Trillium to lose millions in 340B carve-out

Trillium Health on Tuesday said it stands to lose more than $5 million annually if the state proceeds with its carve-out of the 340B program on April 1.

The resources in jeopardy are related to the 340B prescription drug discount program. Pharmaceutical companies that participate in Medicaid are required by the federal government to provide discounts to some types of community health centers like Trillium and their pharmacies.

Trillium and other safety net providers are required to use the savings to fund critical programs and services that address needs such as food insecurity, housing stability and transportation for underserved communities, in addition to providing low-cost prescription drugs to clients.

Gov. Andrew Cuomo in his state budget proposal wants to effectively create a price ceiling for certain high-cost prescription drugs reimbursed under the Medicaid program by requiring a 100 percent supplemental rebate for any amount that exceeds a benchmark price recommended by the state’s Drug Utilization Review Board.

More than 40 lawmakers statewide, including several in Rochester, immediately reached out to the governor opposing carving the pharmacy benefit out of Medicaid and replacing it with a fee-for-service (FFS) model, as advanced by the Medicaid Redesign Team and passed in the Fiscal 2021 budget.

“These savings are provided directly by drug manufacturers as a condition of their participation in the Medicaid program and, as such, do not use any state or federal taxpayer dollars. Eliminating these savings will have a significant impact on chronically ill patients, communities of color and low-income individuals that have already been disproportionately impacted by the COVID-19 pandemic,” according to the letter.

The letter also cites a recent Community Health Care Association of New York State survey that shows the carve-out will result in an estimated loss of $100 million per year for community health centers statewide, and 32 centers would be forced to close their doors. A new analysis also found that the carve-out will result in $154 million in additional costs during the first year of implementation and a total increase in costs of $1.5 billion over the next five years.

Rochester-based Trillium said the $5 million it will lose annually as a result of the carve-out will cause an immediate disruption in services to hundreds of thousands of the most vulnerable New Yorkers and a loss of jobs. It would impact COVID-19 testing and vaccinations, HIV treatment and prevention and harm reduction programs aimed at addressing the opioid epidemic, the Federally Qualified Health Center said.

“Black and brown people are at highest risk for severe illness, hospitalization and death from COVID-19. Likewise, these same communities are most at risk for contracting HIV and not receiving adequate treatment to sidestep its life-threatening symptoms. Quietly eliminating 340B funding in service to ‘recovery’ from COVID-19 is merely trading one epidemic’s negative impacts for another’s, with black and brown communities drawing the shortest straw,” said Urban League of Rochester President and CEO Seanelle Hawkins. “We must seek alternative approaches to COVID-19 economic stopgap measures if we are to interrupt racism’s deadly health impacts in New York State.”

Trillium has vaccinated thousands of community members in the last several weeks – many of whom are older, on a limited income and are persons of color. Officials said these efforts, in addition to many vital community health programs offered by Trillium Health and other health centers statewide, will not be able to continue if the funding cuts go through as planned on April 1.

“People will suffer. And make no mistake— these are the very same people that have been disproportionately affected by COVID. And all the progress to address the opioid and HIV epidemics – which are now further exacerbated by the pandemic—will be undone. The governor needs to understand that this will be Armageddon,” said Trillium President and CEO Andrea DeMeo.

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