About Dr Whitner

Dr. Jangus Whitner is a primary care clinical pharmacist and the 340B Program Manager for PrimaryOne Health in Columbus, Ohio. He also serves on the Board of Directors for the National Center for Farmworker Health and locally on the Clinician Advisory Board for La Clínica Latina Free Medical Clinic in Columbus, Ohio. Dr. Whitner received his PharmD degree from The University of Toledo and completed two years of postgraduate residency training: PGY1 in pharmacy practice and PGY2 in ambulatory care pharmacy. He became a 340B Apexus Certified Expert in 2019 and is the Founder and Chair of the Ohio FQHC 340B Consortium

Twitter: @JangusRx
LinkedIn: linkedin.com/in/JangusRx

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What you will learn

  • The basics of 340B
  • Assault on 340B by Pharma
  • Learn about the national Association of Healthcare Centers and why 340B matters
  • Impact of 340B attack on FQHC’s and Community Health Centers and impact on patient care
  • COMMUNITY HEALTH CENTER LEADERS DEFEND THE 340B DRUG DISCOUNT PROGRAM AGAINST Rx MANUFACTURER ATTACKS

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Transcription

Michelle:
This is Michelle precedent of Michelle Rex pharmacist consulting services and your host for the conscious pharmacist podcast. Welcome to our episode today, where we have an amazing guest who is so experienced in 340 B, which is going to be our topic today. I want to welcome dr. Jengas Whitner to the show today. Dr. Whitner is a primary care clinical pharmacist in the 340 B program manager for primary one health in Columbus, Ohio. And I heard dr. Whitner on the press conference a couple of weeks ago on 340 B and invited him to the show today because this is such a critically important topic and what’s going on with 340 B today and the assault on FQHC and community clinics, and most of all on the patients that utilize these clinics. Welcome to the show dr. Wagner.

Jangus:
Thank you. Thank you. I’m very happy to be here.

Michelle:
Thank you so much. So let our listeners know how you got into the direction of 340 B and becoming such a guru on 340 B and what it means for our patients today.

Jangus:
You know, I like the word guru, I think I’ve been referring to myself as the big nerd, but I like the word guru. I think I’ll adopt that one. So I actually, in my second year of residency through Ohio state and primary one health, where I currently practice, I got introduced to the 340 B committee and they wanted a little more pharmacist’s involvement and you know, being ambitious resident, I was saying, you know, as a young gun, you usually say yes to a lot of things. And so I said, yes, they’ll try and understand what it was about. And throughout the year, I really got to see the large scale impact of what 340 B does for our patients. And we are a federally qualified health center. And I really fell in love with the, not just the impact that 340 B, but how it it’s so complex. And the in order for us to appropriately advocate for patients, we need people to get into the weeds and understand all 340 B works and why

Jangus:
It’s so different than a lot of these misconceptions, right? About 340 B. That’s easy to assume if you don’t do it every day. And so I love to being challenged is always something more to learn. And 340 B really is a bipartisan solution for our patients and some of our most vulnerable patients across the United States. And so when I finished residency, I was able to unfortunate to be hired on at the primary one health and so remained in the FQHC setting, doing part of my days as a clinical pharmacist, seeing patients and for chronic disease States through collaborative practice agreements and such. And then the other part of my time, which right now is about 60% is administrative through the 340 B program. I’ve been doing that for a few years now.

Michelle:
It’s, it’s, it’s really extraordinary work. You know, I I’ve been working with several if QHC is in community clinics here in orange County and assisting them with setting up their 340 B programs and doing advanced practice clinical work in those clinics. And the, the value that this program brings to, to the clinic to provide services to patients is, is quite extraordinary. And recently there’s been the shift in this complete assault on these, on these programs when, when I listened to you on their press conference a couple of weeks ago you, and, you know, the other members were talking about what’s going on with pharma and what they doing to try to really dismantle these programs or limit the, the access to patients within these programs, maybe you can let our listeners know what’s, what’s actually going, like what, what Lily’s done, what AstraZeneca is starting tomorrow and what these pharma companies are suddenly deciding to do with 340 B, that’s going to massively impact the program in a negative way.

Jangus:
Yeah, I’d be happy to. So the and you mentioned Lily AstraZeneca, Santa Fe, and Novartis. Those are, those are two others. But really what’s happening is it’s, it’s a layered attack really. There there’s multiple angles depending on which drug manufacturer we’re talking about. But I think it started in, in July where Lily released something in early July a notice saying that they were no longer going to provide 340 B discounts or discounted pricing for 340 B for the drug Cialis at contract pharmacies. And they truly, Lilly was obviously, they were just testing waters to see if HERSA would push back. At HERSA is the health resources and services administration. That’s a UN agency of the department of health and human services, HHS, and they Hertz was responsible for oversight of the 340 B program. And I think Lily chose Cialis because it’s not a lifesaving drug it’s typically sometimes it may not even be on some of the formularies for Medicaid.

Jangus:
And, and so they knew that it would be low controversy and they were just trying to see, well, if there’s no pushback on this, let’s open the flood Gates type of thing. So, and that’s honestly what happened. And there HERSA was relatively silent regarding that. And the reason I even mentioned the Medicaid formulary is just as a, as a side note drug manufacturers that they want to participate in the Medicaid program, Medicaid drug rebate program, or MDRP, they also are required to participate in the 340 B program and provide discounts to safety net providers that have a lot of uncompensated care that provide services to patients regardless of their ability to pay. So that’s why I mentioned the whole Medicaid part with that. And so after nothing was done about that, then there were a bunch of manufacturers that hopped on board with a variety of requests.

Jangus:
So Merck was one that said they are, they wanted to mandate or request that that the covered entities give contract an egregious amount of contract pharmacy claims data on a biweekly basis that they’re not entitled to by statute. And they, they, the administrative burden that they would put on these covered entities, number one during a pandemic was you know, enormous, but also they were threatening to do something. And I quote substantially less collaborative and more burdensome for the covered entities or something to that extent. And if we didn’t provide this data, and many of those data entities are not even allowed to provide it’s it’s it’s full contract pharmacy claims data that we have certain contracts with, that won’t allow us to share, and they are kind of an all or nothing approach. Now, since that Merck has went silent and you know, there’s some other things that play, but essentially this data they want to use to prevent duplicate discounts in Medicaid, commercial, and Medicare part D.

Jangus:
And this will set the stage for these other drug manufacturers. But essentially we are only required to prevent duplicate discounts for drug manufacturers in Medicaid, the Medicaid program, because that’s the only program that they’re required to do 340 B for it. They want to participate all of the rebates and discounts that manufacturers end to into enter into with pharmacy benefit managers for commercial and part D those are completely voluntary, and they do that to get preferential prioritization on these formularies for drug coverage. And so the drug manufacturers don’t want to give the PBMs or the rebate if they’re going to give entities at 340 B discount. But unfortunately that is something that they entered to voluntarily, and they want to use this egregious amount of data that they don’t, that they’re not entitled to, to be beyond the Medicaid program to prevent and basically stop those rebates.

Jangus:
And what’s what we all know is going to happen. Without a doubt, is that the second that drug manufacturers, if they did get their hands on this data, refuse to rebate to the PBM, the PBM is going to turn around and do discriminatory contracting to our pharmacies and covered entities to recoup that that rebate in some other way and increase their profits. Right? So the 340 B providers, we are, you know, it’s a catch 22 we’re, we’re kind of screwed if we do and screwed if we don’t in that regard because it’s just going to come back around and there’s not a lot of regulations on PBMs taking some of the 340B savings from there. And I know I’m kind of jumping into the weeds here, but the, the reason for all of this is, you know, we have other drug manufacturers like Santa Fe and Novartis who had threatened to to remove 340 B pricing at contract pharmacies.

Jangus:
Completely. If we do not give this data, we have others like AstraZeneca that refuse to offer 340 B at the contract pharmacies at all. They don’t even mention the data. And and with that, they’re doing it for those that don’t have an in house pharmacy. One thing that AstraZeneca is doing is allowing entities like myself, that don’t have an in house pharmacy to designate a single contract pharmacy to, you know, to do that. But we’ll talk about later why that’s not a solution. Yeah. And what Santa Fe and Novartis have not even allowed or are not permitting. And put that in quotations whether or not they’re legally allowed to do this as a different different discussion, but they didn’t give entities the option to even have a single contract pharmacy. If they don’t share the data, it’s just all or nothing.

Jangus:
And so it’s a full on assault on on 340B I like that word, I’ve been using the word attack, but Michelle, you had used assault and it’s extremely unfortunate because ultimately we could go into the weeds about all of this, but at the end of the day, the patients are the ones who are suffering. Some, our most vulnerable patients in America. There’s 30, nearly 30 million patients that rely on health centers, federally qualified health centers for their care. And they are directly affected by this and the drug manufacturers. Ultimately it’s obvious that this is about profit for them. This isn’t about the patient. So if it was about the patients, there never would have been these ultimatums and these drastic measures to attack the 340 B program. Absolutely not.

Michelle:
No, absolutely. And it’s all about for profit. And you know, when, when we see that it’s, it’s, it’s so shocking because you’re right. It’s the patients that suffer. I mean, you alluded to two to one thing is like, now they’re trying to limit the access to one community pharmacy or one chain pharmacy. I mean, how does that even make sense when our patients, or all over the geographic community around these clinics? And a lot of the patients that come to our centers, they don’t have transportation. They don’t have means to get to that pharmacy. How do you limit that? Like that instead of them being able to use the local community pharmacy, that’s been part of this program all the time. I mean, probably the most heart wrenching striking moment in that press conference a couple of weeks ago. And for the listeners out there, I have a link to, to the video for that press conference, which will be in the show notes today. So I, I encourage all of you once you’ve listened to this podcast to click that link and go and listen to this this press conference. But the most striking testimony came from your patient, Gina Moore and her story about not being able to get lifesaving medication if this, this truly happens. And that’s the reality of this patient’s lives are literally in the balance if this continues in this vein.

Jangus:
Yeah. And that’s a good point in Gina’s medication is a concentrated insulin that doesn’t really have an alternative. And she’s tried alternatives before and ended up in the hospital. And her particular insulin is, is affected by one of the drug manufacturers who are not giving an exception for us to have a single contract pharmacy to do this. So we really lose complete access to this for her. And, and again, a lot, you know, a lot of my stuff about the opinions of, you know, I think it’s over profit. You know, these are my opinions, but I think it’s, it’s really obvious of, of what’s what’s going on. Now at my health center, we administer a hundred percent of our program through the 340 B program through contract pharmacy partners without in, through the area. So we don’t own any in house pharmacies.

Jangus:
And we chose this method because like you said, it’s the best way to ensure access to lifesaving affordable medications for our patients, we have 48,000 patients spread across over 200 zip codes in an urban and a rule County in Ohio. And so we wouldn’t be able to serve all of our patients without our contract pharmacy partners. And it’s absolutely essential the contract pharmacy part to supporting and sustaining services within our health center. We also intend to, we try to be intentional about contracting with local independent pharmacies to promote and support the small businesses, especially in underserved areas that are rural and urban of our service areas. But the fact of the matter is we have a three 30 grant that section three 30 that’s for, that gives us the federal grant for our health center. And we would not be able to fulfill those requirements for thousands of our residents without the contract pharmacy, part of the program, contract pharmacies. They play such a significant role in serving our patients, especially during COVID-19 pandemic and, and they ensure safe access to affordable medications for our patients. And we choose them. We choose these pharmacies based on where our patients live, work, worship and play it’s intentional. We want patients to have, we want to bring the 340 B access and the drug access to our patients and not have to have our patients worry about how they’re going to transport themselves to the access.

Michelle:
It is so crucial. And if I think the topics we’re discussing today and the people listening, I want to employ you, how important this is the access for our patients to pharmacies in the communities where they live worship and play. That is essential access to lifesaving. Medications is all that we, as pharmacists and clinicians can, can do for our patients to make sure they have access. And by not having this access because of drug company shenanigans and PBM shenanigans, to try to wangle more profits out of the pharmacies and the patients is just complete. It’s just completely egregious. And, you know, you alluded to another point like in the middle of a pandemic, I think out of this pandemic comes one of the biggest visions or consequences for me is that in this country to have a health insurance tied to our employment is the biggest flaw.

Michelle:
Because now we have millions and millions of Americans be being put out of work because of this pandemic and they’ve lost their health insurance. And where do they go for their healthcare? They come to you, right? And if they don’t have access in this 340 B program, and this assault continues in this manner, how are our patients going to get these life saving medications? I think, you know, like you mentioned, CIL is at the beginning, but it’s now being translated into like real life saving drugs. Like Gina’s insulin, all these other incidents that our patients have to take. So, I mean, where do we go from here? What, you know, and, and the work you do is just so extraordinary. And I can see the torch and the Baton is going on to our students and the next generation of pharmacists coming through. I love the article in groceries, pharmacists from your resident, Ariel McDuffie. That was fantastic. And if we can just have people continue the advocacy and continue the fight, you know, I’ve been a pharmacist for a long time and every day seems like a day of advocacy.

Jangus:
Okay. It has to be,

Michelle:
We cannot let down for even like a moment. And what can you tell our listeners out there and other pharmacists, community pharmacists, some who may think, you know, 340 B like PBMs it’s, it’s a program that needs to go away. What do you say to comments like that?

Jangus:
I, you know, I think 340B is one of those complex programs that if you know, a little it’s, it’s dangerous because it’s easy to create misconceptions and assumptions instead of, you know, and the people who do it every day, who know the reality of it. And, and so 340 B is, is so much, I mean, w number one, it means so much to millions of Americans. And it also means so much for the the safety net provider entities, the ones who are providing these services. So for example, you know, we as health centers by law and mission, we use all of the savings that we get from 340 B in our participation in it to expand our patients’ ability to either access direct medication discounts or expand services. And we are required by regulation to, to reinvest every penny of savings that result from our participation in 340 B to expand access to care.

Jangus:
And so, and that’s consistent with our mission as an FQHC. And so some of these, if we didn’t have contract pharmacies, we would not be able to serve patients in that manner. And so we, we use the remaining 340 B savings to provide, I’m going to give, just give you a list of services that we otherwise would not be able to provide an an oral and provide in a limited capacity without 340 B. So it allows us to expand our substance use disorder and addiction services, our language assistance, and interpreter services, physical therapy, dental, clinical pharmacy, vaccines, nutrition, food, pharmacy, and so forth. And so one of the biggest misconceptions I want to S you know, correct, is that, you know, we’re that 340 B funds are, are being misused. Our health centers are reinvesting this directly to the patients, if not through a discount you know, at the, for the medication we’re taking the savings and putting it for our services.

Jangus:
In many times with the medication discounts, we can actually get a patient, a copay that is cheaper than the 340 B manufacturer discount. And so, like, that was how it wasn’t Gina’s case. We got, we can get her 90 days worth of medication for less than $15 due to her life circumstances. And that is cheaper than the, even the 340 B discounted price of that medication. And significantly cheaper than the over thousands of dollars it would be at retail. And so another misconception about 340 B I’d like to correct is, you know, 340B many people think it’s taxpayer funded and it’s not, you know, we get our federal grant as a health center, you know that does come from tax dollars. And so 340 B is a way for us to get savings, to expand services and create comprehensive care at no expense to the taxpayer.

Jangus:
This is something that if the drug manufacturers want to participate in Medicaid, then they participate in 340 B and they pass this discount on to us. And so the, you know, it’s not taxpayer funded. And I think the last point I wanna make about this about 340 B is many people think that 340 B, just like, so I guess everyone can agree that PBMs rates, you know, are a huge problem with raising drug prices and just raising cost of healthcare in general, with spread pricing and all of these terrible things that you know, that with lack of transparency and lack of oversight and regulation, PBMs have been allowed to exploit. And so for someone who doesn’t know the 340 B program, it’s very easy to think that, you know, Oh 340 B just raises drug prices.

Jangus:
And that’s just simply not the case. So 340 B discounts, the actual discounts represent less than 1%, and this was in 2015, less in 1% in the total U S drug sales in 2015. And based on some calculations, I did you know, off of some of the available data. I believe those discounts represent less than 2% in 2019 of the total U S drug sales. And so it’s, it’s really, to those discounts that are actually given or taken off are really too small to be a major driver of us spending or a major cause of increased drug spending and in pricing. But the other thing that I want to say about it is there is an inflation penalty against drug manufacturers that where they have to offer a bigger 340 B discount if they increase their retail list prices too quickly.

Jangus:
And so if anything, 340 B, not only do we do health centers pass the 340 B discount directly to patients every year and every day, but we also 340 acts as a, a throttle to prevent or a toggle, I guess, to prevent the drug manufacturers from increasing their list prices too high. And there was just an article that came out this month by Sean Dixon is that J D MPH. And he looked at these inflation penalties and whether or not these inflation penalties and 340 B and other programs like Medicaid haven’t increased or decreased the rise in drug prices. And what he found is that brand name drugs with higher sales percentages that were subject to the inflation penalties, like the 340 B penalty, they were associated with lower annual price increases. And there was no data to indicate that inflation penalties or discounts in 340 B were associated with higher price increases.

Jangus:
And so it supports the 340 B programs and it’s intent of helping safety net providers, but also how it actually lowers the drug prices. So drug manufacturers are incentivized to not raise their drug prices. And for the ones that do like, let’s say you know, there’s companies like Lilly right now that have penny price insulin, and this comes up all the time. And with some of the recent executive orders and other things, and companies like Lilly who have penny price, insulin are flaunting, sometimes marketing how this penny price insulin is, you know, as if it’s some charitable initiative by them to do good for patients. When in reality, the only reason that they have penny price 340 B products is because they have raised their drug prices so quickly. And so largely in relation to inflation that they’ve been subjected to an inflation penalty on 340 B, and it’s gotten all the way down to a penny.

Jangus:
So, you know, they they’re drug manufacturers were able to spin it in a way as if they’re doing something good, but in actuality, the bigger 340 discount is all due to because of them raising the list prices and not every drug manufacturer does that. But I just want to point that out because there has been a couple in recent weeks who have tried to change the narrative about how good are, how much good they’re doing for 340 B when in reality, one of them just removed all 340 B pricing without any notice. The covered entities gave us same day effective date on September 1st said today, we’re removing 340 B pricing. They give no other notice, and it was no way for ’em entities to plan and help our patients get these necessary medicines. But then a couple of weeks later come out with an article flaunting,uyou know, all the good they’re doing for 340B in for patients. And in reality, that’s just not true. Uin my opinion,

Michelle:
I mean, it’s, thank you for that. That was a great explanation. And I think cleared up a lot for, for our listeners. So what can HERSA do? What can we as pharmacists and advocate to do? I mean, how, how are we actually going to stop this assault? So

Jangus:
Can, and this is a, this is a loaded question. There’s there’s a lot of advocacy, of course, number one. So talking to your legislators, calling them, letting them know how important the 340 B program is to the millions of Americans and then the hundreds of thousands in your state who rely on it and millions potentially in your state, depending on how big you are. And, you know, letting them know, you know, if you are a constituent and you’re calling them and emailing them, letting them know that this concerns you and ultimately, you know, drug manufacturers have put a, you know, a cover over all of this, about how it’s about compliance and all that, but they’ve given no solutions and, and works towards some of these compliance things other than ways that are gonna directly boost their profits and hurt, covered entities.

Jangus:
And so it’s not collaborative. As much as a lot of these German manufacturers have said, it’s collaborative. It really has not been in, in some of these large scale attacks. And so advocacy by calling your legislators, look for national associations, like the national association of community health center. So they have press releases on their website and that’s N a C H c.org. And then other advocacy groups and patient groups and, you know, we’re really active on Twitter and LinkedIn. And so you know, I know Michelle yet, so you and I interacted on Twitter but sharing the narrative of, and when we have stories and we do have stories of patients that are affected by this, sharing those across your social media platforms, letting them know that, you know, this is real life, this isn’t some line item on a drug manufacturers, profit and loss sheet.

Jangus:
These are patient lives that are at stake. And, and so what we’ve wanted, right, is legislators, legislators have done a pretty good job so far of, of trying to push HERSA to step in and prevent this from happening and really hurts is, you know, they’re stuck between two different avenues. They can step in, and I believe they might be afraid of the drug manufacturers filing a lawsuit against them, or they can do nothing. And by tomorrow they risk getting a bunch of lawsuits from the covered entities and other association and things like that for them doing, for them doing nothing and patients suffering and not enforcing the intent of the 340 B statute that was intended in 1992 to give the in, in require them the drug manufacturers to give these discounts directly and, you know, to the covered entities. And so I feel like drug manufacturers are picking and choosing what parts of the statute language that they want to abide by.

Jangus:
And you know, are using some of the following years guidance to to basically script it in a way that, that tries to justify what they’re doing. But the fact of the matter is, is that patient lives are at stake. And if HERSA does not step in you know, I, we’re going to have health centers that have to close their doors, and that’s going to re reproduce access already when we’re in a primary care shortage in America, in the middle of a pandemic when people have lost their insurance due to lost employment. And, you know, we’re going to have patient lives on the line and services and comprehensive services that are not going to be accessible. So I know there’s probably so much more as well that people can do, I’m only brushing the surface, but you know, there’s, people need to be aware of what’s going on.

Jangus:
And you know, there’s a, a letter that HHS sent to Eli Lilly and basically telling them how Eli Lilly should not have assumed that her says inability to respond to their letter during a pandemic meant that HERSA approved what they’re doing. They didn’t say that they approve what they’re doing. And they said it was wrong for Lily to put that time, you know, a timeline, a deadline to them. And if there was no response, then go ahead and do this type of crazy attack on 340 B. And in that letter, HHS also mentioned how, you know, although the Academy’s rebounding that the unemployment and underemployment rates are still temporarily higher, higher now, and during COVID-19 than at the beginning of the year, and many Americans and small businesses have had difficulty making ends meet. Whereas Lily, on the other hand seems to be enjoying an outstanding year. The price of the Lily stock is increased by more than 11% since January 1st, reflecting among other things. The fact that the company’s comprehensive income jumped 1.4 billion during the second quarter of 2019 to 1.6 billion for the second quarter of 2020, an increase of more than 14% in the middle of a pandemic. And then they do this to patients.

Michelle:
You know, it’s just like you have no words to, to, to like grasp that even you know, one of the guys is, is like, Oh, we need, you know, all the data because there’s fraud at the pharmacies, there’s waste, there’s abuse, there’s this and that. And it’s like, really what you’ve just described is all those wrapped into one little neat package. And it’s, it’s like, so egregious, you know, Adam find from drug channels. I was reading this morning. He’s like September Roundup. And the, the bullet point that’s at the top of his September Roundup list is I agree. FQHC is, are not the problem in 340 B. So I think that just speaks to exactly what you’ve just described.

Jangus:
Yeah. I mean, FQHC is our 6% utilize or their 6% of the utilization of 340B and, you know, a hundred percent of our patients because of the type of entity we are, are eligible for 340 B. So you know, we’re hardly ever the compliance issues. And if there are compliance issues there, the other entities that are not in FQHC are still working very hard to to resolve those concerns in work, in good faith. And so this type of drastic measure is is outrageous. And, you know, one other thing I wanted to add is, you know, in HHS his letter, they mentioned how during the same period of time of their, you know, whatever percent billion increase of a comprehensive income during the pandemic that Lily had, many of our healthcare providers like covered entities that are under subject to 340B we’re, we are struggling financially already, and we are requiring federal assistance, the the provider relief fund and the cares act and other things during the pandemic.

Jangus:
And we are continuing to struggle and depend on emergency taxpayer assistance. So inadvertently the drug manufacturers removing 340 B from contract pharmacies like this, like Lilly, which giving us also a note time to prepare in Santa Fe, give us note, you know, all these things inadvertently, it’s going to, not only just the direct patients going to be affected, but even if you’re not a patient of a health center, it’s going to fall, the burden is this, the drug manufacturers have just increased their profits. Number one, shifted the burden on the patient. And now we’re going to shift the burden further on taxpayers because our entities like federally qualified health centers are going to have to rely on more federal assistance to serve our patients because we’re no longer going to be getting some of this 340 B assistance. And through our assistance and savings with 340 B program. So the drug manufacturers have effectively wiggled their way into increasing their profits at the expense of patients simplified their administrative, you know, their, their burden, and then shifted their a burden to the taxpayers. So even if you’re not a patient that’s affected, you are affected. And that’s just the reality, in my opinion,

Michelle:
No, I agree with you. It affects all of us. And for all the pharmacists out there listening, it affects everything that all of us do every single day in trying to take care of our patients. And I think this, this story is going to just continue and you know, all the, all, all your pharmacists out there, we’ve got to continue the fight. We have to fight and advocate every minute of every day for our patients, from all the fronts that we’re, we’re used to taking on this assault from. And Jengas, I want to thank you so much for, for being on the show. All these links and everything will be put into the show notes and links to your LinkedIn and Twitter and all the other organizations that you mentioned. So all the listeners can get on, get active. We have to keep fighting the fight because if we don’t do it, no one will do it. And remember all of you out there. It’s, it’s, it’s all up to you, Janice, before we end the show. Is there anything last words or anything else you want to say to the listeners?

Jangus:
You know, I, I guess my, my first, my last word would be thank you so much for inviting me number one and to share, and I, obviously, I, I’m pretty passionate about this and you know, I see day in and day out that direct harm to patients. And so you know, if anyone has any type of concern or misconceptions about 340 B and, and, and wants to talk more about that, please reach out. I would rather we start that conversation and talk through it and be transparent about what this program is and what it does for our patients. Because, you know, we’re, I’m, I’m such a fan of transparency and what’s going on and and making sure that we are, our patients are you know, taken care of. And, you know, a lot of these drug manufacturers are not very Fonda transparency.

Jangus:
And I’ll refer to that HSS letter again, where it looks like they’ve called Lily out about, Lilly’s trying to request that their letters to to HHS about these attacks remain exempt from the freedom of information act so that the public can’t see them and HHS, you know, responded back and said, you know, and denied that request saying, there’s no, there’s no real legal or confidential commercial reason why these should be held from the public. So in my eyes that tells me, Lily knows that what they’re doing in other drugs, in my eyes at other these drug manufacturers know what they’re doing is harmful to the public, whether that’s directly to patients or to taxpayers, and they don’t want the transparency about why this is going on and what they’re doing. It’s, it’s obvious that you know, they kind of wanted to fly under the radar of everything else that’s happening during this pandemic and, you know, increase the profits for their shareholders.

Jangus:
And, and, and, you know, we, there’s a group of us we’re going to continue advocating and we’re not going to let that happen. I, you know, I I’ve had nightmares about this. I’ve lost sleep over this. I, you know, I, you know, tiered over this because patients are a stake and you know, I wanna, I just want the public to know. And those that are listening that the, these jogging events are, they’re trying to hide some of what they’re doing, right? So we need to open our eyes to the fact that this is going to happen unless we advocate and push for some action to advocate for our patients. Some of the most vulnerable patients who can’t advocate for themselves that fall within the gaps of healthcare and low health literacy, other things you know, some are vulnerable patients who don’t have access to internet to advocate on social media, all these, a variety of things you know, access to telephones and things like that. So we need to advocate for our patients and our vulnerable patients. And so thank you again for inviting me on here. You know, I really appreciate it. I think this is a very volatile time. It’s a very unpredictable time, but ultimately it’s, it’s moments like this, where we’re getting together to share the stories that effect some of the positive and major change. So thank you, Michelle.

Michelle:
My pleasure, my pleasure. It is it’s it’s through these extraordinary times that we have to step up and we have to advocate for our patients and, you know, again, thank you so much for being on the show and to all the listeners out there. The conscious pharmacist podcast is a proud podcast on the pharmacy podcast network. And remember, you can do this, be the change.

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Michelle
Michelle