Years ago Congress constructed a well-intentioned program to help hospitals and select community and disease-specific health clinics, specifically those that treat high numbers of uninsured, poor or vulnerable patients, control their prescription drugs costs. Unfortunately, good ideas sometimes go awry, and that’s the case with this program, called 340B. It’s having a negative impact on cancer care provided in Macon, across Georgia, and across the country.
340B requires drug manufacturers to sell medicines to certain hospitals and clinics at steep discounts upward of 50 percent, but allows the hospitals to sell the drugs to patients at full price. Because of the tremendous profits hospitals can make from the program, what started out as a legitimate helping hand for hospitals has become prone to abuse. Some hospital systems routinely use these drug discounts as a business strategy to increase bottom lines and dominate local markets, while doing very little (if anything) to directly benefit the patients they said they would help.
Abuse of the 340B program gives hospitals a lot more resources to force local community oncology practices to close. This takes control out of the hands of local physicians and shrinks our nation’s cancer care delivery system while practices like mine try to stay afloat. We have been approached many times, been lured into fancy new outpatient buildings, and offered management status at these clinics. While these may seem like great opportunities, being complicit with 340B abuse is something my staff and I won’t stand for. Our independence is far more important, but not all local practices have been able to survive against this powerful force.
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All of this means that the cancer care once delivered in local practices is now much more likely to be provided in a more expensive, less convenient hospital setting, oftentimes where the same care costs 50 percent more. Our patients hate going to the hospital for treatment, telling me it’s less efficient and that there is little privacy.
Cancer patients want quality, affordable care that’s convenient for them and their families. Community oncology clinics treat people fighting what is often the biggest and most difficult battle of their lives. Each of my patients leaves our clinic knowing they matter, and knowing they received personalized care that’s right for them and not care based on pressure to use more expensive drugs (which the government has found in 340B hospitals). Abuse of 340B by hospitals threatens our continued existence, and that’s bad for our patients, their families, and our entire community.
Fortunately, reform may be on the horizon. The government agency that oversees Medicare recently proposed changes to 340B that would return the program to its original intent. The proposal would be a good first step in curbing the enormous profits hospital corporations generate by abusing 340B.
Macon families and cancer patients across Georgia deserve better. I urge Senators Isakson and Perdue and Representative Bishop to support the new Centers for Medicare & Medicaid Services’ proposal that would curb 340B abuse initiated by hospitals. Sometimes in health care, policymakers miss the chance to do what’s best for the patient. Let’s not ignore this opportunity to put patients before profits.
Bruce T. Burns, MD is an oncologist at Central Georgia Cancer Care in Macon.