Women have fared poorly at the hands of Washington policymakers in recent months. Recently, leaked proposals revealed Trump administration plans to significantly roll back birth control coverage. That’s on top of recent congressional health care proposals that would defund Planned Parenthood, waive maternity care as an essential health insurance benefit and give states the leeway to charge women more for health insurance. But there is another push underway to change the 340B drug discount program, and its potential impact on women is flying under the radar.
Critics of the 340B program have been out in force during recent weeks. House Republicans sent a pointed letter to the Health Resources and Service Administration, noting concerns about the management of the program, eligibility of both patients and covered entities, and how cost savings are being used. Early draft proposals to change the 340B program would cut the number of eligible patients and providers, and if advanced, would pose a whole new threat to women and reproductive health care access.
The 340B program benefits low-income and uninsured patients and our nation’s safety-net care facilities that serve all who need it, regardless of ability to pay. This safety net includes Medicare/Medicaid Disproportionate Share Hospitals, HRSA-supported health centers, Title X family planning clinics, and other facilities especially crucial for women, who often rely on safety-net providers for well-woman care. Women make up 56 percent (more than 16 million) of the total nonelderly adult Medicaid population (nearly 29 million) and are more likely than men to experience barriers to care due to cost.
Nowhere is the importance of 340B program for women more evident than the access it offers to contraception and reproductive health care. Via our mission to provide a low-cost, long-acting reversible contraceptive through the 340B program, we’ve offered intra-uterine devices (IUDs) to tens of thousands of women who wouldn’t otherwise have had that option. We’ve met providers and patients who’ve benefited from the drug discount program — and seen the empowering impact we can have when women of any socioeconomic status have access to and choice of the full range of contraceptive options.
Congress’s hand-wringing over the program may be well-intended, but the criticisms and potential revisions to the program are deeply troubling. Policymakers underestimate the complexities at play and the potential for unleashing a bevy of unintended consequences.
For example, narrowing the eligible patient definition would directly impact access, limiting the number of safety net providers that can participate and shutting out patients the program is intended to help. Changes that limit the ability of safety net providers to get the drugs they need for patients will hamper their ability to use the savings to shore up operations that already run on razor-thin margins.
This domino-effect of consequences would create new vulnerabilities in the safety net and destabilize access to contraception for women. Unless lawmakers act when called upon to preserve the patient definition, they will fundamentally undercut a program that’s allowed thousands of women to access effective birth control of their choice and make important decisions about their lives.
There’s no doubt that improvements can be made to the 340B program. Thoughtful changes in accountability and reporting are good for everyone. The program is an investment in the health of Americans and HRSA should be applauded for its recent actions to improve 340B oversight and administration.
But lawmakers must proceed cautiously so they don’t hollow out the purpose of the 340B program. When those who are underserved have access to quality health care, we are all better for it. The 340B program is working as it was intended to, and it’s worth preserving.
Jessica Grossman is the CEO of Medicines360, a global nonprofit women’s health pharmaceutical company.
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