As New York begins COVID-19 vaccinations, health officials say looming cuts to the states’s 340B drug discount program could make it even more challenging to vaccinate the city’s most vulnerable populations.
Under the 340B program, managed Medicaid providers receive discounted drugs for underserved clients. COVID-19 outreach is among the many types of services funded under this program. Officials told Gay City News that outreach is a costly yet effective part of slowing the spread of the virus. But, looming state budget cuts slated for next spring could threaten these services.
In the past, non-profits were able to apply the difference between the discounted drug price and the Medicaid reimbursement they received to carry out other services. But under the planned cuts, that amount, estimated at roughly $250 million annually, would be diverted back to the state under a fee-for-service model. Governor Andrew Cuomo’s plan to offset a portion of the reduced funding by providing an additional $100 million to such healthcare providers is widely viewed as “just giving with one hand while you take much more with the other,” in the words of Patrick McGovern, chief business development and policy officer at Amida Care, a not-for-profit health plan serving people living with HIV/AIDS.
Charles King, the CEO of Housing Works, a non-profit focused on HIV/ AIDs and homelessness, said the 340B funding is necessary in dispelling misinformation about the COVID-19 vaccine and vaccines in general.
“If we had to spend 20 minutes walking them through why the vaccines important [and] why it’s safe, we wouldn’t be able to afford to take that time,” King said. “It would really undermine our efforts to ensure the people we serve get vaccinated.”
Developing trusting relationships, he said, is critical for follow-ups and helping patients stick with treatment.
“If you’re serving a population that is suspicious of the healthcare system, doesn’t have a lot of education around healthcare issues, and particularly has reason to be suspicious about drugs, you’ve got to take the time to work with people, to listen to them, to encourage them, to hear them out,” King said.
Years of discrimination from doctors make it even more difficult for marginalized people, including people of color and LGBTQ communities, to trust the medical system. A recent study from the Pew Research Center found that while Black Americans are more likely to know someone who has died as a result of COVID-19, they’re still less likely to seek a vaccination when compared to other ethnic groups.
Another study published last month from the Community Health Care Association of New York State shows clinicians are reporting similar concerns.
“We know that a lot of the staff at health centers have a lot of questions. And this is because the vaccine is so new,” said Rose Duhan, the organization’s CEO. “There’s reimbursement for administering the vaccine, but there’s not reimbursement for the clinicians’ time to be spent in conversations… amongst the other clinicians or with the staff.”
But, it’s not just outreach and education that’s at stake. Anthony Fortenberry, the director of nursing at the Callen-Lorde Community Health Center, which specializes in LGBTQ-focused care, said staffing is also at risk.
“Our nurses are funded through 340B dollars,” Fortenberry said. “The lack of 340B [funding] would mean that we would not be able to have the amount of nurses that we would need to be able to meet community demand.”
Slashing these resources from health centers is “bad policy” and “bad timing,” said Amida Care’s McGovern.
“When the state is determined to try to overcome resistance within communities of color to take these vaccines and then trying to figure out how to distribute vaccines in an unprecedented scale,” he said. “You need to rely upon these very institutions that you’re draining all of this support from.”
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