Debate plays out in the blog of a noted health policy journal.
June 23, 2011—Hospitals enrolled in the 340B drug discount program have taken strong exception to a guest column in an influential health policy journal's blog that asserts that 340B is contributing to severe drug shortages.
In a June 8 essay in Health Affairs Blog, John Goodman of the National Center for Policy Analysis (NCPA) said that 340B was part of "a web of [federal] regulations that are preventing life saving drugs from reaching the patients who need them."
"[A] little known program that forces drug manufacturers to give discounts to certain end users" is contributing to the shortage problem, wrote Goodman, who is well known for his advocacy of personal health savings accounts. "Economics teaches that when prices are kept artificially low, shortages develop." The 340B program's expansion under health care reform, he added, "will make things worse."
Ted Slafsky, executive director of Safety Net Hospitals for Pharmaceutical Access (SNHPA), responded with his own essay in the blog on June 21. Goodman, he noted, offered no facts to support his contention that 340B was causing shortages.
Most of the drugs in short supply today, Slafsky pointed out, are generic injectable therapies and hospitals that do not participate in 340B can often buy generic drugs for less than those that do. He also noted the absence of evidence that 340B has a role in shortages, that 340B drug purchases represent less than 2 percent of the U.S. drug market, and that 340B is a fraction of the size of the Medicaid drug rebate program.
Slafsky also pointed out that Pharmaceutical Research and Manufacturers of America (PhRMA), the trade group for drug manufacturers, did not reference the 340B program or government limits on drug prices when it recently published comments on the causes of drug shortages.
The Johns Hopkins Kimmel Cancer Center, meanwhile, objected strongly to Goodman's statement that due to a shortage of the leukemia and lymphoma drug cytarabine, doctors there "are literally deciding who will live and who will die." The center is part of The Johns Hopkins Hospital, a 340B-enrolled provider.
Goodman's depiction of life —and — death decisions at Hopkins was "egregiously wrong and inflammatory," wrote Hopkins spokesperson Vanessa Wasta in the blog post's comments section. "This is most certainly not the case at Johns Hopkins, or anywhere else we suspect."
Wasta added that "there is no evidence that the 340B program referenced in Goodman's blog has contributed to shortage problems."
"Cytarabine is a generic drug, and the 340B program has a very small impact on pharmaceutical sales, yet it is of great importance to hospitals that treat large populations of uninsured and underinsured patients," she said.
The Nebraska Medical Center, Goodman said, was another university hospital where cytarabine was in short supply. Like Hopkins, it too is enrolled in 340B.
According to the center's executive director of pharmacy services, Michael Powell, who was quoted in Slafsky's essay, the 340B program "is critical to our institution's ability to provide access to pharmaceutical care for our most vulnerable patient populations, who would otherwise not be able to obtain prescription medications."
"The savings achieved through 340B pricing help us to sustain other vital services, in addition to pharmaceutical care," he said.