Health clinic drug prices beat Canada

By Kate Long
Staff Writer

SCARBRO — Last spring, Scott Brown, head pharmacist at the New River Health Clinic, heard that the Legislature had passed a law designed to cut drug prices.

He quickly got a copy.

“I was impressed. But, to tell the truth, I was also shocked by what I didn’t see in there,” he said. “They were talking about state government importing drugs from Canada and doing this and doing that. But they were missing an important part of the picture.”

The Legislature created a cost-cutting council to find ways state government can save money when it buys drugs. And it authorized formation of a Web site to help people who make less than $16,000 and couples who make less than $20,000.

“All that’s good and important,” Brown said. “But there’s this other big group of people who need help, too.” He was talking about uninsured West Virginians who make too much to qualify for free drugs and have no connection to state government.

Specifically: More than 300,000 West Virginians between 18 and 64 had no insurance last year, according to West Virginia University’s Institute for Health Policy Research.

“Community health centers are already helping thousands of them right now,” Brown said. “And we’ll help a whole lot more as this program expands.”

At 15 West Virginia community clinics, more than 20,000 uninsured patients now fill prescriptions for about half the price they would pay at Rite Aid.

On average, they pay less than they would pay in Canada, according to the West Virginia Primary Care Association.

In 2003, West Virginia’s 340B programs filled more than 250,000 prescriptions, according to the West Virginia Primary Care Association. “No matter what your income, if you’re our patient and you’re uninsured, you’re eligible,” Brown said.

Different clinics have different sliding scales. At some clinics, one uninsured patient might pay $5 and another might pay $50 for the same prescription, depending on income. But they all get discounts.

How can they offer

those prices?

Section 340B of the Veterans Health Care Act of 1992 says that, if drug manufacturers sell brand-name drugs to federal agencies at big discounts, they must give similar price breaks to nonprofit programs that don’t turn away low-income people: community health centers, school-based health centers, black lung clinics, AIDS clinics, and hospitals that provide large amounts of free care.

Every week, at 340B clinics like Cabin Creek and New River, uninsured patients pay, at most, between $50 and $60 for a 30-day prescription of cholesterol-lowering Lipitor. At Rite Aid, they would pay $118 for the same prescription.

In Canada, they would pay about $70. The 340B prices average 15 percent to 20 percent lower than Canadian prices.

To get that discount, a person must be a patient at a 340B health center. Many clinic patients drive from several counties.

The New River clinic alone filled prescriptions for 17,000 people in 2003: 12,000 got free drugs; 5,000 got 340B prices.

“And we’re working very hard to make this program available to uninsured people all over the state,” said Brian Cunningham, who is in charge of expanding 340B programs for the West Virginia Primary Care Association, working through the state Division of Primary Care.

“We aim to offer 340B programs at 90 sites in at least 48 counties by 2006,” Cunningham said.

Twelve more centers are completing their paperwork now, he said, including the FamilyCare Center on Charleston’s West Side. “Many others have expressed interest. This program is growing fast. People need help.”

By federal law, health centers do not have to pass their 340B discounts along to patients. If they choose, they can mark up all the drugs and use the profits to pay for other parts of their program.

But so far, West Virginia’s community health programs are passing the discounts along to patients who have no drug insurance. “Of course we are,” said David Hughes, administrator at Cabin Creek Clinic. “If we didn’t, a lot of patients wouldn’t get their medicine.”

“Every day, we see people struggling. They make too much to qualify for the free drug programs. They’re too young or too old for government insurance — Medicare or Children’s Health Insurance — but they can’t afford to buy their medication. So they do without. And may end up in the ER, with worse problems than they would have had.”

Drug prices have quadrupled since 1992, he noted.

Many New River and Cabin Creek patients say they can’t afford to buy their medication without the 340B program. Dothan resident Joan DeLung said, “My husband and I both work, but we can’t afford insurance.”

Her husband is an electrician. He suffers from arthritis. “Before we got into the New River clinic program,” DeLung said, “he’d just grit his teeth and bear the pain, because the medicine cost so much.”

The DeLungs make too much to qualify for any free drug programs, “but those discounts do make a really big difference.”

People who do qualify for free drugs get them at the clinic too, the day the prescription is written. “We keep bulk amounts of the free drugs on hand through agreements with the manufacturers,” Brown said.

“You feel like you’re

helping somebody”

On Monday, Maryanne Gilson drove to the New River Health Clinic in Fayette County from Raleigh County, to pick up medicine for her kids. Her prescription was the 519th the clinic filled that day. The clinic averages 370 per day.

Every day, in her counseling job, Gilson said, she listens to people who don’t have health care, from Wyoming, Raleigh and Mercer counties. “I tell them to come here,” she said. “And they do. They tell me they never knew a place like this existed.

“My children are covered by insurance, but I’m not,” she said. Her husband, Eddie, gets insurance with his job, she said, but his insurance doesn’t cover anybody else in the family.

A third of the clinic’s patients, including Gilson’s husband, have health insurance. “They come here because we offer high-quality medical services,” said David Sotak, who administers the clinic. “It’s a myth that community health clinics are for low-income people only.”

Insured patients make it possible for the clinic to offer high-quality services to all patients, Sotak said. Their insurance companies are charged the rates the companies normally pay. The clinic uses the extra dollars to subsidize people who can’t afford their medication or to pay for other clinic programs. “That was the intent of the federal law,” Sotak said.

“We like that,” Gilson said. “You feel like you’re helping somebody else out too while you get your medical care.”

Her husband is insured, but she gets her health care through the Promise program, an invention of the clinic. Through Promise, she gets 340B drugs, plus medical services, for a low monthly cost.

The clinic makes enough money to subsidize Promise, in part because New River joined a huge nationwide 340B buying group that buys more than $10 billion in drugs per year. Its members can buy drugs at 38 percent of average wholesale price, compared to the usual 49 percent.

The extra dollars also bought a new X-ray machine and funded home visits for homebound patients.

Those savings have definitely caught the attention of the state’s new Pharmaceutical Cost Management Council. Pharmacist Brown is now on the discount subcommittee. This Wednesday, the council will hear a presentation on 340B programs.

The Wise administration has been looking at 340B for about a year, according to Shana Phares, a council member and Department of Health and Human Resources official. The Public Employees Insurance Agency, for instance, wants to create a pilot program for state employees. Employees would get health care and 340B drugs through a community clinic.

“It would be a copout if this council was only finding ways to reduce prices for state government,” Phares said.

“We’re happy that 340B is part of the overall planning,” Cunningham said. “This program won’t be the answer for all West Virginians, but it is a very good answer for some of them.”

‘Those West Virginia values’

In his Primary Care Association office, Cunningham keeps a big West Virginia map, dotted with colored pins that locate 340B clinics, clinics that are completing 340B paperwork, and clinics that have expressed interest. He can reel off details about each one.

When he was a teenager in Ivydale, Clay County, he imagined himself working in a 100-story building in New York, concocting complex financial transactions for people he didn’t know.

Instead, he works in a two-story building in Charleston, concocting complicated health-care programs for West Virginians who remind him of his Clay County friends and family. “My grandparents instilled those West Virginia values in me,” he said. “I guess I have them to thank.

“Opening a program can be a big step for a clinic to take,” he said. “We’re here to help them.”

He speaks with passion and urgency, as do many who work with 340B programs. “People who need medication need it now,” he said. “This program can help them. Now. It doesn’t require further legislation. But lots of people don’t know it exists. I want to shout it from the rafters.”

He admires the spirit of the people who started the first programs: New River, Cabin Creek, Community Health Systems in Raleigh County. Four other 340B centers have opened their own pharmacies. At those centers, the doctor writes the prescription, then the patient fills it in another part of the center.

“And if a clinic doesn’t want to open their own pharmacy, they can contract with a local pharmacist to dispense the brand-name prescriptions,” Cunningham said.

So far, eight health centers have done so. The pharmacist gets a per-prescription fee of around $9, significantly more than most government programs pay. The health center supplies the drugs, so the price doesn’t affect the pharmacist one way or the other.

Different centers use different systems, said Phil Schenk, who directs the state division of primary care. “If you’re a patient at Pendleton Community Care, you get a little card, color coded by your income. So you take that in, and the pharmacist charges you based on the price for that color card. That’s an example of how you could do it.

“It seems like a solid program by which the pharmacies don’t suffer financially and the patients benefit, so it seems to be a win-win situation,” said William Douglass Jr., director of the state pharmacy board.

“I’m doing my part for the community,” said George Karros, who fills 340B prescriptions for Shenandoah Valley Medical Systems at Patterson’s Pharmacy in Martinsburg. “We just started this contract with Shenandoah. It’s time-consuming at first, but in the long run, it will work. It will take about a year to get up to speed.”

Cunningham is busily gathering support materials and resources for contract pharmacists like Karros. “That’s a next step,” he said. “Building a network for the pharmacists.”

He noticed that at cost reduction council meetings, drug company lobbyists recently began to volunteer positive remarks about 340B. Other lobbyists joked that maybe 340B is looking good to the drug companies, compared with Canadian importation, price controls and other measures the council is considering.

“I don’t want to speculate about any of that,” Cunningham said. “All I know is, this program can help a lot of people, and they need it.

“The council will lead the process as the state moves forward. We’re glad to be part of it, and we’re happy it’s getting this kind of attention from people who can help move it forward.”

More information about 340B programs is available at the West Virginia Primary Care Association Web site: www.wvpca.org/ 340bdrugprogram.

To contact staff writer Kate Long, use e-mail or call 348-1798.