How Hospitals and Health Systems are Transforming 340B Dollars into Community Impact – Part 1

Key Takeaways:

• 340B programs help safety-net hospitals improve medication access and address health inequities. Health systems such as Sinai Chicago and Cottage Health use 340B savings to support specialty pharmacy services, care coordination, community health workers and other programs that help underserved and uninsured patients access care.  

• Hospital-owned specialty pharmacies can reduce barriers to specialty medications and improve patient outcomes. Embedded pharmacists, patient liaisons, copay assistance, free drug programs, home delivery and coordinated medication management can help patients access complex, high-cost therapies while improving adherence and continuity of care.  

• Specialty pharmacy can strengthen both clinical and financial performance for health systems. By identifying eligible patients for new therapies, reducing administrative burdens such as prior authorizations and generating resources that can be reinvested into service lines and community programs, specialty pharmacy can support better patient outcomes while creating financial sustainability.

Clearway Health’s Allison Arant, Senior Vice President, Client Development and Marketing, recently moderated a Becker’s Healthcare webinar on How Sinai Chicago and Cottage Health are Transforming 340B Dollars into Community Impact. Joining the panel were:

• Sameer Shah, PharmD, MHA, CSSBB, FACHE, President, Mount Sinai Hospital, Sinai Chicago

• Scott Wester, President and CEO, Cottage Health

• Brandon Newman, PharmD, CEO, Clearway Health

Question and Answer:

Allison Arant: How does your health system maintain care equity for marginalized, low income and uninsured communities?

Scott Wester: Cottage Health, located in Santa Barbara, California, is a unique community health system serving a region with significant disparities in wealth and access to care, including a substantial population of uninsured and underinsured patients. As the area’s safety-net provider, Cottage Health is committed to caring for everyone regardless of ability to pay, and we invest in services designed to address barriers that other organizations may not provide. Through strong partnerships with community health centers, a robust financial assistance program and a 340B specialty pharmacy program, Cottage Health works to ensure that financial circumstances do not prevent patients from accessing the medications and care they need.

Sameer Shah: Mount Sinai Hospital, the largest private safety-net health system in Chicago, has built an infrastructure focused on addressing health inequities. The model combines clinical care, research to identify disparities and their root causes, and community-based programs that address community needs such as food, housing, employment and other social determinants of health. A key differentiator is the integration of community health workers across service lines, connecting patients to the resources they need and creating a continuum of support that extends beyond the four walls of the hospital and into the communities they serve.

Allison Arant: How does Clearway Health support our hospital partners in serving these communities?

Brandon Newman: Clearway Health partners with Cottage Health and Sinai Chicago and other hospitals and health systems across the country to help patients access high-cost and complex-to-manage medications. We help health systems establish and administer copay assistance and free drug programs, while ensuring patients qualify for these programs in a compliant manner so they can begin treatment as quickly as possible.  

We also embed pharmacists and patient liaisons within our partner health systems to provide personalized support throughout the medication journey. The extensive education and guidance these on-site teams provide make a significant difference in helping patients understand and manage high-cost specialty medications. Ensuring access and affordability is especially important for patients in marginalized and underserved communities, where financial and other barriers can make it more difficult to access critical therapies.

Allison Arant: How can we help address the gaps created by the growing number of retail pharmacies closing, especially for providers and patients who have relied on those pharmacies? How do services like home delivery fit into that continuum of care?

Sameer Shah: We’re seeing a significant number of closures among retail pharmacies across all of Sinai Chicago’s service areas, which is concerning. As more pharmacies close, health systems need to think about the full range of medication access options for their communities. The community members will be relying more on us to make sure they can continue to get the medications they need.

Scott Wester: We are growing our Cottage Health Medical Group. We serve a very large geographical footprint. To ensure we provide the right level of access for not only primary care but also specialty care, and to make sure we are at the right locations for the people we serve, we recently expanded our specialty pharmacy and specialty pharmacy network.

We are seeing reduced access to pharmacies across our county, partly due to the implications of HR1, the One Big Beautiful Bill Act. Larger retail pharmacies are closing, and at some locations, there could be a line outside the door of people waiting for their medications. For many patients, that becomes a significant barrier.  

At Cottage Health, we do everything from emergency room visits, meds to beds, specialty pharmacy on site and home delivery. We have much better coordination to guarantee people get their medications on time and we do whatever it takes to ensure compliance with their medications.  

Allison Arant: Scott, what are some of the proud moments of the work that you and your team are doing in Santa Barbara?

Scott Wester: How we connect our patients with the use of our specialty pharmacy network is very impressive, including the work we support for our patients with chronic conditions such as HIV or cystic fibrosis, MS or other immunological conditions. We help patients understand and manage their treatment plan. We also have community health workers and navigators, and we provide as many resources as possible to the patients and families we serve to improve the continuity of care.  

We see a heavy reduction in the use of emergency room visits for chronic care patients because they adhere better to their medication, medication management, and a reduction in readmission.  

Our goal is simple: to make sure we provide the right care in the right setting while we keep our patients connected to the resources that we provide them. We remove as many barriers as possible, whether if it's a financial barrier, barriers in care coordination, and even provide home delivery for medications to ensure getting access to their medication is something that's not a barrier for our patients.  

Allison: Brandon, based on your work with Clearway Health’s clients across the country, what trends or common challenges are you seeing across health systems?

Brandon Newman: The successes we’ve seen across our partner sites include supporting new treatments that address population health priorities. We do this by using clinical markers in a hospital or health system’s EHR to identify and match eligible patients with breakthrough medications as soon as these drugs are approved by the FDA.  

If we know when new medications are going to become available, we can identify which patients may be good candidates. We use data to empower the providers to prescribe potentially life-changing medications to the patients who need them most. With new drugs hitting the market every day, we help our partners identify eligible patients, gain access to these medications and get them the treatment they need.

Another example is Clearway Health’s work with CABENUVA, a medication for patients diagnosed with HIV. CABENUVA is given once every two months, offering a more convenient option than taking daily pills. We’ve found that when patients have more convenient dosing options, we see improved adherence, which can lead to better health outcomes. More patients can achieve undetectable viral loads, which is also important in helping prevent the spread of HIV in the community.

The landscape is changing fast. There are a significant number of drugs in the pipeline that address new diseases and offer better treatment options than those currently available. We’re also seeing new, cleaner drugs that may provide effective treatments with fewer adverse effects. This means health systems can not only take better care of patients but also create new revenue opportunities. The connection between clinical care, quality and financial performance is particularly important—it can improve both patient outcomes and the health system’s overall operations. These additional resources can then be reinvested into programs that support and serve the community.

A trend we found, especially in hospitals and health systems serving underserved areas, is the belief that these drugs are not a possibility for their patient populations because they are so expensive, and they know access is tough. They may have limited nurses available to spend hours to help access these drugs. What they're finding is that when they have a partner to help with medication – an expert like Clearway Health - that's not the case. If you have the right resources and the right partner to be able to access medications, it is possible for these patients to get the medications they need. And this is greatly beneficial for patients and the community.  

‍

‍Sameer Shah: One of the things we were most excited about when we started this program was reducing the burden of prior authorizations on physicians and nurses. You would see piles of them sitting at their desks, creating delays that can prevent patients from getting medications quickly. Within months of launching the program, we reduced prior authorization turnaround times to about 48 hours, which helped patients start treatment sooner.  

‍

Allison Arant: What does the 340B Program mean to your hospital and the underserved patients you serve?

Sameer Shah: The biggest impact has been on access to medications and making our service lines more comprehensive. Those are the two most important things. You can have all the innovations in the world. Pharmaceutical companies are creating some amazing therapies and treatments, but if your communities don't have access to it, it's not a good feeling for all of us leaders. And I know our physicians are feeling the same way.  

We've improved that significantly. Our GI digestive health service line has an amazing group of physicians and clinicians on the team. We're doing a lot of preventative care and cancer prevention through colonoscopies. One of the concerns from the team was that many inflammatory bowel disease patients were coming through our ED with significant issues. These patients were being sent elsewhere to get treated and then these same patients ended up right back in our ED.  

It goes back to social determinants of health. It's complicated for these patients to go to different specialists in different health systems when they trust Sinai Chicago and they trust our physicians and our ability to care for them. This program has allowed us to add inflammatory bowel disease, fatty liver disease and weight management clinics. Holistically, patients can be treated by our physicians at Sinai Chicago, and that's been a game changer. We are hearing more stories about remission and treatments for our patients because we can now deliver that therapy, and it increases the satisfaction of our physicians and patients.

One of the things we're trying to do to remove inequities is to create multidisciplinary care teams, so the burden isn't just on the physician or the nurse. Many of our patients require extensive help, so being able to add community healthcare workers, liaisons and navigators within a care team of our service lines is a big lift for our services. We are seeing great outcomes. It's ideal if you're able to embed pharmacists with the physician; that gives the physician capacity to do more. Medication therapy and adherence are enhanced. We have improved our care teams and made them stronger to deliver on these service lines.  

You cannot operate a high-quality service line in this environment without the financial resources to support it. Hospitals need to make more money than they spend. That's how service lines operate. Having a specialty pharmacy in place not only lifts quality and outcomes, but it also generates savings that can be put back into the service line, so we are able to operate something we're very proud of. And that's been a big game changer for us.  

Scott Wester: For Cottage Health, the 340B program is much more than just a pharmacy program; it helps us support the continuity of care and specialized services that individuals in our community can't find anywhere else. The savings that are generated with the 340B Program allow us to invest in programs like having pharmacists in clinics to provide access to strengthen care coordination through navigation, having our community health workers, and to be what we've always intended to be and serve everybody in our community regardless of their economic conditions. Those investments help us to sustain programs, whether pediatrics, chronic care disease management and specialized programs such as our high-risk OBs, to continue to serve patients within our community. The 340B Program is an essential tool for extending care to patients who might otherwise face significant barriers to access.  

One of our biggest concerns is the impact of changes coming out of Washington. With more frequent redeterminations and enrollment changes, along with provisions in the HR1 bill, we expect the number of people without coverage to continue to increase across markets throughout the United States. However, when the Affordable Care Act was passed and more people gained access to care, the specialty pharmacy world was so much different back then than it is today. The reliance on the 340B Program to serve our communities is more than essential today. The safety-net pharmacy system has become increasingly important as large “big box” retailers and insurance-owned specialty pharmacies begin to retreat from the market. We want to make sure that pharmacies and specialty pharmacies don’t become a desert in communities across the country, because access to these services is essential for many communities.

To watch the full Becker’s Healthcare and Clearway Health webinar click here.