Federal agency sides with pharmacists

The debate between area pharmacists and Northwest Community Health Center Executive Director Maria Clemons concerning the potential for the health center to expand participation in a discount drug program has both sides saying they simply want the best for their patients. But the agency writing the rules for the program weighed in on the matter four years ago.

The federal Health Resources and Services Administration changed the rules of the 340B prescription drug program in 2010 to allow health centers to expand the program to any pharmacy that was willing to participate. The agency indicated that patients would have more accessibility to discounted drugs and greater choice of providers if more pharmacies were allowed to participate.

In a public notice dated March 10, 2010 regarding the ability of participating grantees and covered entities to now partner with multiple pharmacies, Health Resources and Services Administration noted that the change was made after receiving “many comments in support of the proposal.”

“It would be a significant benefit to patients to allow the use of more easily accessible, multiple contract pharmacy arrangements by covered entities,” according to the document. “This would permit covered entities to more effectively utilize the 340B program and create wider patient access by having more inclusive arrangements in their communities which would benefit covered entities, pharmacies and patients served.”

However, Northwest Community Health Center has decided to maintain an exclusive contract with Granite Pharmacy in Libby, making Granite the only pharmacy in the county that can disburse the discounted medications that originate from prescriptions written at the health center. Clemons said expanding the program to every pharmacy in the county would be an administrative nightmare.

The federal discount drug program provides deep discounts on drugs to a variety of participating health centers nationwide. The program has been controversial for many reasons during its 22-year history, and it has undergone several changes during that time.

Prior to 2010, for instance, health centers participating in the 340B program were required to partner with one pharmacy to distribute discounted drugs, but the change allowed grantees to participate with an unlimited number of pharmacies.

Pharmacists in Libby, Eureka and Troy have said they hear customers complaining that they can’t get the discounted drugs from the pharmacies that have served them for years. While Granite Pharmacy holds the current contract, the health center plans to hire a clinical pharmacist capable of filling prescriptions in-house.

Michael Wells, a pharmacist with Kootenai Drug in Troy, said he wrote a letter on behalf of county pharmacists to the health center in September requesting a meeting with Clemons. That meeting was declined.

According to Wells, the group of pharmacists wanted to raise the issue of accessibility. That point is further highlighted in Health Resources and Services Administration’s explanation for the change, which indicated that many health centers across the county believed expansion would be a benefit to their patients.

“Many of (the comments) came from covered entities that participate in 340B and highlighted how their delivery of patient care would be enhanced with a multiple contract pharmacy option. According to these comments, some patients currently face transportation barriers or other obstacles that limit their ability to fill their prescriptions,” according to the public notice distributed by the Health Resources and Services Administration.

Clemons said she wants to partner with the pharmacies eventually, but now is not the time. She said her limited staff is busy handling a construction project that will add a second floor to the building and expand services. She also said she was dissatisfied with what she saw as an uncouth approach to discussing the matter after several county pharmacists raised the issue during an economic prosperity meeting earlier this month.

“I hadn’t heard anything about them wanting to be involved with this program until last year,” Clemons said.

Clemons said she previously offered to partner with Kootenai Drug in Troy, but Chris Hermes, the owner of Kootenai Drug, turned down the offer.

Hermes said he never turned down an offer, but did think he was close to an agreement about six months ago.

“At the time, I thought we were going to be a 340B pharmacy with them,” Hermes said. “Then, for some reason, they said they wanted to table it. I like the CHC and I like helping people in need, but I can provide that too, if they let me. For some reason they want to monopolize that deal. Hopefully, they see the light of day.”

Northwest Community Health Center grossed $257,888 from pharmacy services last year, according to the nonprofit organization’s public tax records. In total, the health center grossed $4,578,558 in revenue last year, including $1,432,613 in government grants. Two years ago the Health Center grossed $82,990 from pharmacy services.

Clemons said the program is supposed to raise revenue for health centers like the one she oversees. She dismissed the prospect that the building expansion the health center is undergoing would be impossible without the significant growth of 340B revenue.

The Alliance for Integrity and Reform of 340B, a collection of healthcare organizations and associations, released a paper this summer addressing what they see as needed changes for the program.

“The effects of 340B on community pharmacies can also include the loss of business from covered entities’ employees, who may be encouraged to seek care at the facility and use its on-site or contract pharmacy.”

Hermes said he speaks with customers on a daily basis who are leaving his pharmacy due to a lack of 340B drugs.