Nearly 27.4 million people across the country have no health insurance, and about 147 million more have inadequate health insurance, according to an analysis by the Kaiser Family Foundation in 2017. This means that more than half of the American population experiences some form of health care insecurity and therefore may not be receiving proper medical care. To alleviate this problem, the 340B program was created in 1992 to aid vulnerable and uninsured Americans by reducing health care costs.
The 340B drug discount program provides cheaper drugs to community health centers and nonprofit hospitals. According to the National Institutes of Health, 16% of our nationwide epilepsy population does not have health insurance. Vulnerable patients are more likely to skip medications and end up in the emergency room for a seizure that could have been prevented with proper medication adherence. People with epilepsy often experience other chronic illnesses making it difficult to manage their health and access various medications.
Constant oversight of programs and policies is necessary, and at 27 years old, the 340B program is past due for re-evaluation. While this program was designed with honorable intentions, like any program, it can easily have negative outcomes if not monitored properly. What started as a way for low-income patients to receive less expensive health care has turned into entities, such as Disproportionate Share Hospitals and contract pharmacies, taking advantage of the benefits of the program at the cost of vulnerable patients.
In 1992, there were about 50 participating 340B health care facilities. This number increased to 583 in 2005, and then to almost 13,000 in 2017, according to a report by the House Energy and Commerce Committee. However, this growth is not necessarily indicative of success when many of these DSH hospitals are actually providing lower levels of charity care.
Why are decreased levels of charity care happening? Because 340B DSH hospitals receive drug manufacturer discounts ranging from 20% to 50% off regular drug prices, but regulations do not strictly outline how the drug savings are then utilized. The savings are often not passed down to uninsured patients and instead may go toward hospital construction, employee bonuses and other hospital interests. 340B DSH hospitals do not even have to disclose how these savings are being used. When a program has such lax oversight, one can see why it can be so easily and widely exploited.
It’s time for us to stand up for vulnerable patients and get this program back on track by prioritizing vulnerable patients over profit. Enforcing stricter guidelines and establishing clearer definitions for participating facilities will protect these patients and ensure the program is not abused. We need to bring the 340B program back to its true intentions — our epilepsy community deserves better.
Karen Basha Egozi is President & CEO of Epilepsy Florida and Julie Martin is executive director of Epilepsy Alliance Louisiana, based in Baton Rouge. They are both members of the Epilepsy Alliance America.