Rep. Axne Leads Fight Against Increasing Costs on Insulin and Epinephrine

September 15, 2020
Press Release
Axne letter with over 100 cosigners urges change to an executive order from July that would raise the cost of insulin, epinephrine for patients of community health centers

Today, Rep. Cindy Axne (IA-03) led a letter to U.S. Department of Health and Human Services (HHS) requesting they rescind or decline to enforce an Executive Order which would drive up the costs of insulin and epinephrine for patients at community health centers (CHCs).

On July 24th, the Trump Administration issued an Executive Order that mandates community health centers sell insulin and epinephrine ‘at cost’ – which puts drug price variation in full control of the drug manufacturers. This eliminates CHCs’ flexibility to provide sliding-scale payment methods, free and reduced medications, and other options for low-income patients in need of these lifesaving medications.

“Lowering the costs of prescription drugs should be a key priority for all of government, but this Executive Order missed the mark,” said Rep. Axne.I commend any effort to tackle the skyrocketing costs of prescription medications, but by targeting the centers providing these medications to those without insurance or the means to get the care instead of big pharmaceutical companies, HHS risks making things worse for a community already in need. Community health centers provide critical lifelines in our communities. They aren’t the reason why drug costs, especially insulin costs, are too high in this country.”

Earlier this year, Rep. Axne conducted a prescription drug survey to hear directly from Iowa’s Third Congressional District about the rising costs of medications.

One of Rep. Axne’s constituents shared that his insulin was more expensive per ounce than gold.

Support from Community Health Centers:

The July 24th Executive Order charges that CHCs are marking up the sale of these prescription medications but offered no supporting evidence.

Instead, study after study has shown that CHCs are able to provide medications at well below market value and the cost they were purchased. 

“We are incredibly grateful to Representative Axne for leading this letter in support of Community Health Centers and their work to ensure that underserved and vulnerable individuals can access affordable prescription drugs, including insulin and epinephrine,” said Steve Carey, Chief Strategy Officer of the National Association of Community Health Centers (NACHC). “By law, regulation, and mission, every penny that health centers save through the 340B program is used either to make medication affordable for low-income patients, or to support other activities that expand access to care. We cannot underscore enough how vitally important such discounts are as health centers battle COVID-19 on the frontlines of hot zones across America. We deeply appreciate the leadership of Representative Axne and the support of many members of Congress who cosigned this letter.”  

“Congresswoman Axne is a strong supporter of community health centers, which is clearly demonstrated through her leadership of this letter. The Iowa Primary Care Association and our member community health centers are grateful for her support and for her advocacy on behalf of community health center patients, staff, and the communities served in not only Iowa, but across the country,” said Aaron Todd, Chief Executive Officer of the Iowa Primary Care Association. “Community health centers and the 340B program are part of the solution to ensuring all Americans have access to low-cost pharmaceuticals. The attack on community health centers is misguided and could lead to devastating impacts for those who need access to these life-savings medications. We are proud of Representative Axne’s leadership and are grateful for the many other supporters in Congress that are taking a stand for community health centers.” 

The full letter:

Over 100 Members of Congress joined Rep. Axne’s efforts to request that the Administration repeal or not enforce this order.

The full text of the letter can be found below:

Dear Secretary Azar, Administrator Engels, and Associate Administrator Macrae,

We write today expressing our concerns with the Executive Order on Access to Affordable Life-saving Medications (“Executive Order”) issued July 24, 2020. As issued, the Executive Order targets how the 340B Drug Pricing Program applies to Federally Qualified Health Centers (FQHCs), commonly known as community health centers (CHCs), for two medications – insulin and epinephrine. While we share the goal of tackling high drug prices, we worry that the Executive Order jeopardizes the ability of CHCs to offer affordable medications to our most vulnerable populations under the 340B Drug Pricing Program. 

CHCs provide access to affordable, high-quality primary and preventive healthcare to millions of low-income and medically underserved individuals, regardless of their ability to pay. There are more than 1,400 community health centers nationwide providing care at more than 12,000 sites in every state and territory. Together, they serve nearly 30 million patients, 20% of uninsured persons; 91% of those patients are low-income individuals.

Congress created the 340B Drug Pricing Program in 1992 requiring drug manufacturers to sell prescription drugs to safety-net healthcare providers – those that provide care to the nation’s most vulnerable populations – at discounted prices. Because of the 340B Program, health centers have access to outpatient drugs at reduced prices, enabling them to provide accessible pharmacy services and affordable medications to their patients. 

The recent Executive Order targeted at CHCs charges they do not pass along savings from two drugs acquired through the 340B Program – insulin and epinephrine – to low-income patients. However, CHCs have proven to be good stewards of the 340B program. CHCs are already providing access to these lifesaving medications at significantly discounted costs to the underserved, uninsured, and underinsured populations they serve. 

Targeting CHCs’ use of the 340B Program is ill-suited to achieving the goal of providing prescription drugs at lower costs; in fact, it damages this goal by potentially limiting CHCs’ ability to participate in both existing programs and innovative new approaches to providing prescription drugs at affordable prices. Even as CHCs continue to provide affordable prescription drugs, every program has costs associated with administering and dispensing prescription drugs. The 340B Program is no exception. Mandating CHCs provide prescription drugs at cost would risk participants having to withdraw from the program, thereby limiting access to affordable prescription drugs for medically underserved patients and further exacerbating the issue of unaffordable prescription drugs for all Americans.  

As federal grantees, CHCs are subject to intensive and ongoing oversight from the Health Resources and Services Administration (HRSA), which administers the 340B Program. Further, by law and by mission, savings that result from participation in the 340B Program are used to ensure that medications are affordable for the most vulnerable patients. These savings are also used to offer essential primary care services that would have otherwise been unfunded and therefore unavailable in communities that rely on CHCs. Some examples of those essential services include behavioral health and substance abuse services, oral health care, innovative chronic disease management programs, and numerous community health outreach programs.  

Our nation’s CHCs are trusted safety-net providers committed to ensuring access for all, and right now they are playing a vital role on the frontlines of the fight against COVID-19. It is critical that Congress continue its support of CHCs and their ability to utilize the 340B Drug Pricing Program to provide accessible and affordable medications and care for their patients. 

The Executive Order may be well-intentioned, but it is not the solution to our country’s high drug prices. We need longterm, sustainable solutions that build on programs that work – like the 340B Drug Pricing Program – and go further. CHCs have consistently supported efforts to reduce drug prices, have demonstrated ability to help their patients access affordable prescription drugs, and are committed to being part of the solutions that reach our shared goal of lower drug prices. 

We therefore urge you to rescind or not implement the July 24 Executive Order on Access to Affordable Life-saving Medications to provide administrative clarity and financial certainty for our nation’s community health centers.

Thank you for this attention to this important matter.