In response to commentary by Robert Chapman published in the SFV Sun on July 30.

Dr. Fong, in his commentary, Federal Drug Program Puts Profits over Patients, gives a highly misleading view of 340B drug discount program. In truth, it helps millions of needy Americans receive affordable medications and clinical care every year.

The program was designed by Congress to give safety-net hospitals and other healthcare providers a mechanism to help cover the enormous cost of treating patients who cannot pay for services.  These hospitals shoulder a staggering $25 billion a year in uncompensated care.

Under the program, providers receive discounted medications from drug companies. They give those medications for free or on a sliding scale to underserved patients. Hospitals can also provide the drugs to insured patients and use the proceeds to help fund vital services for the community, including oncology, diabetes, dental and primary care clinics.  This is exactly what Congress intended when it created the program in 1992.

By definition, safety-net hospitals treat the poor. They care for almost twice the number of low-income patients as other providers. To be eligible for 340B, they must show the government annually that they treat high numbers of low-income Medicare, Medicaid and Supplemental Security Income patients. Oversight of the program has been robust with more than 250 government audits of 340B hospitals conducted during the last two years.

Dr. Fong overstates the growth in the program by ignoring the fact that 60 percent of the hospitals in 340B are tiny rural providers with 25 beds or less. In its wisdom, Congress voted to add them in 2010 to help remote hospitals better serve their communities – and keep their doors open. The $7.5 billion 340B program is sustainable because it is funded not by taxpayers, but by the highly profitable drug industry. It represents just 2 percent of the U.S. drug market and will continue to do so.

Hospitals in the 340B program cannot be blamed for the economic woes of private oncologists. The real drivers for that are lower Medicare reimbursements under the Medicare Modernization Act of 2003 and the move towards integrated delivery systems and accountable-care organizations.

The author neglects to mention that private oncologists regularly shunt their poorest patients to the nearest safety-net provider for treatment.  In turn, these hospitals are obligated to treat all patients, regardless of their ability to pay. This is why they receive discounted chemo drugs from the pharmaceutical industry under 340B in the first place.

Hospitals sometimes do charge more for oncology services to our insured patients – because we must shoulder the enormous burden of caring for all the people who cannot pay for treatment. Hospitals also offer a much broader range of oncology services, including advanced diagnostics, surgery, radiation therapy, infusion services, patient and family counseling, home care services and palliative care.

Critics of the 340B program – supported by the drug industry — want to “reform” it limiting provider and patient eligibility. Such a move would result in less access to medications and clinical services for the underserved across America.

Robert Chapman, MD, is director of the Josephine Ford Cancer Institute in Detroit, MI

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