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Re the 340B proposal in the EO: It would require FQHCs to sell insulin and epi-pens to qualifying patients at 340B price (which will be a penny in many cases) plus an administrative fee (1/8)
Currently FQHCs already have requirements to have a sliding fee scale and not charge people below poverty (2/8) https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-9.html
The EO says patients eligible to pay the 340B price will have to have low incomes (as determined by the secretary) AND either 1) have high cost sharing for insulin/epi-pen 2) have a high unmet deductible OR 3) have no health insurance (3/8)
If “low income” is defined as under 100% of poverty, this may not really change anything. Even if the income level is set somewhat higher, most patients likely would still have been protected by the sliding fee scale without this change. (4/8)
Requirement will be a condition of “future grants available” to FQHCs. FQHCs will likely fall under this requirement within a year of when it kicks in since their operating grants are annual. It is unclear how FQHCs will document that they are in compliance. (5/8)
Overall this seems like it may not dramatically help very many people (short of an extremely generous definition of “low income”) and may create a burdensome new requirement for FQHCs. (6/8)
Also for 340B nerds, it is notable that HHS is using its authority under Section 330(e) of the Public Health Service Act – and not its authority under 340B. This may be why the policy does not apply to hospitals. Recently HHS said it cannot enforce 340B guidance (7/8)
And many thanks to (twitterless) Jennifer Tolbert who spent her Friday night talking this through with me! (8/8)
