A Patient’s Perspective on 340B

Speaker 1 (00:04): Welcome to 340B Insight from 340B Health. David Glendenning (00:12): Hello from Washington DC, and welcome back to 340B Insight, the podcast about the 340B drug pricing program. I'm David Glendenning with 340B Health. Our guest today is Jennifer Gallagher, the lead pharmacy technician at Parkview Medical Center in Pueblo, Colorado. Jennifer doesn't just work for a 340B hospital. She also is a patient who has benefited from 340B. We are celebrating the 29th anniversary of the enactment of the 340B program on November 4th and we thought this was the perfect time to have a patient on the podcast to discuss the difference the program has made in her life. David Glendenning (00:52): But before we go to that interview, let's take a minute to answer one of your questions about 340B. One of our listeners asks, "Does HRSA conduct audits of drug companies participating in 340B? If so, what are some of the results?" For the answer we checked in with Steven Miller, our vice president of pharmacy services here at 340B Health. Steve tells us that HRSA planned five audits of manufacturers for the fiscal year that just ended. That compares with 200 audits of covered entities for the year. David Glendenning (01:25): Government so far has posted the results of four of those manufacturer audits on its website. And for three of those four audits, HRSA issued findings stating that the companies had failed to offer the correct 340B prices to covered entities on several of their products. The eight agency is requiring the companies to repay affected providers and to implement corrective action plans to prevent such overcharges in the future. You can find a link to those results in the show notes. Steve notes, that HRSA audits of both covered entities and drug manufacturers are part of the agency's oversight of 340B program compliance. David Glendenning (02:05): Since HRSA began collecting quarterly pricing data for the government's 340B ceiling price website in 2019, the agency has been issuing more audit findings against drug companies for charging more than those maximum prices. Those findings are in addition to the nearly 40 notices that HRSA has posted in recent years regarding manufacturers recalculating ceiling prices and determining that they needed to repay providers for past overcharges. If you are a member hospital with any questions about the audit process or the ceiling price website, Steve and his team are here to help answer them. David Glendenning (02:42): And now for our feature interview with Jennifer Gallagher. We first met Jennifer a few years ago when we filmed her story for a video series we call, faces of 340B, in which both patients and health providers discuss the importance of the program. Miles Goldman recently sat down with Jennifer to see how she has been doing since then. Here's that conversation. Miles Goldman (03:06): Thank you, David. I'm joined by Jennifer Gallagher, the lead pharmacy technician at Parkview Medical Center in Colorado. Jennifer. It's great to have you joining us today. Welcome to 340B Insight. Jennifer Gallagher (03:21): Thank you, Miles. It's an honor, and I'm so excited to be a part of this podcast today. And thank you so much for the opportunity. Miles Goldman (03:31): Tell us more about yourself and why did you choose to become a pharmacy technician? Jennifer Gallagher (03:37): My father was a physician in Pueblo for 35 years and my mother was a nurse. So I grew up in a house where healthcare was a part of our lives. And I went to college at Colorado state university of Pueblo in the early eighties. And when I was picking a career path, I decided on medical technology. As I got closer to graduation and looked further into the actual career, I decided it really wasn't the best fit. Jennifer Gallagher (04:09): So I went and became a veterinary technician and I was in a community veterinary technician clinic for veterinary practice for 11 years. But one of the aspects I really enjoyed about that position was filling prescriptions and ordering medications. And so after a number of years, I decided to make a career switch and move into healthcare. And I became a technician at Parkview Medical Center in 1998. And I have worked at Parkview for the last 23 years. Miles Goldman (04:46): Thank you for giving us a good sense of your journey. And how did you first learn about 340B? Jennifer Gallagher (04:53): I learned about the 340B program when one of the pharmacists took on the role of implementing this program at Parkview Medical center. But I really had very little knowledge about the program as a technician. I knew that it was saving the hospital money on drugs purchased for the outpatient setting, so outpatient surgeries and that sort of thing, where people came in, had a procedure and they went home. But it wasn't really until I became a patient that I realized the impact of the 340B program and what it means not only to me, but to the community. Miles Goldman (05:37): Tell us more about that? How Parkview has helped you with your own healthcare needs? Jennifer Gallagher (05:43): Miles, for the last 10 years, I've been on a health journey where I've had some major medical problems. And in 2011, I had a fall, I broke my neck and had a spinal cord contusion. And after the surgery, I was in a neck brace for three months and was not able to work at Parkview for two and a half of those months. That's my first opportunity to see what Parkview provided to the community and the patients beyond just a hospital setting. In 2012, I suffered another major event in my life with a abdominal abscess and I required a surgery to remove a foot of my bowel. Jennifer Gallagher (06:29): And in 2013, my health continued to decline and I was diagnosed with heart failure. This is pretty traumatic because in a short amount of time, not only did I get diagnosed with heart failure, but I was an AFib and I needed an open heart procedure. They scheduled the surgery. But before the surgery, I had to get Coumadin to prevent any clots because the AFib. And again, working in the inpatient pharmacy, I was well aware that Parkview had implemented an outpatient Coumadin clinic, but I had never been there. And when I went, it was a real eye opener. Jennifer Gallagher (07:13): Quite honestly, I was just astounded by the knowledge and the expertise that the pharmacist provided in that outpatient setting. And really, they looked at the whole picture of me as a person. And with this clinic, it took the pressure off the provider trying to manage my Coumadin and provided weekly or every couple weeks going in having my lab, having my blood drawn and tested and being able to do the proper dosing for the Coumadin and also make recommendations to help keep that INR within range. Jennifer Gallagher (07:55): And this is a drug where at a pharmacy tech you think, "Oh, yes, I know that that drug can cause bleeding and complications." But until you're in a patient setting, you really have no idea how it impacts your entire life, because Coumadin can be affected by everything you eat and drink, your physical health, your mental health, whether you're anxious or whether you have a cold. And so it's very tricky to manage. And even as a pharmacy tech, you just never stop learning how this drug reacts to everything that's going on in your life. Jennifer Gallagher (08:35): After that surgery, I encountered a number of setbacks and complications. I had bleeding and it made for a really long recovery. But where my health started to improve was the surgeon referred me to the Parkview outpatient cardiac rehab program. Now I will tell you, no one understands until you go through this, that when you have an open heart surgery, your survival is dependent on what you do, not only getting through the surgery, but more importantly after. Because you essentially can't even and take care of yourself. Jennifer Gallagher (09:16): My husband had to address me, I was on oxygen for six months, I could not drive, could not work. I was dependent on my husband and family and coworkers to get through this. And the cardiac rehab, is really why I am here today. Because the cardiologist sets up a program tailored specifically for each patient, whether they've had a heart attack, whether they've had heart surgery or diagnosed with a heart condition, the nurses are all cardiac trained nurses and they work closely with the cardiologist. Jennifer Gallagher (09:55): And there's constant monitoring. This program takes you through the phase two of postop to get you on the right healing path. So all the exercises are monitored specifically for you. Your vitals are monitored closely to make sure that you're not getting too stressed and it helps your mobility, helps your strength and everything you need to try and get back to a normal life. And because of that program, I was able to return back to work. And if it wouldn't be for the 340B savings, that program would not, not be possible. Miles Goldman (10:38): Well, it's incredible to hear about all the support you've been receiving, Jennifer, from Parkview and really sharing with us all the different healthcare services you've been able to access. Jennifer Gallagher (10:51): Parkview, because of the 340B savings with drugs, we save roughly 40% on our drugs for the outpatient surgery center, for the outpatient pharmacy at Parkview. And those savings allows Parkview for the size of the community of Pueblo to provide comprehensive care. And what I learned most in the last years, when a patient has to deal with comorbidities and very serious illnesses, the most important thing is that everyone a part of the team is on the same page and working together to support that patient. So for me, the Coumadin pharmacist, the outpatient pharmacy at Parkview, my providers are all working together and communicating everything that's going on with my health. And without that, I don't think I would be in a good shape as I am now. Miles Goldman (11:51): Were you able to access Coumadin with 340B's help? Jennifer Gallagher (11:55): Absolutely. Because Parkview was able to open up an outpatient pharmacy and that's where I get my Coumadin. And those dollars that are saved through that outpatient are clearly why we have that pharmacy. And without those savings, we wouldn't have a pharmacy. And really not only for me, but that outpatient pharmacy really supports the poor, the indigent to ensure that when these patients leave, they have their medication. Jennifer Gallagher (12:28): And that really is what not only prevents patients from coming back to the hospital because they didn't get their medication, but it also helps them on their road to recovery by having those medications. And our hospital, the outpatient pharmacy, the pharmacy technicians are actually go to the patient room and can deliver the medication to the patient before they ever leave their room. And that really ensures that they get their antibiotic, they get their heart medication, they get their blood thinner, whatever the case may be. Miles Goldman (13:07): Really is great to hear Jennifer, how much 340B has been intertwined in helping you with your care and with your recovery. And it's great to hear how you're back to work. You're speaking to us from your office, right? Jennifer Gallagher (13:22): I am. And I'm full-time. Since my heart surgery, I have had more procedures, both in the outpatient and in hospital. I've had three more surgery. And every two weeks I go to the outpatient Coumadin clinic. They're able to keep my INR at a very stable level. I go to the outpatient pharmacy on a regular basis. Miles Goldman (13:49): How has everything been for you during the pandemic? Jennifer Gallagher (13:53): Initially, I did some remote work and then they moved my office to a more secluded area to reduce my exposure. My immune system is compromised. I continue to struggle with lung issues. But I've been extremely careful and it's allowed me to still maintain work, but I'm very, very careful what I do and washing hands and all that stuff. Jennifer Gallagher (14:23): It was a tough go this summer with having breathing issues. The smoke from Oregon and California have been really, really bad in Colorado, along the front range where day after day, just the haze and the smoke were bad. Miles Goldman (14:42): You touched on this a bit earlier, but wanted to talk about it a little more with you. How does your personal experience with 340B help you in your role as a pharmacy technician? Jennifer Gallagher (14:54): Miles, it pushed me into an advocacy role. And I actually, as a patient, served on the Parkview advocacy board for three years. And I really feel that that's my calling is to be an advocate, to share with family, with friends, the work that Parkview is doing and the services that are provided. And I have spoken about the 340B program. Jennifer Gallagher (15:23): I had an opportunity four years ago to go to the 340B conference and to meet with legislators and go on Capitol Hill and share my health story and my journey. And the work that Parkview is doing for this community. And I was humbled to be on Capitol Hill because everyone was so kind, so respectful and they listened to me and I walked away with a experience I'll never forget. Miles Goldman (15:57): Well, I'm so glad you were able to come to DC and share your story. Can you tell us more about community Parkview is serving and would healthcare be different in Pueblo if 340B didn't exist? Jennifer Gallagher (16:10): So I live in Pueblo and it's a poor community. Pueblo is surrounded by many rural communities that are farmers. We're a disproportionate hospital, which I really feel is a point to mention because 80% of our patients at Parkview are either Medicare or Medicaid. So Parkview and all the employees and the providers have to work very diligently to be able to use our resources to the utmost prevent waste and efficiency in order to continue all the services that we provide for the community. Jennifer Gallagher (16:53): And without the 340B program, I don't think Parkview could provide all the services they would need. And as a patient, having an open heart surgery, having a neck surgery, abdominal surgery, if I didn't have Parkview, I don't think I would be here today. Because if I had to go outside of Pueblo to get care when I can't drive, when I can't take care of myself, it would be a huge burden. And also, I don't think I would be working because I don't think my recovery would've been the same way. Miles Goldman (17:31): Jennifer, thank you so much for taking the time to share your personal story with us. And really appreciate that. And obviously appreciate that you continue to share your story. It was great to catch up with you and hear how you're doing. Jennifer Gallagher (17:48): Well, I'd just like to express my sincere gratitude to you and to the 340B program. Because you just don't realize what it means to a community and to a patient. And I believe Parkview and the community are better off because of the 340B program. And I know as a patient, I'm better off. I was a success story that even though I have continued health issues, I'm able to work, I'm able to be a part of the community, I volunteer and I certainly try and be an advocate whenever possible. I humbly thank you for the opportunity today. David Glendenning (18:28): Our thanks again to Jennifer Gallagher for telling us the latest about her health journey and what 340B has meant in her life. We are proud to feature Jennifer among the 70 patients and health providers who are part of our faces of 340B series. As we celebrate the program turning 29 this year, we encourage our listeners to watch all those inspiring stories. You can find the links in the show notes for this episode. We remind those of you who have not yet done. David Glendenning (18:58): So to register for the annual 340B coalition winter conference, which will be taking place January 31st to February 2nd in San Diego. This premier event for all those in the 340B world will be the first chance in a while that we have had the opportunity to meet in person as a community. So we very much hope to see you there. You can find more information and register at 340Bwinterconference.org. As always, if you have questions for us or an idea for a episode, please email us at podcast@340Bhealth.org. We will be back in a few weeks with our next episode. As always, thanks for listening and be well. Speaker 1 (19:48): 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 at 340B Health and submit a question or idea to the show by emailing us at podcast340Bhealth.org.