our doors open and they are there at 10 p.m. when we close. We serve as the health-care provider for some of California’s neediest patients, most of whom work the fields of the Central Valley, where they breathe dirty air and suffer some of its highest rates of COVID-19 infection.

At Family HealthCare Network we get more than 1 million patient visits a year at our 39 clinical sites in Tulare, Kings and Fresno counties, and treat more migrant farmworkers than any provider in the nation. We are part of the Community Health Center Alliance for Patient Access, a statewide organization representing health centers that serve more than 2.1 million patients from Redding to San Diego.

Many individuals come to us for traditional primary care. But increasingly they require an integrated care approach that includes specialized services in areas such as mental health and neonatal care. Diabetes is an epidemic in the Central Valley, and currently our health centers are able to provide insulin at a fraction of the cost for patients who otherwise would be forced to choose between taking their medication and putting food on the table.

We have been thrust to the front lines of fighting the coronavirus, providing tests for thousands of people and administering vaccines — when we can get them — to older adults, high-risk individuals and eventually essential workers, including teachers.

Now we face a new threat from the state, and from giant drug companies, that could undermine access to care for millions.

At issue is the future of the federal government’s discount drug pricing program, more commonly referred to as the 340B program. Community health centers are able to purchase drugs at a discount and negotiate market-rate payments from managed care plans.

Congress intended that the savings be used by federally qualified health centers to provide patients with greater access to care. We depend on 340B program to help support everything from insulin discounts to support staff to vans that transport patients to our clinical sites.

The state, however, wants to exclude the health centers from eligibility for the program. California’s Department of Health Care Services intends to move all pharmacy services from Medi-Cal managed care to a fee-for-service system. The state’s failure to implement a reimbursement system for federally qualified health centers outside of Medi-Cal managed care could mean less access to, or the end of, critical programs and services, including vaccinations, screening, counseling, testing, and treating for HIV/AIDS and Hepatitis C.

The state says the policy change will result in a savings of about 2.5% in Medi-Cal pharmacy costs, while depriving community centers of critical funding to serve underinsured and uninsured patient populations hardest hit by the pandemic.

At the same time, Eli Lilly, AstraZeneca, Novartis, Merck and other major pharmaceutical companies have taken steps to deny health centers in California and across the U.S. access to medications under 340B. As a result, attorneys general from 27 states, including California, have urged the U.S. Department of Health and Human Services to hold drug companies accountable for maintaining the discounts.

The drug companies say they are forced to take action to curtail waste and abuse. In 10 years as a clinical practitioner I have not witnessed any such abuse. What I do know is that the savings realized through the 340B program are absolutely vital for centers such as ours to provide medical care to our patients.

We need the state to take steps to ensure that community health centers are able to continue to realize the benefits from the 340B program. Furthermore, we need big pharmaceutical companies to put patient health ahead of profits.

This is not only fair and just, but simply put it is sound public health policy that will help ensure health equity and access to care.