The Benefits of the 340B Program
Patients who come to UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco for care often have overlapping vulnerabilities – financial, psychosocial and geographic. UCSF stretches its scarce resources by leveraging access to discounted outpatient drugs and savings generated from our 340B program to support these areas of need, particularly uncompensated care for our pediatric and cancer patients.
For fiscal year 2018, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco realized $125 million from 340B savings. These savings allowed UCSF to support its critical mission without regard to patients' severity of illness, level of income, or area of residence. In general, the 340B program savings provide significant support for our hospitals to:
- Ensure Medicaid and uninsured patients can access specialty clinics that provide lifesaving treatments such as organ transplants, complex cancer care, immunological care (including bone marrow transplants), neurological and neurosurgical care, cardiovascular care and cardiothoracic surgery.
- Provide specialized care for thousands of children with life-challenging medical conditions, such as cancer, organ failure, genetic diseases, heart defects and epilepsy. Roughly half of these children are covered by Medicaid.
- Ensure that Medicaid and uninsured patients can access clinics that treat illnesses such as HIV, hepatitis C and asthma, which disproportionately impact vulnerable patients.
- Subsidize costly chemotherapy and immunotherapy for Medicaid and uninsured patients at our on-site infusion centers and clinics.
- Provide financial assistance to patients who can't afford their prescriptions, including free discharge prescriptions.
- Enable low-income and homeless individuals in our community to access specialty care that is otherwise not available to them.
- Provide free nicotine replacement therapy to parents who smoke during their child's hospitalization.
- Vaccinate parents of hospitalized children, at no cost, during the flu season.
- Support pharmacists providing HIV management to a largely Medicaid population.
- Sponsor outreach events to Bay Area seniors to review the Part D plans that will be most cost effective for each senior and to maximize their existing drug benefits.
The stories below help illustrate how 340B savings have allowed UCSF to provide life-changing services.
- A 10-year-old girl from a remote area of Northern California was diagnosed with severe ulcerative colitis. Despite their best efforts, her family was unable to find a provider in their community who would accept their insurance because it didn't adequately reimburse for the infusions she needed. The 340B savings allowed UCSF Benioff Children’s Hospital to absorb the financial losses associated with the bi-monthly infusions required to control her disease. The outcome is a 10-year-old who excels academically and participates in soccer after school.
- A 21-year-old student at a local college was diagnosed with acute leukemia. The medical team determined his best course of treatment was an expensive, non-formulary oral drug. Despite UCSF Medical Center assisting him to sign up for Medicaid, his plan did not initially cover the drug. However, access to 340B pricing and savings generated from participating in the program enabled UCSF Medical Center to cover the cost of his first month of therapy. This allowed him to begin healing while appealing, and he ultimately received ongoing coverage for this therapy. Without 340B savings, this talented young man would likely have first received, and failed, an inferior therapy before being allowed to use the more effective drug.
- A young boy with leukemia had a 20 percent remission rate following conventional therapy and bone marrow transplantation. A new therapy that costs approximately $400,000 per course of treatment was available, but the child’s insurance did not cover this expensive therapy and the child’s parents were unable to pay for it. UCSF again absorbed the expenses associated with this therapy. The expected outcome is an 80 percent remission rate of the child's cancer. UCSF Benioff Children’s Hospital could not have afforded to proceed with this new treatment without the savings realized from the 340B program.
- UCSF Benioff Children’s Hospital also provides care for many low-income patients who struggle to find adequate care for serious or rare diseases in their communities. UCSF Medical Center pioneered fetal surgery to help repair the spinal cord defects associated with spina bifida. Children who undergo the surgery are significantly more likely to walk independently and have better motor function than those who don't, without the medical and public health costs historically associated with these birth defects. This treatment is not available in most communities and pregnant women come from all over the West Coast for treatment at BCHSF. 340B savings enable UCSF Benioff Children’s Hospital to provide financial assistance to these patients.
- 340B savings also allow UCSF Medical Center to provide vital medical services to vulnerable patient populations closer to their homes. UCSF Medical Center has a very large solid organ transplant program that includes kidney and liver transplants. Our patients from California’s Central Valley must make the four-hour drive to UCSF Medical Center for their transplants. To improve outcomes, UCSF Medical Center now provides pre- and post-transplant care to these patients in Fresno. Sending our clinicians to Fresno enables close follow-up for patients who reside in that medically underserved area. 340B savings again make it possible to stretch our dollars, help absorb the costs of this service and provide improved outcomes for patients.
Impact of Scaling Back the 340B Program
At UCSF Medical Center, we are deeply committed to our mission to care, heal, teach and discover. Our mission is central to everything we do. In the face of declining reimbursements over the past years, UCSF Medical Center has resisted reducing mission-critical services and has instead utilized funding from the 340B program to expand these services.
Scaling back the 340B program would threaten UCSF Medical Center’s capacity to offer all the services described above to our patients.