Dr Michael Kolodziej Outlines Ways to Reform 340B

There are 3 potential solutions for reforming the 340B drug pricing program, according to Michael Kolodziej, MD, national medical director of oncology solutions in the Office of the Chief Medical Officer at Aetna.

Transcript (slightly modified)

Can you highlight the improvements to the 340B drug pricing program that you outline in your paper for Evidence-Based Oncology?

We discuss 3 potential solutions. The first is to really attempt to define the participating entities in the spirit which we originally started the program. So that would be a relatively easy fix. The second would be to pass through the discount for patients who are adequately insured that treated at institutions that are qualifying for the program under the current set of rules. So that we would thereby allow the institutions to continue to derive the benefit, but really for the population for whom the benefit is determined and then the payer would receive, if you will, a rebate from that institution, based on the discount.

And the third solution, which honestly is the best, is to make the 340B actually not an institutional benefit but a patient-level benefit. And I think we do that all the time in healthcare and I think we could do that with this. The huge advantage of that of course is that it would allow patients to use the 340B benefit in a portable fashion. So they would not be tied to a specific institution. They would have the opportunity to be treated wherever they chose to be treated without fear of economic consequence. And I think that is a wonderful solution, and actually is an implementable solution, but I think we could expect significant resistance from the institutions that are benefiting from the program now.

And who should be involved in the discussions on how to transform 340B?

Clearly, the federal government—it's a federal government program. So Health Resources and Services Administration has got to take the lead. I think Medicare should be very, very interested in this. I think they have a lot to gain in this. I think also we should make sure we engage the disproportionate share clinics and the institutions that really need this to make sure that they're not going to somehow get short-changed by whatever reform gets instituted. And then I think patients actually should be asked about this.

The only wrong answer, in my opinion, is to leave the system as it is. I think any of those 3 would be a step in the right direction.