Working in close partnership with the National Association of Community Health Centers (NACHC), Advocates tracks and coordinates response to federal legislation and budget actions. 

California CHC Top Priorities: Guaranteeing Equitable Access for all Californians 

340B Drug Pricing Program

• 340B savings are essential to the financial sustainability of the CHCs in California and access to care for our patients.
  • CHCs represent only 6% of the of national 340B sales, but the program is critical to CHCs’ ability to provide affordable medications and offer additional services to their patients.
    
  • This network allows our patients to have convenient access to their medications.
• Contract Pharmacy Threats
  • It feels like every month, a new manufacturer restricts shipments to contract pharmacies unless the covered entities disclose detailed claims data, which raises patient privacy issues.
  • To date, a total of 17 manufacturers are restricting 340B shipments to Contract Pharmacies.Of these, 10 have exempted CHCs, one does not make drugs that CHCs prescribe, and six are impacting CHCs – Eli Lilly, Sanofi, Astra-Zeneca, Gilead, United Therapeutics, and Merck.
  • The manufacturers are instructing CHCs to pick one Contract Pharmacy to which they will ship certain 340B medications.
  • (If applicable) My health center has already lost considerable 340B savings because of the actions taken by [Insert manufacture(s)].
  • If [Insert health center name] had to pick just one Contract Pharmacy out of our network of [Insert #] for all 340B medications, that would restrict pharmacy access to many of our patients causing them to have to pay more for needed medications and dramatically reducing our 340B savings.
  • We believe that these actions violate the statutory requirement that drug companies charge no more than the 340B ceiling price when selling their products to 340B providers.
  • While there is an ADR process in place at HHS, claims are adjudicated very slowly. The National Association of Community Health Centers (NACHC) filed a claim over a year ago. During the time the claim has been in process, several additional manufacturers have restricted 340B shipments.
  • We believe that the only way for these manufacturer actions to stop is for Congress to specify in statute the role that contract pharmacies play in the 340B program and force the manufacturers to ship 340B drugs to all contract pharmacies, not just a select few.
• Pharmacy Benefit Manager (PBM) and Insurer Threats – “Pick-pocketing”
  • PBMs and insurers continue to find ways to “pick-pocket” or retain for themselves CHCs’ 340B savings.
  • PBMs and Insurers have been forcing CHCs to accept contracts that offer lower reimbursements for drugs that are purchased under the 340B program.
  • CHCs are relatively small and can be shut out of local and regional markets if they don’t accept these contracts.
  • PBMs continue to demand that CHCs provide them with data on 340B drugs, which provides them with information they use to restrict 340B payments.

CHC Request on 340B Drug Pricing Program

• There is no statutory prohibition on “pick-pocketing,” so Congress needs to pass legislation for the practice to stop.
  • H.R. 4390, the PROTECT 340B Act, would prohibit PBMs from retaining covered entities’ 340B savings. A Senate companion is expected to be introduced soon.
    • State legislation – about 25 states have passed their own laws to block pick-pocketing, but state legislation cannot control Medicare Part D plans.
    • Senator Pan has introduced SB 939 this year in California that would prohibit pick-pocketing, but that bill has been tabled for this legislative cycle.

Workforce

• The silver lining of the COVID-19 pandemic is the public recognition of and efforts to address the systemic inequities in healthcare access.  CHCs play an integral role in advancing more equitable delivery of care, especially for the BIPOC community.
• The pandemic laid bare the worsening workforce challenges that existed before 2020: provider wellbeing, burnout, competitive labor market, early retirement, and high educational costs that inhibit the growth and diversification of culturally competent health professionals. 
• California’s CHCs require more staff, especially primary, behavioral, oral, and allied health professionals, like Medical Assistants, Dental Assistants, Social Workers, etc.
• Sustainable federal investments are needed to meet patient needs, become an employer of choice, and train health professions students in the community.
• When most people think about the health care workforce, they think about doctors and midlevel providers who provide care directly to patients, but behavioral and allied health professionals are equally important.
• We are seeing shortages across all levels of the care team, in particular these two disciplines.
  
• Throughout California, CHCs are experiencing challenges in recruiting and retaining staff, who are limited in supply and enticed to work in non-CHC settings to quickly repay educational debt.
• The workforce supply is limited, so we must continue to grow our own workforce.

CHC Request on Workforce

• Invest in innovative solutions that address CHC recruitment and retention challenges during the current competitive labor market.
• Reserve additional funding for health professions education and training. Support is needed to create enhanced pipelines for community health workers, behaviorists, medical assistants, behavioral health assistants, and nurses and that place a priority on racial, ethnic, cultural, and linguistic sensitivity.
• Thank you for the additional funding for the National Health Service Corp through the American Rescue Plan. However, we need the flexibility to use NHSC funds for different types of providers.
• We also ask that you support a permanent extension and expansion of the Teaching Health Center GME program and other creative ways to attract providers to CHCs.

Reproductive Health Care: Title X

• Congress level-funded the Title X program in FY 2022 despite much increased need for Title X services around the country.
• This resulted in and $8 million loss for California’s Title X program.
  
• With the Supreme Court decision in Dobbs v. Jackson Women’s Health overturning Roe v. Wade, the comprehensive family planning services offered by Title X providers have become even more vitally-needed.

CHC Request on Reproductive Health Care: Title X

• Please support increased funding for Title X in both the annual appropriations and any budget reconciliation package that Congress considers.

Telehealth

• When statewide shutdowns began in March 2020, California’s CHCs quickly transitioned much of their provision of care to a virtual model to ensure that their patients continued to receive vital care while limiting the risk of staff and community spread of COVID-19.  
• At the peak of the pandemic before vaccines were available, California CHCs were utilizing telehealth, both video and telephonic visits, for over 60% of their patient care.
• While safe reopening has brought this volume done, much has been learned. Many patients prefer telehealth, and telehealth appointments result in far fewer missed visits.
• Telehealth has the potential to be the great equalizer, eliminating long-standing barriers to care like transportation, childcare, and work schedules.
• Federal leadership will be critical to supporting these policies in Medicare and encouraging state Medicaid agencies across the country to do everything in their authority to support future telehealth innovation.

CHC Request on Telehealth

• To guarantee these innovations also continue in the Medicare program post-pandemic and can be utilized as part of the long road to an equitable recovery, federal action is needed.
• Thank you for your support for the Advancing Telehealth Beyond COVID-19 bill that was overwhelmingly adopted by the House in July.
• That bill would extend the Medicare telehealth flexibilities set to expire 151 days after the end of the PHE for an additional 2 years:
  • Recognize health centers as distant site providers;
  • Remove originating site restrictions to allow for care regardless of the patient location;
  • Ensure payment for both behavioral health and physical health visits at the FQHC Prospective Payment System (PPS) rate; and
  • Permit health centers to continue providing audio-only telehealth visits for patients.
• This two-year extension will allow patients to continue to receive care in the manner that works best for them while data can be collected about health outcomes related to telehealth expansion.

Gun Safety

• Our statewide association CPCA’s Legislative Committee voted to support the recently-enacted Bipartisan Safer Communities Act. This and other gun safety legislation and acknowledge that gun safety is a public health issue.
• We support the gun safety provisions in the bill and believe that the mental health funding will complement the work health centers are already doing on behavioral health.