The Trump administration's plan to lower insulin and Epi-Pen costs for community health center patients is unnecessary and could do more harm than good, according to comments on the proposed rule.
The National Association of Community Health Centers said the proposed rule reflects "a fundamental misunderstanding" of Federally Qualified Community Health Centers and the 340B program. Providers argued community health centers already have to care for patients based on their ability to pay and usually have programs to help them afford their medication if they don't have enough money.
"If the rule is finalized, the major impact would be to restrict funds available to (community health centers) to best meet the needs of their communities. We do not believe that was the intent of the 340B Drug Pricing Program," the Association of American Medical Colleges wrote.
Providers worried the rule could reduce patients' access to care by cutting deeper into community health centers' thin operating margins.
"Patients at community health centers are disproportionately low-income and people of color, who have been especially hard hit by the pandemic and rely on (community health centers) as a safety net," the American Academy of Family Physicians wrote. Community health centers "are already struggling to keep their doors open, and patients are increasingly dependent on their services."
National health insurer Cigna is concerned the rule could be difficult to put into practice unless the Health Resources and Services Administration provides up-to-date information about which Federally Qualified Health Centers have to follow the rule. It also asked the agency to require community health centers to submit a prescription claim for patients with health coverage.
"Having a comprehensive view into medical and prescription utilization is important for whole health care coordination and identifying gaps in care that can lead to negative outcomes and increased spending," the company wrote. "For this program to succeed, it needs to be simple for (community health centers), pharmacies and patients."
The proposed rule would deny grant funding to Federally Qualified Health Centers unless they charge low-income patients the acquisition price for insulin and Epi-Pens, plus an administration fee. It would only help patients with incomes between 200 and 350 percent of the federal poverty line—about 10% of patients.