Advocacy Issues and Take Action

Issue:

Ensuring access to pharmacy services is an essential part of the health center model and an important aspect of providing high-quality care to the patients health centers serve. The federal 340B Drug Pricing Program provides health centers and other 340B entities access to outpatient drugs at a reduced price. Health centers use the savings from those reduced prices to offer cheaper prescription drugs to eligible patients who don’t have drug coverage and to support other patient services their organization provides, allowing health centers to stretch their scarce resources. While every health center decides how its 340B savings can best benefit its patients, these savings often support clinical pharmacy programs, extended evening and weekend hours, case management services for at-risk community members, and sliding fee discounts for healthcare services– ultimately increasing patient access to care. Currently, however, the 340B program is facing challenges from pharmaceutical manufacturers which limit access to reduced price drugs or make it more difficult for health centers to receive drug savings.

Many pharmaceutical manufactures have made it more difficult for 340B entities like health centers to benefit from the savings associated with discounted drugs. They do this by restricting the number of 340B contract pharmacies discounted drugs can be distributed to. Those savings are a critical part of how health centers serve their patients and sustain their operations, and they are required by federal law to be reinvested into health center programs and services. Health centers are subjected to detailed requirements and federal oversight that they must adhere to and which guide their participation in the 340B program to ensure savings received are appropriate.

Beyond the fiscal problems the limitation of contraction pharmacies causes the restriction on the number of contract pharmacies can cause issues with patients having access to discounted medications due to the distance they may have to travel to get to a 340B pharmacy.

Recommendation:

MPCA recommends supporting legislation that would prohibit pharmaceutical manufacturers from limiting the number of 340B entities’ contract pharmacies.

Background:

The Health Center Careers Training Program (HCCTP) was launched in March of 2022 to train and employ up to 300 new healthcare professionals using a 7.6-million-dollar investment from the Michigan Department of Health and Human Services (MDHHS). Participating health centers receive funding to cover employer costs, including tuition and wages, which avoids prohibitive student loan debt or cost barriers for individuals. To date, over 428 individuals have participated in the HCCTP.

MPCA is approved by the U.S. Department of Labor to serve as an Intermediary for health centers transitioning their training programs into Registered Apprenticeship Programs. The HCCTP has enabled rural, urban, and tribal health centers to grow local talent and provide economic opportunities within the low-income, underserved, and BIPOC communities they serve. MPCA is actively exploring new opportunities to build on the program’s success by innovating apprentice-style training and paid internship opportunities for behavioral health professionals.

Recommendations:

Reinvest in the Michigan Health Center Careers Training Program (HCCTP) to sustain and expand on-the-job training and registered apprenticeship programs that surmount barriers to entering health professions and rapidly grow the workforce needed to meet healthcare needs in Michigan’s low-income and medically underserved communities. Support permanent funding ($2 million per year) for the HCCTP program to enable Michigan Health Centers to sustain their newly established training programs for entry-level health careers and grow innovative training program models to support advanced careers training opportunities for behavioral health professionals.

Background:

Informed by the research of national partners, MPCA’s updated estimates show over 78,000 patients- the equivalent of 1 in 8 patients served by Michigan health centers today- will lose their health insurance coverage through Medicaid or the Marketplace because of OBBBA, including the impact of Medicaid work requirements, increasing the frequency of Medicaid redetermination, and the loss of enhanced premium tax credits in the Health Insurance Marketplace. Losing affordable health insurance coverage will have a profound effect on health center patients by reducing their access to care, increasing delayed or forgone healthcare, and intensifying financial strain and the likelihood of medical debt- all leading to poorer health outcomes.

Proposed changes to the health insurance coverage programs will also negatively impact the stability of health center services for everyone, not only those losing coverage. MPCA’s updated estimates show that over $94 million in reimbursement for services will be lost annually because of patients becoming uninsured. Health centers already operate on razor-thin margins, and they will not be able to maintain all current healthcare services given the loss of these resources, forcing centers to scale back critical programs or even close the doors of critical healthcare service delivery sites.

Recommendations:

To the greatest extent possible, provide state resources to replace federal cuts to Medicaid.

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