Opinion | A drug safety net program is leaving Black Michiganders behind

Across Michigan and our country, Black individuals suffer from chronic illnesses and disability at a greater rate. Black Americans are twice as likely to develop diabetes or die of a sudden cardiac arrest compared to White Americans. In Michigan, the mortality rate from heart disease and stroke is 1.4 times higher for Black residents than for White residents.

It’s why I led efforts during the COVID-19 pandemic to bring Choose Healthy Life to Michigan. Choose Healthy Life is a national program that funds Black churches to hire a trusted health navigator from within the local community to address the health inequities that exist.  Programs like Choose Healthy Life are truly having an impact on the health of those who need it most.

For the Black communities we serve, federal safety nets, such as the 340B Drug Pricing Program, are vital to enable our neighbors to afford and access their medications. This is especially true as more Michiganders navigate the challenges of inflation and struggle to put food on the table and pay their bills. That’s why it’s so discouraging to see the Michigan Legislature consider reforms to 340B that would allow for uncontrolled exploitation of the program, rather than ensuring that the most vulnerable among us benefit from drug discounts.

The 340B program was established with the intent to help vulnerable low-income and uninsured patients access their prescription medicines. The program requires drug manufacturers to give discounts on prescription medicines to certain health organizations, often called “covered entities” and for-profit “contract pharmacies.” The intent was — and still is — for these organizations to pass 340B drug discounts on to patients to help them afford their medications. In concept, 340B has good intentions to ensure treatment access and eliminate inequities in care for those in Michigan and beyond.

Instead, the 340B program has become a huge profit driver for corporate pharmacy chains and big hospitals in Michigan. Walgreens and CVS  account for 60% of the contract pharmacies in the program today, and a 2020 report found that the average profit margin on 340B medicines dispensed through contract pharmacies was 72%, compared with just 22% for non-340B medicines. Meanwhile, most patients are receiving 0% in prescription medication discounts even though the medication was purchased at a 340B discount.

To make matters worse, access to contract pharmacies has decreased in the low-income, predominantly Black and Hispanic communities the program was intended to serve. In Michigan, 13% of residents live below the poverty line, relying on federal safety net programs like 340B to access essential health services. Yet in Michigan, only 28% of contract pharmacies are located in medically underserved areas and 92% of 340B hospitals are below the national average for charity care levels. One study found that there is a disproportionate divide between 340B profits and charity care as 340B hospitals in Michigan make more than 8.5 times as much from 340B as they spend on charity care. All the while, the most vulnerable patients among us are struggling to afford their care.

While the evidence tells us a scathing story about 340B, Michigan legislators have proposed H.B. 5350, which would only fuel these abuses from big hospitals and big pharmacies instead of prioritizing underserved patients in Michigan. The unintended consequences of this legislation could put community health, especially in our Black community, at risk across the state.

This June, Choose Healthy Life joined numerous other advocacy groups in testifying in strong opposition to H.B. 5350, urging the Michigan House of Representatives to instead focus on patient-centered reforms that would help the most vulnerable in Michigan access their medicines.

In our work in Michigan, we focus on providing Black churches — the oldest and most trusted institution in the Black community — with the necessary resources, training, and support to address health disparities in hard-to-reach communities. Frankly, H.B. 5350 would do more harm to the Black community than good and is not a solution that will help our neighborhoods in need. The intent of the 340B program when it was founded was to help communities like the ones we serve at Choose Healthy Life.  If this program was run correctly, the people most in need would actually benefit from it.

Michigan legislators should oppose H.B. 5350 and instead focus on patient-centered reforms that will help the most vulnerable people in Michigan manage their health.