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Of those remaining, 10 did not generate enough revenue to exceed drug-related costs, and six did not report enough information for GAO to determine the extent to which revenue was generated. Several factors affected B revenue generation, including drug reimbursement rates. Regardless of the amount of revenue generated, all covered entities reported using the program in ways consistent with its purpose. For example, all covered entities reported that program participation allowed them to maintain services and lower medication costs for patients.
Entities generating B program revenue that exceeded drug-related costs were also able to serve more patients and to provide additional services. However, B stakeholders reported issues with covered entities accessing intravenous immune globulin IVIG at B prices. These restrictions happen on an ongoing basis because the IVIG is susceptible to drug shortages. However, GAO continued, HRSA's guidance on program requirements often lacks the necessary level of specificity to provide clear direction, making participants' ability to self-police difficult and raising concerns that the guidance may be interpreted in ways inconsistent with the agency's intent.
Moreover, GAO said the B program has increasingly been used in settings, such as hospitals, where the risk of improper purchase of B drugs is greater, in part because they serve both B and nonB eligible patients.
To ensure appropriate use of the B program, GAO recommended that HRSA take steps to strengthen oversight regarding program participation and compliance with program. HRSA began conducting such audits in HRSA reportedly is studying the matter.
HRSA has issued guidance on these issues. Review of B Prices [45] Objective: To determine whether B covered entities pay more than the statutory defined B ceiling price and, if so, the potential reason for the price discrepancies.
The study found that: B DSH hospitals provide nearly twice as much care as nonB hospitals — Although B hospitals accounted for only 35 percent of all hospitals included in the analysis, B hospitals provided 58 percent of all uncompensated care. In addition, when taking hospital size into account and looking at uncompensated care as a percent of total patient care costs, B hospitals across all hospital sizes provided consistently high levels of uncompensated care.
A higher percentage of B DSH hospitals provide public health and specialized services — many of which are unprofitable but essential to their communities — than nonB hospitals. Outpatient Prescription Dispensing Patterns Through Contract Pharmacies In [ edit ] A study published in the November edition of Health Affairs provided the first comparison of B prescriptions [48] and all prescriptions dispensed by retail pharmacies operating under contracts with B covered entities.
The study used data from Walgreens, the national leader in B contract pharmacies. The study found that: Medications used to treat chronic conditions such as diabetes, high cholesterol levels, asthma, and depression accounted for an overwhelming majority of all prescriptions dispensed at Walgreens as part of the B program.
The majority of B prescriptions dispensed at Walgreens originated at tuberculosis clinics, consolidated health centers, disproportionate-share hospitals, and Ryan White clinics. And as safety-net community providers, FQHCs use the funding to benefit all patients of the community, indirectly passing savings to the state as a whole," said the report which was commissioned by the Oregon Primary Care Association.
Oregon is weighing whether to require these health centers to hand over essentially all of their savings on B drugs provided to Medicaid beneficiaries. The analysis raises questions about whether the current B eligibility criteria specifically used for DSH hospitals are serving the spirit and intent of the law in that they may be overly broad and not just target those entities that serve high numbers of vulnerable, uninsured patients.
Specifically, the new research shows: More than two-thirds of hospitals that receive B drug discounts provide less charity care as a percent of patient costs than the national average for all hospitals, including for-profit hospitals which do not qualify for B under current eligibility criteria. Currently, hospitals that qualify for the program claim B discounts for most outpatient prescription drugs, for both insured and uninsured patients. And while the B program lowers outpatient drug costs for qualifying hospitals on the presumption that it will help significant numbers of vulnerable, uninsured patients, participating hospitals currently see no restrictions on the way they spend the revenue generated if they charge both insured and uninsured patients higher prices than the B-discounted price.
This stands in contrast to many other covered entities that participate in the B program as a result of a specific grant often referred to as "grantees" from the U. Department of Health and Human Services.