Tag: medicaid

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.

Andrea DeMeo
Andrea DeMeo

“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.

[email protected] / 585-653-4021
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Trillium joins coalition to protest health center cuts

Trillium Health Inc. has joined a statewide coalition to protest cuts to community health centers.

The Protect the Safety Net campaign, led by advocates and Medicaid patients, seeks to reverse a provision in the New York state budget that strips a critical federal benefit from health care providers and patients statewide. Campaign leaders said the “carve-out” provision harms all safety net providers in the federal 340B drug discount program and further jeopardizes the health of some of New York’s most vulnerable Medicaid recipients during the COVID-19 pandemic and economic recession.

The provision, which was recommended from the Medicaid Redesign Team II and advanced by Gov. Andrew Cuomo, would require the New York Medicaid program to carve out the pharmacy benefit from the state’s Medicaid managed care program and shift payment of drugs covered under that benefit to fee-for-service reimbursement.

Coalition members say that if the provision is implemented it would harm federally qualified health centers, safety-net hospitals and other safety net providers in the 340B drug discount program and adversely impact the financial stability of health care clinics across the state.

Clinics rely on the funding to operate food pantries, provide transportation assistance, offer sexually transmitted infection testing and run harm reduction programs, services they say are “grossly underfunded” by the state.

Andrea DeMeo
Andrea DeMeo

“In the rush to approve this year’s budget, a little-noticed provision was adopted that would devastate community health centers across New York State. The same clinics that have been fighting COVID-19 will be forced to eliminate services or close – leaving people living in poverty without access to testing, food pantries, transportation and housing assistance, STI screening and treatment and programs to fight the opioid epidemic,” said Andrea DeMeo, president and CEO of Trillium Health. “In addition, clinics that have been battling HIV/AIDS for decades will be financially devastated, reversing all of the progress that we’ve made in the fight against HIV. Therefore, we are calling on the governor and state legislators to reverse this harmful carve-out.”

The federal 340B Drug Discount Program is a lifeline that allows safety net providers, including HIV/AIDS clinics receiving support under the Ryan White CARE Act, to obtain prescription drugs at below-retail prices. The program was established with bipartisan support as part of the Veterans Health Care Act of 1992.

“Without this benefit, there’s no way I can afford my medicine. We have been struggling to make it through the pandemic, but this is the breaking point. I would welcome whoever came up with this terrible idea to come to my clinic and see the people impacted by this heartless decision,” said Annie Brooks, a patient at Trillium Health.

The Governor’s Medicaid Redesign Team II made budget recommendations that were approved by the Assembly and Senate and signed by Cuomo in April. The budget, including the carve-out provisions, is set to go into effect at the start of the next fiscal year beginning on April 1, 2021.

[email protected] / 585-653-4021
Follow Velvet Spicer on Twitter: @Velvet_Spicer

New York AG issues warning to 17 area medical transport companies

New York State Attorney General Letitia James has ordered 78 medical transportation companies and providers of transportation services to Medicaid recipients statewide, including 17 in the Rochester area, to stop providing group rides.

An individual in the AG’s office said this week that because the investigation was active the names of the providers could not be released.

A statewide investigation conducted by the attorney general’s Medicaid Fraud Control Unit revealed that dozens of transportation providers have failed to follow the state’s requirements explicitly prohibiting medical transportation providers from conducting medical transports with more than one occupant per vehicle.

Despite the prohibition, the 78 providers continued to conduct group rides, which often involve transporting multiple individuals to medical appointments or clinics, officials said in a statement.

“We have invested a particularly high level of trust in our medical services providers during this crisis,” James said in the statement. “For these companies to continue to conduct group medical transport rides in the face of an explicit prohibition during the unprecedented outbreak of a highly contagious disease is simply and completely unacceptable. We take these violations very seriously and my office will deploy any legal means necessary to stop providers from endangering erring patients and the general public.

In addition to Rochester’s 17 companies, some 31 companies in Buffalo had violated the prohibition, 15 companies in Syracuse and 15 companies in Albany. The state Department of Health had issued the guidance on March 21 in response to the rapidly expanding coronavirus pandemic.

[email protected] / 585-653-4021
Follow Velvet Spicer on Twitter: @Velvet_Spicer