Thundermist laid off 150 employees in 2024. How drug makers played a role
WOONSOCKET – What would you do if you had $5 million?
For Matthew Roman, the chief operating officer of Thundermist, the answer is easy: prevent 150 employees of the community health center from being laid off last September due to financial troubles.
In Roman's case, the question is not just hypothetical. Thundermist lost $5 million last year in potential revenue due to drug makers' skimping on a federal program designed to help safety-net providers that care for low-income patients.
'Last year alone, Thundermist lost $5 million because of the pharmaceutical restrictions. Guess what that $5 million would have done? We would still have 150 employees here,' Roman said at an event at Landmark Medical Center in Woonsocket last week.
Rhode Island's community health centers, which provide primary, dental and behavioral care for one in five Rhode Islanders, have been struggling financially. Over half of their patients are on Medicaid, and reimbursement rates have not kept up with rising costs of supplies, services and salaries.
There is another significant pain point: the 340B Drug Discount Program.
Created by Congress in 1992 through the Veterans' Health Care Act, the 340B program was designed to help health care providers who serve low-income or uninsured patients buy drugs at a discounted rate. This allows organizations like community health centers to make drugs accessible to patients who may otherwise not be able to afford them.
It also serves as a source of income. Health care providers buy drugs at discounted rates and earn the difference between what they paid and the reimbursement. The program requires this revenue to be reinvested into the organization.
'Those dollars are often referred to as 'access dollars' because the organizations reinvest them into services to provide additional access. That could be in the form of community health workers where there's not enough funding to support them,' Roman explained.
Safety-net providers have relied on revenue from the 340B program to supplement low reimbursement rates, but in recent years, drug makers have imposed restrictions on which pharmacies are included in the program, cutting their earnings.
This has had a drastic effect on the bottom lines of community health centers. Since 2020, six of the eight community health centers in Rhode Island have seen their revenue from the 340B program decrease by $16 million, according to the Rhode Island Health Center Association. (This figure does not include Thundermist or Blackstone Valley Community Health Care.)
The 340B program is not without its critics. The Government Accountability Office (GAO) found in the past that some hospitals participating in the program prescribed more expensive medications. There is evidence, too, that some hospitals strategically adjust their status to qualify for the program and target wealthier communities.
In 2022, GAO recommended that the Health Resources and Services Administration, which oversees the program, scrutinize which organizations qualify for it. GAO also recommended that more stringent oversight be given to prevent organizations from receiving duplicate discounts from federal programs.
Two bills in the General Assembly are seeking to regulate drug makers who put restrictions on the 340B program.
House bill H5634 sponsored by Rep. Jon Brien – an Independent from Woonsocket and North Smithfield – and a sister bill in the Senate – S0114 – sponsored by Bridget Valverde – a Democrat from North Kingstown, East Greenwich and South Kingstown – would prohibit drug makers from restricting which pharmacies can participate in the 340B program in Rhode Island. The bills would also prohibit them from reimbursing organizations participating in the 340B program at rates lower than those paid to organizations outside the program.
Similar bills failed to pass last year, but the community health centers and hospitals in Rhode Island are hoping to get a win this legislative session. Part of their argument is that the drug makers, not the state, would bear the cost of the 340B program.
'It's one of those things where, pass the legislation, it does not cost Rhode Island one cent,' Roman said.
This article originally appeared on The Providence Journal: Bills aim to regulate drug makers who restrict 340B drug program in RI
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
New York Times
30 minutes ago
- New York Times
We Saw Medicaid Work Requirements Up Close. You Don't Want This Chaos.
Many of the Republicans pushing for Medicaid work requirements — permanent program cuts that will strip up to 14 million people of their health care coverage — likely have no idea what it takes to comply with them. We do. As legal aid lawyers, we were on the front lines helping low-income people in Arkansas keep their health care coverage when the state rolled out work requirements in 2018. The policy caused chaos for everyone involved: people receiving Medicaid, hospitals and health clinics, pharmacies, social services organizations and state agency caseworkers. No officials serious about governing should willingly create such problems for their own state. Over 18,160 people in Arkansas lost coverage in only five months before courts halted the policy. Many were our clients. Adrian McGonigal had chronic obstructive pulmonary disorder, for which he received treatment. At the time he held a job working 30 to 40 hours a week at a poultry plant, which paid more than any other job he'd had before and should have satisfied the requirement. But the state's system for automatically identifying working people was faulty, and Mr. McGonigal struggled to navigate the complex monthly reporting system on his own. Unable to report his work, he lost Medicaid, couldn't afford his C.O.P.D. medications, wound up in the hospital emergency room several times, lost his job and never fully recovered. For the next several years he struggled in various minimum-wage jobs, earning much less than he had at the poultry plant. Sadly, he died in November. We saw many working people face similar challenges. Our clients ran the gamut of low-wage work: fast food workers, restaurant dishwashers and servers, construction workers, janitors, landscapers, motel cleaners, gas station clerks and nursing assistants. Many had disabilities, and their ability to continue working depended on getting treatment to manage chronic pain, asthma, injuries, cancer and mental health conditions. Some lost coverage simply because they couldn't navigate the policy's complicated requirements and labyrinthine reporting process. Others lost insurance because of the instability of low-wage work: Bosses cut their hours or laid them off without warning, limited public transit narrowed their options or they lived in struggling rural areas where jobs were hard to come by. When the state cut them off, their health worsened and many lost jobs, as well as the ability to work new ones. Nobody on Medicaid was free from the tumult. Despite outreach from the state, there was widespread panic, as people didn't know if they had the type of Medicaid that the new requirements applied to. People received confusing 10-page letters from the state Medicaid office, which often contradicted other coverage letters people received around the same time. The website to report compliance shut down every night at 9 p.m., and when it was running, it was so complex that we put together video tutorials to help people navigate it successfully. (Many still couldn't.) People spent hours on the phone or at agency offices trying to figure out their status or fix errors, often needing a lawyer's help. In some cases, they had to pester their employers for extra proof of wages or statements that met the state's requirements. All told, 18,164 people were terminated because of noncompliance with the work requirements, and thousands more people lost coverage because of related paperwork burdens. What's more, these penalties operated as a tax on key economic sectors. Hospitals and health clinics, many already barely surviving in rural areas, assumed additional costs to untangle billing nightmares, absorb more uncompensated care and help confused patients document their eligibility for coverage. Local nonprofits, including services for the homeless, domestic violence shelters, food banks, soup kitchens and senior centers, spent their scarce resources trying to help people comply. Pharmacists dealt with the desperation of people learning for the first time that they had lost coverage and would have to pay out of pocket for their prescriptions. The state Medicaid agency also bent under the weight. Agency management sloughed off the thankless and time-consuming tasks of cleaning up endless system errors, figuring out workarounds and calming frantic people to overburdened caseworkers. At one point, the state's call centers were so overwhelmed that the agency expanded its hours of operation, which still didn't prevent lengthy wait times. Want all of The Times? Subscribe.
The Hill
31 minutes ago
- The Hill
GOP looks to win over Collins, Murkowski on Trump bill
Senate Republicans are trying to win over Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) to back the party's ambitious tax cut plan amid fears they could lose a couple of conservative senators. President Trump has made it a priority to engage with Sens. Ron Johnson (R-Wis.), Rand Paul (R-Ky.) and Josh Hawley (R-Mo.), who all have concerns about the emerging package. But some Republicans worry Johnson and Paul could be particularly tough sells on the legislation, which makes winning over Murkowski and Collins all the more important in a vote where the GOP cannot afford more than three defections. 'It's shortening,' one Senate Republican told The Hill about the party's margins. Paul has long been viewed as highly likely to vote against the eventual bill as it includes a $4 trillion debt ceiling hike. He's made it known that is a red line for him. But it's Johnson who is a more acute problem for leadership. According to two sources familiar with the meeting, Johnson on Wednesday got into an extended back-and-forth with Trump during the Senate Finance Committee's meeting at the White House, with one of the sources going a step further and describing it as 'contentious.' While Republicans think Johnson may still come to back the bill, the exchange only made GOP leaders more unsettled about him. That means they have to make sure Murkowski and Collins, who memorably voted against Trump on various issues in his first term, are in play on the bill. 'It's a very delicate balance,' Senate Majority Leader John Thune (R-S.D.) told The Hill. 'Obviously, we have people that have different priorities, different equities that run the gamut in terms of the political spectrum.' 'We're hearing everybody out, finding out what's important to them, and figuring out if there's a way to address that in the context of the bill,' Thune continued. 'But it's a process.' Thune is bearing the brunt of the Collins-Murkowski work, multiple Senate GOP sources said. He's held a number of one-and-one and small group meetings. Both senators have big-ticket items they want to see revised in the bill. Murkowski has made clear her worries about potential Medicaid work requirements, as she believes her state will have trouble implementing them due to its outdated payment systems for the program, and the bill's potential nixing of renewable energy tax credits. The pair have both expressed concerns over what overall reductions could mean for key segments of their states, including tribes for Murkowski and rural individuals and hospitals for Collins. The Maine Republican also cited possible Medicaid beneficiary cuts when she voted against the budget blueprint in early April. The push is only expected to intensify in the coming days as relevant committees unveil their portions of the bill text. 'We're still building things on our side. … Everyone is pulling this gumby in lots of different directions,' Murkowski told reporters on Thursday, explaining that while there are provisions for energy and the Coast Guard that are very positive for her state, more is needed on the Medicaid side. Murkowski also indicated that while she has not gotten the call from Trump just as conservatives did, she also is in touch with other administration figures. Among those is Centers for Medicare & Medicaid Services Administrator Mehmet Oz, whom she talked to briefly after he addressed a Senate GOP luncheon last week. The two are expected to speak early this week to discuss her concerns more in depth. Collins separately is expected to lean on a number of agency heads as she carries out what members have described as a methodical process. 'Susan works extremely hard, [is] very detailed, knows everything, has a lot of history. [There's] different issues in Maine than in a lot of other places and everybody respects that.' said Sen. Shelley Moore Capito ( a member of GOP leadership. There are also political considerations at play, leading some to believe Murkowski will be easier to win. Collins is up for reelection next year in a state that voted for former Vice President Harris. Whether either backs the bill may depend on the impacts of the package on their respective states. Murkowski backed the 2017 Tax Cuts and Jobs Act in large part because the bill opened up the Arctic National Wildlife Refuge for drilling, which had been among her top priorities in the upper chamber throughout her tenure. 'If it works for Alaska, he's not going to need to pressure me,' Murkowski said when asked if it would be a mistake for Trump to pressure her during this process. 'If it works for Alaska, it works for me and gets my vote.'
Business Insider
an hour ago
- Business Insider
4 moves the Trump administration could make if courts strike down its tariffs
President Donald Trump has four more swings at implementing his tariffs — even if courts strike down his use of the IEEPA. Experts in international trade told Business Insider that Trump could take four different routes to imposing trade barriers without Congress. All four are doable, though significantly more complicated, and are unlikely policies he could change at will overnight. "Now we're over a hundred days into the tariffs, andtariffs are a very top-of-the-agenda item," Drew DeLong, lead in geopolitical dynamics practice at Kearney, a global strategy and management consulting firm, told BI. "There are a number of motivations underneath tariffs, and whether his current tariffs stay, he will find ways to continue to amplify pressure on trading partners," DeLong added. After small businesses sued Trump and his various trade officials over tariffs, the US Court of International Trade ruled unanimously on May 28 that he doesn't have the authority to levy sweeping tariffs using the IEEPA — a 1970s law typically used for economic sanctions during national emergencies. The Court of Appeals for the Federal Circuit resumed the tariffs a day later, but their fate remains uncertain. "That decision, if it is favorable to Trump, would still go to the Supreme Court for review," said Kent Jones, Professor Emeritus of international economics at Babson College. "Many conservative judges, even Trump appointees, have tended to view Trump's use of IEEAP as overstepping the limits of delegating tariff-making power from Congress to the President." Here are four things the Trump administration could do next to keep trade barriers up without Congress. Section 122 DeLong said Section 122 of the Trade Act of 1974, also known as the Balance of Payments Act, could be the White House's first choice if it wants to "continue the pressure immediately" on trading partners. The act's official language allows it to be applied only if there are "large and serious United States balance-of-payments deficits," otherwise known as trade deficits. "Section 122 is probably going to be a top pick," Robert Shapiro, an attorney of international trade at Thompson Coburn LLP, told BI. "That gives Trump some vehicle, but it's a limited 15% for 150 days, and then he has to go to Congress." "That would open the door for Congress to pass a whole bunch of trade actions, but the administration obviously didn't want to go through that first," Shapiro added. Section 232 Section 232 under the Trade Expansion Act of 1962 allows the White House to raise duties on imports it deems a threat to national security. A recent probe into critical mineral imports, for example, argued that the US is overly dependent on foreign sources for materials essential to defense, infrastructure, and innovation. DeLong said that at the moment, there are at least eight ongoing Section 232 investigations, including those involving copper, timber, and semiconductors. He said the recent June 3 tariff hike on steel and aluminum from 25% to 50% is also being done under section 232. Jones said, however, that each section 232 tariff requires a formal investigation, and the sectors it could be applied to are limited. "The problem with section 232 is that it requires a separate action for each industrial category of goods against which tariffs can be imposed," said Jones. "The perceived advantage of the IEEPA was that it allowed broad tariff coverage across the board to all industries." Section 301 Section 301 of the Trade Act of 1974 gives the US Trade Representative — now Jamieson Greer — broad authority to investigate whether other countries are violating existing trade agreements or hurting American businesses. DeLong said that the first Trump administration leaned heavily on the provision to impose tariffs on hundreds of billions of dollars worth of Chinese goods and aircraft from the European Union. But section 301 would require a formal investigation and even a public comment period. "The problem with sec. 301, however, is that it requires a separate determination of specific foreign unfair or discriminatory trade practices, country by country," said Jones. "The IEEPA, again, seemed to give the President more flexibility in declaring an emergency against all global imports into the US without the need to document specific foreign practices," Jones added. Section 338 DeLong said Section 338 of the Tariff Act of 1930 could theoretically allow any US president to impose up to a 50% tariff on countries that discriminate against the US. However, he said this would be a very uncommon approach that could again bring the tariff argument into uncharted territories. "That has not been used — and I don't think I'm understating this —in decades, or ever," said DeLong of section 338. "That would be relatively new."
