August 03, 2023

By Dr. Benjamin F. Chavis, Jr.

President and CEO, National Newspaper Publishers Association

All Americans should have equal access to high quality healthcare.  As our nation steadily emerges out of the awful debilitating aftermath of the COVID-19 pandemic, the majority of communities of color, and in particular the African American community, are all facing lingering challenges and prolonged difficulties in having access to affordable and quality healthcare.

The United States Department of Health and Human Services (DHHS) has many important and life-saving public health related programs that are structured and funded to ensure access to the best of healthcare offerings including the provision of affordable pharmaceuticals with respect to the most vulnerable and underserved communities across the nation. 

One of those important governmental healthcare programs is known as the Charitable Medicines Program (340B). The 340B program began in the early 1990s when Congress wanted to require pharmaceutical manufacturers, as a condition of benefiting from government programs, to donate at low or no cost prescription drugs to charitable hospitals. These hospitals, overwhelmingly located in underserved urban and rural communities with patients of all races and ethnicities, were in turn expected to use these discount price medicines to serve patients who otherwise could not afford these drugs.

Today, Americans are facing unprecedented times. We are rebuilding our economy from a global pandemic. But there is another epidemic in this country (Entities putting profits over people) which must be addressed, and it must be addressed now. It’s one of the few things reasonable Americans on all sides of the political spectrum can agree on these days. Where it happens, there ought to be robust, bipartisan reform efforts to fix it. When it happens inside the context of a government program meant to help the poorest among us, it should mean robust oversight from the Congress and the Administration. That’s exactly what’s going on now with the charitable medicines program known as “340B.”

For a while, the program worked as intended. The average discount on a 340B drug is nearly 60%, and for many drugs it’s much more than that. But over time, greed has cropped up and made a mockery of the program resulting in practices which furthers health inequities in our nation.

The definition of a “charitable hospital” was never well-defined in law, and today 57% of all hospitals participate in the drug discount program. They are happy to accept the cheaper medicines, but where do they end up? Out of the nearly 13,000 hospitals and community pharmacies participating in the 340B program today, fully six in ten are in middle class and affluent areas, not the poorer zip codes the program is meant to serve.

How is this possible? How has a program Congress created to get Big PhRMA to give affordable drugs to charitable hospitals gone so far off the rails? The answer is that no one is minding the store in Washington. There are zero requirements for hospitals to use the cost savings from 340B to help needy patients, and there isn’t any rule requiring these hospitals to let patients know they are eligible for these drugs.

In addition, stand-alone hospitals are now the exception compared to the rule of a broad hospital network with facilities in diverse income areas. A hospital or clinic that qualifies for the discounted drugs in this program might be one of dozens of health care centers in a network conglomerate. As a result, the drug price reductions are eagerly gobbled up and the drugs fed into the larger system. To put a fine point on it, medicines intended for poor urban and rural areas are being re-routed and sold at full price to insured patients in more affluent areas. That’s the definition of health inequity.

This is not a mere theoretical concern. Last year, the New York Times https://www.nytimes.com/2022/09/24/health/bon-secours-mercy-health-profit-poor-neighborhood.html broke a story that Bon Secours, a hospital network in the Richmond, VA area, was accepting 340B discount drugs at Richmond Community Hospital, not telling local patients they were eligible for these free-to-inexpensive medicines, and selling the drugs for full price to patients in more affluent hospitals in their network. This led Richmond mayor Levar Stoney to send a letter to Bon Secours, charging them with using “loopholes [to increase] profit margins for the hospital system while they have reduced services in one of our predominantly Black communities.”

Notably, Mayor Stoney also called on the Biden Administration to increase oversight of the 340B program: “I request for your administration to urgently investigate the effectiveness and unintended consequences of 340B--not only regarding Bon Secours in the City of Richmond, but in other localities across the country.”

Untold stories like this exist in communities across the country. But the fact is the hospital lobbyists have influenced Congressional and Administration oversight officials from both political parties for decades. Every Congressman has a hospital in their district, and the 340b program must be used by the hospitals as Congress mandated.

That’s why I was proud to hear about a panel earlier this year organized by the Rev. Al Sharpton on this topic where he stated, "This affects everybody. If you are having people abuse government funds that should be reinvested, this is not a right-wing or left-wing issue."

The executive branch runs the 340B program out of the Health Resources and Services Administration, a branch of the Department of Health and Human Services. HRSA, as it’s known, makes determinations of what entities are covered by the program, and they have been very generous over the years. According to the Government Accountability Office, the number of hospitals and clinics HRSA has approved has increased from fewer than 10,000 in 2010 to nearly 13,000 today–an increase of 30 percent in a little over a decade.

And while HRSA is supposed to collect information and conduct audits on 340B covered entities, they simply don’t have the manpower to do so. The little number of questions they do raise are answered and accepted, because there is no real oversight possible. There are only the staff resources to facilitate drug discounts to hospitals.

What’s urgently needed is a combination of Congressional hearings and a more inquisitorial HRSA. Until that happens, low income patients across America will be the excuse giant hospital chains use to get drugs at a discount rate and sell them at full price to more affluent patients.

June 22, 2023

By Andrew M. Cuomo and

Dr. Benjamin F. Chavis, Jr.

America 2023: tumultuous times. Yes.  Yet, amidst the greatest domestic challenges of American history, our nation has attempted to respond to the challenges through transformative public policy initiatives that have moved America toward a more perfect inclusive union.

Today there are new challenges to be sure, but also there are ongoing battles that have yet to be won.

There are civil rights struggles and conditions that harken back to the 1960s that still abuse people of color every day, that still deny justice, equality and opportunity for all.

There’s an old saying: The first step to solving a problem is admitting it — and the first step can be painful.

There is still gross inequity in our education system, between rich school districts and poor districts. There is still inequality in access to healthcare, employment, to financial credit and there is a basic violation of civil and human rights in our criminal justice system.

Misguided pseudo-progressive policies such as “defund the police” and soft on crime procedures are literally contributing to the killing of hundreds of Black people and other people of color every day across America.

The truth is, crime is out of control in this country, especially in too many of our cities. While many choose to turn a blind eye, it is people of color who are the majority of the victims: People of color account for 73 percent of rape victims; 72 percent of robbery victims; and 80 percent of felony assault victims; and 68.7 percent of the people in prison are Black and brown and 44% percent of the people killed by police in the United States are Black and brown.

We do need police reform and reform of the entire justice system.

• One: we need to change the culture and premise of policing. Our basic police system was designed in the mid-1800s — a different time and place. Today, it’s estimated that less than 10% of police officers' time is actually fighting violent crime. We need a different vision, we need to rethink how we police — 911 calls signal an emergency, and we need more specialized and better trained emergency responders for different needs: domestic violence, substance abuse, mental health, homeless issues, gang problems as well as violent crime in progress.

• Second: We need dangerous guns off the streets and all guns away from dangerous and mentally ill people. By far, most gun crimes are committed in urban areas with handguns.

We need to reduce not increase concealed weapons in our cities.

We need to keep guns out of the hands of anyone under 21.

We need to fill gaps in the background check system so it’s universal and nationwide.

And we need to bring back the assault weapons ban because weapons of war have no place on our streets or in our communities.  Assault weapons enable the horrific mass shootings that continue to plague our country.

• Third: We need to reduce recidivism. The vast majority of violent crimes are repeated by a small number of people who keep hurting others over and over.

• Fourth: We need to have more effective alternatives to incarceration, safer jails, but dangerous and repetitive violent people must be taken off the streets to protect all Americans, and in particular for the most vulnerable who are disproportionately victimized by violence and crime in Black and brown communities.

• Fifth: We have to stop over criminalizing petty, non-violent acts. 80 percent of crimes are for misdemeanors, and many are petty non-violent acts. And some charges are deliberately vague and are subject to discretion that can be abused by police, like loitering, vagrancy, trespass, or failure to pay a fine. In fact, some of the most horrific examples of police abuse occurred when a minor crime arrest escalated: Eric Garner killed for selling loose cigarettes; Rodney King beaten within an inch of his life for speeding; George Floyd killed for a bad $20 bill; Alton Sterling killed for selling CDs; Philando Castile killed for a broken taillight; and, Michael Brown killed for jaywalking.

We believe that the time to act is now. These specific categories of civil rights have been violated for too long and the time to make a difference is surely too short. As a nation we cannot afford to remain silent about extremists’ hatred, violence, crime, and the fear-filled deterioration of American cities and towns.

This is for us a sense of urgency and civic responsibility. We have decided to work and act together, and to speak out publicly with recommended commonsense solutions to crime, violence, guns, and police reform that we know the majority of the American people support.

Andrew M. Cuomo, American lawyer who served as the 56th Governor of New York from 2011 to 2021, Chair of the National Governors Association, U.S. Secretary of Housing and Urban Development, and former Attorney General of New York.

Dr. Benjamin F. Chavis, Jr, President and CEO of the National Newspaper Publishers Association (NNPA), Executive Producer/Host of The Chavis Chronicles on PBS TV stations across the nation; former Executive Director and CEO of the NAACP, and today serves as a National Co-Chair of No Labels.

June 22, 2023

By Rhonda Smith

While everyone agrees high health care costs are a major problem, one critical aspect that often goes unnoticed is the role Pharmacy Benefit Managers (PBMs) and health insurers play in driving these high costs. It is past time we shed light on this topic and demand a fairer system. Thankfully our local legislator, Senator Steven Bradford (D-Gardena), is doing his part and standing up for patients through SB 873, which would immediately lower out-of-pocket costs at the pharmacy counter.

With PBMs acting as the middlemen between pharmaceutical manufacturers, pharmacies, and health insurers, they play a big part in determining the cost of prescription medicines. Using rebates as leverage, they negotiate prices, manage formularies, and administer prescription drug benefits for millions of Americans.

Imagine this scenario: a patient walks into a pharmacy, presents their insurance card, and receives their prescribed medication. They pay their copay or coinsurance, unaware that behind the scenes, the PBM previously negotiated with the drug manufacturer a rebate on that medication, which, on average, is 49% of the list price. So, if the list price of a medication is $200, the PBM’s health insurer client only pays $102, but the patient still pays based upon the $200 list price instead of the $102 rebated price. How is that fair?

What’s worse, because the system lacks transparency or accountability requirements, PBMs end up pocketing a significant portion of the rebates instead of sharing the savings with patients by ensuring their costs at the pharmacy counter are based upon the rebated price, not the higher list price. While a $98 spread in the scenario above doesn’t seem like a lot, a report from the Department of Managed Health Care showed that health plans in the state received $1.7 billion in rebates in 2021 alone.

It’s simply not right that despite having insurance, Californians are being forced to pay increasingly higher co-pays and other out-of-pocket costs for their medications. Especially when we know that historically underserved communities have lower utilization of and adherence to prescribed medicines. A 2019 study found that Asian, Hispanic, and Black Americans were 20-50% more likely to not take their blood pressure medications as prescribed and 35-60% more likely to not take their cholesterol medications as prescribed due to cost.

It’s clear that marginalized communities and those with chronic illnesses face the greatest challenges when it comes to accessing affordable medications, yet the current system makes it even harder for them.

In 2020, nearly 1 in 10 new prescriptions were never picked up at the pharmacy. According to the report, only 10% of patients with out-of-pocket costs of approximately $10 abandoned their medicines, but when costs rose to more than $2,000 per prescription, almost 50% of patients abandoned their medicines. With non-adherence and medication abandonment leading to worse outcomes and the widening of existing health disparities, it’s imperative we take action.

By following the path outlined by SB 873, California can reform this broken system, alleviate financial strain, and ensure equitable access to lifesaving medications for all. Requiring health insurers and their PBMs to share rebates directly with patients at the pharmacy counter will immediately lower out-of-pocket costs, particularly for Californians living with cancer, diabetes, cardiovascular disease and other chronic or rare diseases.

Fortunately, we know this type of policy is easy to enact because some national PBMs have already done so, and states like Indiana, West Virginia, and Arkansas have too. One national PBM owned by a health insurer even found that sharing rebates at the point-of-sale saved patients an average of $130 per eligible prescription and improved medication adherence rates between 4-16%.

While critics argue that sharing rebates will lead to higher premiums, the benefits here far outweigh any costs. First and foremost, SB 873 will ensure patients no longer have to choose between their essential medications and other basic necessities, allowing them to prioritize their health without financial strain. Second, studies have shown that critics’ claims about premiums are seriously inflated.

A study by the California Health Benefits Review Program of a similar policy measure found that premiums could slightly increase 0.3%, but patients would save more than $70,000,000 annually. And in comments to the New York Times, a PBM representative said providing point-of-sale rebates “would have a minimal effect on premiums” while “the benefit to the individual is meaningful.”

In my eyes, SB 873 is a no brainer.

We need proactive measures, like SB 873, to ensure that PBMs and health insurance plans are held accountable – after all, we rely on them for our well-being.

By demanding transparency and passing SB 873, California can take a significant step toward the creation of a health care system that truly values patients over profits. It is time to empower patients with timely access to affordable medications like they rightfully deserve and foster a healthier future for our communities.

Rhonda Smith is the Executive Director of the California Black Health Network, the voice and trusted resource for Black Health Equity in California and the only Black-led, statewide organization dedicated to advancing health equity for all African Americans and Black Immigrants.