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Conn. Health Providers Say Drug Maker Restrictions On Discount Program Will Leave Patients Stranded

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Shortly before his 24th birthday, Jesus Morales Sanchez of New Haven was diagnosed with Type 1 diabetes, a chronic illness that requires him to take insulin for the rest of his life.

But at the time, he was in between jobs and didn’t have health insurance, so the medication would cost him several hundred dollars that he didn’t have. 

That’s when Sanchez was able to get insulin at a low price through the federal 340B Drug Pricing Program.

“340B literally saved my life and was able to give me a stepping stone so that I could go back into my daily life,” he said. “Eventually I was able to get a job and I was able to get health insurance and afford my medication once again.”

The 340B Drug Pricing Program was created as a safety net to help uninsured and low-income patients afford medications. It requires drug manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to hospitals, community health centers, clinics and other eligible health sites.

But this fall, several drug makers that provide a large bulk of chronic disease medications in the United States put restrictions on the types of health sites they will service and the kinds of medications they will provide as they demand stricter program oversight and additional claims data.

Connecticut residents and health providers say this will leave many people with fewer options in affording necessary medications, even as the pandemic rages on and people with underlying health conditions continue to be more at risk of serious COVID-19 illness.

“In the midst of a pandemic, discounted drugs for people who are uninsured should be absolutely provided in greater quantities,” U.S. Sen. Richard Blumenthal said Monday. “What the pharmaceutical drug companies are doing here is absolutely unconscionable and unacceptable.”

Eligible hospitals, health centers, clinicians and pharmacies have to be individually approved by the federal program before they can sell discounted medications to patients. 

Dr. Laura Nally, a pediatric endocrinologist at Yale New Haven Health and Yale Medicine, is an approved prescriber. She said providers don’t typically get notified ahead of time when there are changes to pharmaceutical company participation.

“We first realized that there was a problem when we were getting calls from patients who were using 340B and who said, ‘I can’t get my insulin from the pharmacy anymore,’” she said.

Sabrina Griswold, director of pharmacy at First Choice Health Centers, based in East Hartford, said this can be a drastic change for patients and families that negatively impacts their overall quality of life.

“A lot of patients will often be able to access their medications for less than $15,” she said, “and quite literally overnight, it changes and their drug, if they go to the pharmacy the next day, is hundreds of dollars.”

Nally and Griswold said the new restrictions and demands from drug makers have left both providers and patients scrambling to find other affordable solutions.

“A lot of people won’t know what to do and they won’t know who to call or how to navigate this tricky system,” Nally said. “So I think there’s a lot of pressure on all of us -- medical professionals and pharmacies -- to try and help communicate where patients can go. I think that’s going to be very difficult.”

Connecticut Attorney General William Tong appealed directly to drug companies Novartis Pharmaceuticals, Merck, Sanofi U.S., Astra Pharmaceuticals (AstraZeneca), and Eli Lilly in emailed letters dated Oct. 5.

In them, he urged companies to abandon “unilaterally restricting access to low cost drug pricing by covered entities in Connecticut” at the risk of undermining the 340B program.

Tong wrote that their decisions defy federal participation requirements and “are especially appalling given that these critical safety-net health care institutions are on the front lines of our response to the ongoing COVID-19 pandemic.”

Blumenthal said he and his colleagues are leaning on federal regulators to step in.

“The drug companies have a legal obligation to comply with section 340B,” Blumenthal said. “The federal authorities ... have a responsibility to crack down on these abuses of the program, because they ought to recognize it’s a matter of life and death.”

Meanwhile, the drug makers’ changes, including a discontinuation of discounted drugs to certain pharmacies and facilities, have already taken effect or will beginning in January.

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