Priya Desai on what FQHCs lose if the 340B fight goes the wrong way
The COO of Coastline Community Health Network argues the policy conversation has drifted away from the populations 340B was designed to serve.
Priya Desai is the chief operating officer of Coastline Community Health Network, a 19-site federally qualified health center system serving roughly 84,000 patients across coastal California. She is also, by her own description, tired of explaining 340B to people who have decided what they think before the conversation starts.
The 340B Drug Pricing Program lets safety-net providers, including FQHCs, buy outpatient drugs at significant discounts and apply the savings to expand patient services. Critics, mostly drug manufacturers and the trade press they fund, have framed the program as a loophole exploited by large hospital systems. Desai's view is that the framing has bled into the FQHC conversation in ways that misrepresent what the program actually does at her network.
"At Coastline, 340B savings fund our medical transportation program, our diabetes group visits, and the dental sliding scale," she said. "None of those are profit centers. They are the reason patients show up." She walked through specific line items: roughly $4.2 million in 340B-attributable savings last fiscal year, of which 71 percent went directly to non-billable patient services that no other payer reimburses.
“If we lose 340B savings, the first thing that goes is the bus that brings patients to the clinic.”
Desai is careful to distinguish FQHC use of 340B from the contract-pharmacy expansion at large hospital systems that has drawn most of the criticism. "There is a real conversation to have about how 340B has scaled. We can have it. But that conversation should not collapse the program for safety-net clinics serving Medicaid and uninsured populations."
Her closing argument was operational and unglamorous, which is how she prefers to argue. "If we lose 340B savings, the first thing that goes is the bus that brings patients to the clinic. Then it is the bilingual community health workers. Then it is the dental program. The harm shows up fastest in the things that were already hardest to fund."