1. 340 B Program Where do we go from here?
Christian Downs, JD, MHA Association of Community Cancer Centers

2. ACCC 2,200 hospitals and physician group practices across the country
Multi disciplinary membership including physicians, nurses, pharmacists, social workers and administrators
Main mission is advocacy and education
40 years

4. their oncology team members.
The Association of Community Cancer Centers has 28 Chapter Members of state oncology organizations that include oncologists and
their oncology team members.
The Arizona Clinical Oncology Society Minnesota Society of Clinical Oncology Association of Northern California Oncologists Missouri Oncology Society  Medical Oncology Association of Southern California Nevada Oncology Society  Rocky Mountain Oncology Society New Mexico Society of Clinical Oncology  Connecticut Oncology Association North Carolina Oncology Association*  Florida Society of Clinical Oncology Ohio Hematology Oncology Society  Hawaii Society of Clinical Oncology * Society of Rhode Island Clinical Oncologists  Illinois Medical Oncology Society * South Carolina Oncology Society*
 Indiana Oncology Society * Tennessee Oncology Practice Society *  Iowa Oncology Society* Texas Society of Medical Oncology *  Louisiana Oncology Society VA Association of Hematologists & Oncologists *  Massachusetts Society of Clinical Oncologists Washington State Medical Oncology Society
Michigan Society of Hematology & Oncology Kansas State Medical Oncology Society
Wisconsin Society of Oncologists West Virginia Medical Oncology Society*
* Managed by the Oncology State Society Network (OSSN)

5. Agenda Review of the 340 B program Four Major Trends
What needs to be done
What probably will happen
At the end of the day…

6. 340 B Program
Since 1992, certain covered entities may purchase prescription drugs at a discount if they treat high numbers of uninsured indigent patients.

7. Oversight done by participants.
340 B Basics
Since 1992, certain covered entities may purchase prescription drugs at a discount if they treat high numbers of uninsured incident patients.
Oversight done by participants.

8. Clarity “I am from Washington and I am here to help.”
Congress has expanded access to the 340 B program.
Regulators have struggled to provide clear instructions to stakeholders.
Courts have limited regulators authority.

9. Cancer Delivery- Circa 2000
Hospitals
Uninsured
Not covered
Expensive
No services
“hot mess”
Offices
Insured
Expensive
Better run
Cheaper
More services
Patients

10. Cancer Delivery Hospitals Offices Uninsured Insured Not covered
Expensive
No services
“hot mess”
Offices
Insured
Expensive
Better run
Cheaper
More services
Patients

11. Stakeholders Reformers Status Quo Whoa We are paying the freight
Beverly Hills
Raises costs for some patients
You get reimbursed more than the drug cost
More of everything
You charge too much for shipping
Beverly Hillbillies
Lowers cost for other patients
Pot meet kettle

12. Major Trend- Payment Revolution
Movement away from fee for service
Bundling of payment
Payment for reporting
Emphasis on primary care
Focus on therapies

13. Major Trend- Consolidation
Larger and larger “systems”
Hospitals purchasing hospitals
Practices purchasing practices
Hospitals purchasing practices
Market specific
Experience of other specialties

14. Major Trend- Integration
Creating a longitudinal treatment algorithm
Corporate structure
Cancer treatment delivery is complex
Use of data and technology
Focus on therapies

15. Major Trend- Coverage Expansion
Exchanges for individuals and small business
Medicaid eligibility expansion
More covered people, less covered services
Nominally should reduce uninsured and indigent

16. What Needs to be Done…
Clear, comprehensive rule about how the program shall work
Carefully review the role of non-providers
Identify methods to improve the program
Qualify patients not providers
Understand how the trends impact the program

17. What Probably Will Happen…
HHS releases sub-regulatory guidance
Congress does not move any legislation
AHA and Pharma fight it out
No real improvement takes place

18. At The End of the Day…

19. On behalf of our member hospitals,
THANK YOU
On behalf of our member hospitals,
practices and our individual cancer professionals THANK YOU
for your support.