May 29, 2012—Members of Congress concerned about 340B oversight and program integrity are continuing their inquiries, turning their attention to a Georgia health system and an Alabama hospital.
Two members of the House Energy and Commerce Subcommittee on Health recently sent a letter to the Health Resources and Services Administration (HRSA) asking it to audit [ms-protect-content id=”2799″]Phoebe Putney Health System in Georgia. Reps. Bill Cassidy (R-La.) and Joe Barton (R-Texas) have questions about the system’s 340B purchases last autumn of fluorouracil (also called 5-FU)—an oncology medication whose injectable form has been in short supply. They say the quantities purchased appear to be far above previous monthly averages.
The health system told the lawmakers that the purchases were made for a number of its facilities, including its cancer center and clinics. The lower monthly averages that the lawmakers cited, it said, were for a single rural hospital in the system. The system, one of the busiest cancer care providers in the Southeast, said it wanted to ensure that its patients’ therapy regimens would not be disrupted. The members of Congress still have concerns about the purchasing pattern and have asked HRSA to investigate.
Also, earlier this month, Senate Judiciary Committee Ranking Member Charles Grassley (R-Iowa) sent a letter to UAB Hospital in Birmingham, Ala., asking a series of questions about its use of the 340B program. He is one of four members of Congress who have asked various stakeholders for a wide range of documents about their involvement in 340B. Senator Grassley expressed concern that the hospital “appeared to advocate changing a patient’s status from inpatient to outpatient to become eligible for the discount program.” He said he was particularly concerned about the possibility that the hospital might have changed the admission status of transplant patients.
A hospital spokesperson told the trade publication Inside Health Policy that the hospital was responding to Senator Grassley’s letter.
“The hospital’s first priority is ensuring appropriate patient care; treatment decisions are based on what is best for the patient as determined by their physicians,” the hospital said, adding that it does not generate revenue from participating in 340B. “At University Hospital, cost savings from participation in the 340B program help the hospital continue to provide care to our patients.”
UAB pointed out that it is the largest health care safety-net provider for indigent and low-income citizens of Alabama and last fiscal year served thousands of underserved patients at a non-reimbursed cost of more than $86 million.
Some lawmakers believe that 340B was intended only for low-income patients and that hospitals have improperly been generating revenue from commercially insured patients.
Safety Net Hospitals for Pharmaceutical Access (SNHPA), which represents hospitals enrolled in 340B, pointed out in the Inside Health Policy article that the program was never designed to for uninsured patients only, but rather to give discounts to hospitals and other providers serving large numbers of indigent patients so that they would have the resources to fulfill their safety net mission. SNHPA also said it was confident that hospitals’ decisions about treatment protocols and policies on admissions and discharges are subject to rigorous internal medical review prior to implementation.
SNHPA said it “is committed to the integrity of the 340B program and working with Congress on measures to ensure program compliance. SNHPA is also committed to protecting patient safety and advancing patient outcomes.”[/ms-protect-content]