340B Hospitals Are COVID Vaccine Leaders

Announcer (00:04): Welcome to 340B Insight from 340B Health. David Glendinning (00:11): Hello, from Washington, D.C, and welcome back to 340B Insight. The podcast about the 340B Drug Pricing Program. I'm David Glendinning with 340B Health. This episode is sponsored by 340Basics. 340Basics is a third-party administrator that combines its intuitive drug inventory system and split billing software, ensuring the administration of the 340B program in a hospital setting remains compliant, is uncomplicated, and furnishes improved management of the 340B program. Please learn more by visiting 340basics.com. David Glendinning (00:51): This is a very special episode. With the advent of the first COVID-19 vaccines, the nation has been focused on how these life-saving medicines get into people's arms. Our guest today is Scott Milner, a senior director of pharmacy at St. Luke's Health System in Idaho. Like many of the pharmacy staff at our member hospitals, Scott and has been busy overseeing the rollout of the vaccines. We wanted a first-person perspective from the field at this critical stage of the pandemic response. But before we go to that interview, let's take a minute to cover some of the latest news about 340B. David Glendinning (01:35): There are new developments in the legal dispute over 340B contract pharmacies. You will recall from our previous news update that the top HHS lawyer issued a late December opinion stating that drug companies are violating federal statute when they refuse 340B pricing on drugs dispensed to contract pharmacies. Following up on that opinion, attorneys for hospital and pharmacy groups that had filed a joint lawsuit in December over this issue, including 340B Health, sent letters to six drug companies demanding that they cease such unlawful pricing restrictions. But so far, the companies do not show any signs that they will be complying with federal regulators. Three of the six companies filed their own lawsuits against HHS. They ask federal judges to declare that the HHS opinion cannot be enforced and that drug makers are not required to offer 340B discounts on drugs dispensed to contract pharmacies. David Glendinning (02:33): By digging in on this issue, the companies are increasing the chances that resolving this conflict will require a lengthy legal process. This is the first full week of the new Biden administration. The change in leadership, as well as the new Congress, gives safety-net hospital advocates a wealth of opportunities to educate elected officials and their staff on the 340B program. If you haven't already, be sure to listen to episode 14 of our podcast when we heard from two government experts about what the new political scene might mean for 340B. David Glendinning (03:16): Now for today's feature interview with Scott Milner at St. Luke's Health System in Idaho. Scott has more than a decade of experience as a hospital pharmacist, including extensive experience managing 340B programs. He shares a compelling and very moving story about his system's role in the COVID-19 vaccination campaign. And it all started when he received word that's very special mail had arrived for him at the hospital. Aaron Myles Goldman sat down with Scott to hear that story and to discuss how the vaccination is going. Let's listen to that conversation. Aaron Myles Goldman (03:53): Thank you, David. I'm joined by Scott Milner, the Senior Director of Pharmacy Business Development Purchasing 340B and Infusion Services at St. Luke's Health System. Scott, you've had a large role in the Health System's efforts to distribute the vaccine. And I'm looking forward to discussing your experiences. Welcome to 340B Insight. Scott Milner (04:13): Thank you for having me. Aaron Myles Goldman (04:15): The distribution of vaccines against the COVID-19 virus has provided hope that we've reached a turning point in confronting COVID-19. Across the country, pharmacists are delivering these vaccines to their coworkers and patients. And one of the reasons we wanted to speak with you is the reaction you had when the vaccine arrived at your hospital. It was pretty incredible. Can you tell us about that? Scott Milner (04:37): Personally, I had a lot of questions about the vaccine, what it was going to be. I've had COVID myself. And while I'd say my case is fairly mild, I definitely don't want to go through that if I can avoid it. I had things that are still lingering today with my sense of taste and my smell to some degree. So, knowing that and having some of the things that are just missing out on just all of 2020, the things that have become normal to have masks everywhere, not be able to do things, or go to concerts. It's actually something I didn't think about until with a lot of buzz. Scott Milner (05:11): We have some of our pharmacy leaders and other leaders with us trying to make sure we had a fluid process because we wanted to get those doses immediately within the custody, following the check-in guidelines and education, but then turning them around and getting them out to our clinics so we could start the vaccination process when they called it was really, really somber. And so when I answered the phone, I was kind of caught up in all the logistics. We had a number of people talking in the background, and I had put it on speaker, and he said, "Hey, I got a package for you." And they all suddenly realized the moment. I kind of want to remember that. Scott Milner (05:47): So I grabbed my camera and took a video of my phone. And said, "Say that again." And you could hear the excitement, even in the dockworkers, the delivery drivers of the company that brought it to our system, just the fact that it was here and we celebrated, we ran down and grabbed it from the delivery area, brought it back in and started that whole process. I didn't realize how much it would mean to not only me personally but my coworkers and others around us, but I'm glad I was there for it. Aaron Myles Goldman (06:15): Well, I'm glad to hear you're feeling better, although I know you said you're still trying to recover. The video you posted on LinkedIn is so powerful to watch. I hope our listeners will take the time to watch it, as I believe we're going to have a link to it in our show notes. You alluded to it just a moment ago about all the preparation involved. Can you walk us through how St Luke's prepared for delivering the COVID vaccines? Scott Milner (06:41): Yeah, it's something I still have to go back and think about it because it seems so long ago. I feel like we were told to make preparations but not fully given all of the details. We knew general temperatures, general volumes of things that might happen. We went out and acquired a bunch of syringes, needles, and such, thinking that we were going to have to provide those in anticipation that they wouldn't be coming in syringes. But that was a gamble that we had to question, are they going to come into vials or syringes? So there's a number of those decisions that we had to operate with some information, take a little bit of a gamble to some degree. And some of those we bought a bunch of things that we're utilizing, we still have to use for them, but we're not doing for vaccines. Scott Milner (07:27): Another thing was the cold chain. At the time, we heard that it would require these temperatures and that there were two. And so we purchased some ultra lows for the Pfizer product and some other freezers for our maternal products, knowing that we were in the populations we serve, we have about half a million or more patients that come through our facilities in our communities, that our facilities are at. And so we made purchases of equipment and made sure they were on generator backup power. Scott Milner (07:58): We made plans to acquire dry ice on a routine basis and how to dispose it and put carbon monoxide and dioxide detectors in the area on gloves and equipment. So there's hundreds of... I couldn't even tell you the litany of decisions that we had to make feeling like they were on the fly operating with the best information, but even up until the day, it was officially approved. Things were very fluid. And then, even since then, how to make sure we dilute and draw and do everything appropriately when we do. So there's just a lot of learning and a lot of movement that we're in healthcare, not always used to, to some degree. Aaron Myles Goldman (08:37): It's just amazing as you're discussing. I can't help but think about how detail-oriented this was, and you're doing all this right. While you're still taking care of patients with COVID-19 and all the pharmacy decisions that are involved with that. Right? Scott Milner (08:52): Yeah. So, I mean, this is in addition to like the bamlanivimab and Regeneron, and those therapies that are for COVID positive patients in the outpatient infusion environment in addition to Remdesivir and the inpatient, and trying to make sure that we balance inventory and the cost associated with buying that, but we're at the same time we were standing up infusion areas. Again, we have infusion centers where we have people with different either immunosuppressed or infectious disease treatments that are being given. And we can't have COVID-positive patients. And we have PPE that's been somewhat scarce. We're trying to make sure we're doing it appropriately for our nurses that are infusing. And so those are also layered on top of all the preparations for the vaccination, in addition to the things that we're dealing with 340B and other stuff that, again, 2020 was just a whirlwind. Aaron Myles Goldman (09:43): Now that the vaccine is here, how is the vaccine distribution going so far? Scott Milner (09:49): It's going really well. We're trying to make sure we're holding the line on whose turn it is. Right? So if we have a tear into phase one here in Idaho, we have multiple steps in the first phase of employees that are facing and workload areas. Those are support hospital operations. So trying to make sure those individuals have their turn, this isn't mandatory. And so we're not requiring this. So how do we know we've given a chance to everyone who wants to opt-in? We're trying to base it on appointment availabilities. And then also making sure that in our communities across our state, that we're working with our state leaders to not get ahead of somebody and then not waste anything because their doses at the end of the day, that if we have an extra on, we don't want to waste. Given that I feel like every day, it feels like groundhog day, but also in that we are on the same calls, in the same groups, in the same conversations, but it's shifting. Scott Milner (10:44): The other stories happened because of the delays that we had with shipping. And so because of those logistics, as the packages didn't come, as we expected, the time came and went, we had clinics lined up to return and receive those vaccines. We actually had to enlist our air St. Luke's, our Life Flight Network. And we actually, the second they hit our doors, we turn to put them on our fixed-wing jets actually and shipped them out to our areas across our state to make sure that those vaccines, again, got out appropriately. We're trying to add extra clinics and add an extra capacity to make sure our community members can actually get the vaccine as fast as we can. Aaron Myles Goldman (11:24): It sounds like you've been traveling to various St. Luke's hospitals to make sure the distribution is going well. Scott Milner (11:30): Yeah. And not always me, but at first, I tried to be there at the front of the first vaccines that were given here in the Boise area. We call it the Treasure Valley, making sure that the education was clean. We had some clinics that have they're very vaccination savvy. This isn't a new concept, but however, COVID vaccine is a new thing, and we have pharmacy personnel that are helping dilute and draw to make sure we turn things around quickly and safely and so making sure that the education, we had a standardized, because we had heard that people could potentially get an extra dose instead of just five per vile, making sure that I understood what that meant. Scott Milner (12:14): I wanted to make sure that we weren't gaming the system in any way, shape, or form. There was no pressure if you got five doses, then that's it, that's I didn't want someone to try to feel like they should "help out." And so, yeah, we did have a lot of onsite, both verifying the education, making sure people understood. And every time, I mean, one of the times, I popped into a clinic to make sure things were going well. As we enter a hospital or a clinic, we get a new mask. As we enter, I grabbed my mask, and as I got back to where they were vaccinating and preparing, I mean, these people had already worked 40 hours, right? These were volunteers to work extra hours, and they were so happy to be there. Scott Milner (12:55): I share a story of our first weekend. We had our vice presidents, chief medical officers, people over our finances who are the first volunteers to step up and not only step up on a Saturday but get there at 6:00 in the morning. And who are the people getting vaccines that day? Those were our COVID employees. Those are the people who have taken care of the people who have been sick, ill, who have passed away, members of our St Luke's family, members of our community. So for me, it was probably the most rewarding thing of my career to have my vice presidents, our CEO, making sure that our employees, whether you are a nurse, a doctor, a housekeeper, a respiratory therapist, if you worked in that area, you had your chance to be vaccinated. And I loved it. I love it. It's one of the things. Again, I'm motivated by it. And I think my other peers in our system are doing the same thing over and over. Aaron Myles Goldman (13:51): Well, it's great to hear about all the teamwork and how much hands-on support you're receiving from your hospital leadership. When you were speaking about the medevac helicopters early, you're trying to make sure that rural communities are reached. And I was hoping you could tell me more about St Luke's and the communities it cares for. Scott Milner (14:11): Idaho is snowy and has some cold winters. There are some times where the roads are closed. I've been driving on the freeway and had the arm closed down in front of me. And I've had to turn back and try another route or stay in the hotel overnight. That's not common. It doesn't happen every day or every month, but it's not necessarily unheard of with people that have lived here for a long time. And so these cities are a few hours out and through mountain passes and can be sketchy and icy and snow. We also have a few farming communities across the state where we serve and have critical access facilities there. And that's in addition to our dish facilities were here in the Boise area. So again, we have a sole community. We have critical access. And then three of our dish facilities, which has a hemophilia treatment center, we are the largest employer in the state. We also have a number of things that we do as again, as a not-for-profit, not just because we qualify for 340B, but utilizing that to increase patient access and make sure patients are cared for. Aaron Myles Goldman (15:14): Can you tell me a little bit more about the patients the hospital serves? Scott Milner (15:19): I think that the Affordable Care Act and some of the things have tried to minimize, uninsured, but we still have a number of patients are uninsured or don't have adequate insurance is another huge gap that we have. Some of our pupils that live on the outskirts of our Boise metropolis, so to speak in our counties here, they have mixed positions working two or three part-time jobs to piece a living together. We have well over a hundred million dollars of uncompensated care to go on through our system. And 340B is just trying to displace that by a fraction in all reality. And so our 340Basics program is what we've called it over the years. We actually leaned on some other systems across the country, whether that was Johns Hopkins, University of Utah, and other systems that have started down the way. Scott Milner (16:12): So shout out to people that are willing to share some of the best practices. We appreciate that. We have patients who can come in and get medications, things like treatment for diabetes, sometimes mental health issues that have been unmet otherwise. They come into our facilities, they get the prescriptions from our providers, and they go to our retail pharmacies, and they don't pay for them. We're approaching 1800 patients who benefit from some version of assistance. And that's one of the more rewarding things. We've had them featured, on 340B house, at least one of our patients. And she was nervous about that, but we appreciate her telling that story. It's one of those things that I feel like we're fortunate that not only do we have the opportunity but that we know our patients are grateful for being able to receive that care. Aaron Myles Goldman (17:03): Someone who's also spoken with patients is as part of our 340B Health phases of 340B series that you mentioned there. I always appreciate working with our members on that and always appreciate the patient sharing their stories, turning back towards the vaccine, where we started the conversation. Are there specific details that you've been focused on in order to make sure that underserved communities receive access to it? Scott Milner (17:33): Not everyone had an ultra-low. I mean, there's no way we would set expectation on every rural town and not only from the cost, but I mean space. And so that was one of the immediate things that we looked at. And again, we're fortunate that we're able to centralize that and then design a delivery system that would meet the needs of those communities. So you need 10 a week, great, we'll cover you. You need 30 or 100. We got you. We have a clinic over here that can do 500 a day. We're equipped for that. And again, we have another local hospital, a very small town, less than 1000, I'm sure. And maybe 20 employees that work a week, and they only wanted 30 doses total. Well, it's hard for someone at the state level to give them a tray when literally almost all of it won't be needed. Scott Milner (18:21): So even though they're not part of us, we've worked with them and other facilities that aren't on our managed by our system, but both with vaccines and also bamlanivimab. That's been another project we've worked with some other local hospitals that are owned by the community, and they're all three or four to be entities in their own right. We've made sure that we help them have the access. And we're fortunate to be able to do that. Aaron Myles Goldman (18:46): Well, it's good to hear how you're giving that access. Do you have any final advice you would give your fellow pharmacists as they participate in this life-saving effort? Scott Milner (18:57): I don't think anyone's lost in the fact that this is a historic moment. I look at what this has meaning for pharmacy as a position, as a career. Fantastic. It's exciting. But it's also exciting is part of the health system as a health network, as an allied healthcare professionals, that we're engaging with everyone. From a health system standpoint, we're talking with it, nursing, doctors, IHT, people that are our environmental service workers. We're engaged with everyone to help deliver this. And I think that is fantastic. Scott Milner (19:35): On a personal level, this has given me something back. Early on, my father actually fell and broke his hip, and he lives in Canada, or he lived in Canada, and during COVID, as we made plans for vaccines and everything, I kept trying to find a way to go see him because the borders to Canada have been closed. There's certain details that you have to apply for or do. And as he moved from facilities, it was hard to coordinate and make sure I go see him. And unfortunately, in the heat of everything, when I got COVID, that virtually blocked me from seeing him one more time. Scott Milner (20:13): So with that in mind, as he passed away, the best thing I feel I could do since I could not see him and say goodbye, face to face, we've utilized technology and that networked. And I feel grateful that I live in the age that I do, but for me, the greatest thing I have for a hope of a better return to some normality is to make sure that we get this vaccine where it needs to be. And that we educate, we encourage, we support people that are reluctant or nervous. I welcome that. I feel that this COVID vaccine is the greatest thing we have to be able to back. Given everything that is has taken from us, as a people and like me personally, what is it taken from me? And so, for me, the vaccine's greatest side effect is hope. Aaron Myles Goldman (20:59): Well, Scott, First of all, my condolences on the loss of your father. I appreciate you sharing your personal story with us. I imagine that there are many people who can relate, and thank you as well for taking time out of your hectic schedule to join us. We appreciate all the hard work you and your team are doing to help your communities during this challenging time. And we wish you the best as the vaccine distribution effort continues. Scott Milner (21:29): Thank you for the chance to share the story. And I appreciate our 340B teams out there doing the work. David Glendinning (21:36): Our thanks again to Scott Milner for sharing such a deeply personal story about hope amid heartbreak. We're so touched to hear about how he is honoring the memory of his father by ensuring that many others in his community will have a healthy future. And we are grateful to him and the many others at 340B hospitals across the country who are fulfilling their missions with such passion and dedication during this pandemic. Be sure to check out the show notes to watch Scott's short video of him receiving the word that the COVID-19 vaccines had arrived. It's quite an emotional moment. David Glendinning (22:11): Please mark your calendars for our next member webinar on Thursday, February 11th. Our government relations staff will be discussing what the new Biden administration and the 117th Congress might have in store for the 340B program and the hospitals that participate in it. So you won't want to miss that one. And if you haven't already registered for the 340B Coalition Winter Conference, you'd better hurry as it begins February 16th. As always, we welcome your episode ideas and feedback as we plan out our full 2021 season of 340B Insight. You can email us at podcast@340bhealth.org. We'll be back in a few weeks as always. Thanks for listening, and be well. Announcer (23:01): Thanks for listening to 340B Insight. Subscribe and rate us on Apple Podcasts, Google Play, Spotify, or wherever you listen to podcasts. For more information, visit our website at 340bpodcast.org. You can also follow us on Twitter @340bhealth and submit a question or idea to the show by emailing us at podcast@340bhealth.org.