Don’t Harm Health Services for LGBTQI TGNCNB New Yorkers and People with HIV: Dangers of Pharmacy Benefit 340B “Carve-Out”

March 30, 2021

Assembly Member Richard N. Gottfried 
250 Broadway, 19th Floor
New York, NY 10007

RE: Don’t Harm Health Services for LGBTQI TGNCNB New Yorkers and People with HIV: Dangers of Pharmacy Benefit “Carve-Out” for 340B Drug Discount Program Safety Net Providers and HIV Special Needs Plans (SNPs)

Dear Assembly Member Gottfried,

We, the undersigned organizations, urge you to stand by your earlier commitment to delaying the Medicaid pharmacy carve-out in this year’s budget, and strongly advise that you listen to the community healthcare providers in your district and across New York State who are directly impacted by changes to the 340B program.

Equality New York and the NEW Pride Agenda have put repealing and delaying the Medicaid pharmacy carve out at the top of their budget priorities list because of the catastrophic impact on health services for Lesbian, Gay, Bisexual, Transgender, Gender Non-conforming, Non-binary, Questioning, Queer and Intersex New Yorkers (LGBTQI TGNCNB) and people with HIV. It is unacceptable for you or the Assembly to work with Governor Cuomo to undermine healthcare and life-saving services for LGBTQI and TGNCNB communities and people with HIV over the objections of healthcare providers.

We are also in the midst of a deadly COVID-19 pandemic, and such drastic changes will result in $245 million annually being taken out of the 340B community healthcare safety net, leading to service reductions, clinic closures, and disrupted healthcare delivery to New York’s most vulnerable New Yorkers covered by Medicaid and people who are uninsured.

We are deeply concerned about the effect the Medicaid pharmacy carve-out will have on these patients and community members, and the health care facilities and organizations that serve them. An explicit charge of the Medicaid Redesign Team was to “strengthen the sustainability of safety net providers serving vulnerable populations,” but this carve-out will have an opposite, destabilizing effect. New York’s safety net providers, including community health centers, Ryan White providers, hospitals, HIV Special Needs Plans (SNPs), and other community-based organizations already operate on thin to negative margins, and this year have been stretched beyond their limits due to COVID-19.

We strongly support the NYS Senate and Assembly positions opposing implementation of the carve-out. We urge you to stick to your earlier commitment of at minimum delaying the carve out for three years and collaborating with health care providers and legislators to find alternative reforms that will provide real savings and greater transparency in management of the pharmacy benefit without harming the state’s 340B community health program safety net, the HIV SNP model of care, and the people who rely on their services.

We strongly oppose Governor Cuomo’s proposal to proceed with the carve-out to fee-for-service and then develop a “reinvestment fund” for 340B providers. This “block funding” approach would be subject each year to the state’s budget process and would threaten the long-term viability of community healthcare providers. The “reinvestment fund” concept still has extensive cross-sector opposition. It also does not address the devastating impact of the carve-out on HIV SNPs and the impact on that model of care, which is critically necessary for the health and well-being of those living with and at risk for HIV.

Without the stability in planning that the 340B benefit provides, financing for neighborhood health clinics will be almost impossible for safety-net entities to secure. This will lead to clinics not opening in areas that need expanded primary care services, and it will lead to clinics closing in areas that also need life-saving services.

Moving forward with any kind of reinvestment fund will NOT mitigate the harm to the safety-net, even if the fund were upwards of $200 million. Caving to Governor Cuomo’s proposal will harm the very communities that you have spent your political career championing.

Safety net providers, HIV Special Needs Plans, and community organizations serving people living with HIV/AIDS (PLWHA), hepatitis B and C, have built a successful statewide system in New York that has saved countless lives and made tremendous progress toward ending the HIV/AIDS and the hepatitis B and C epidemics. Carving out the pharmacy benefit from Medicaid managed care will lead to decreased access to curative treatments for hepatitis C and a decrease in the HIV viral suppression rate across our state, thus threatening progress toward New York State’s goals of ending the HIV/AIDS epidemic (ETE) and eliminating hepatitis C.

We have seen too many friends and loved ones die of HIV/AIDS and hepatitis B and C. We have seen too many friends and loved ones die of COVID-19. It will greatly disappoint us if you side with Governor Cuomo to harm our community healthcare safety net.

This new policy will provide little to no benefit to the state and will devastate patients and the safety net providers they rely on for care. We urge you to re-commit to your earlier position of delaying the “carve-out” as soon as possible.

Signed,

ACR Health

Albany Damien Center

AIDS Healthcare Foundation

Ali Forney Center

All Souls NYC Pride Team

Alliance for Positive Change

Alliance for Positive Health

Apicha Community Health Center

Black and Latino LGBTQ Coalition

Brooklyn Community Pride Center

Callen-Lorde Community Health Center

Central NY HIV Care Network

Community HealthCare Network

Damian Family Care Centers

Dutchess County Pride Center

Empire Liver Foundation

Equality New York

Evergreen Health Services

Exponents

Harlem Pride

Harlem United

Hepatitis C Mentor and Support Group (HCMSG)

Hetrick-Martin Institute

Hispanic AIDS Forum, Inc.

Hispanic Health Network

Housing Works

Jim Owles Liberal Democratic Club

iHealth

Iris House

GLSEN Lower Hudson Valley

GMHC

Greater Rochester LGBTQ+ Political Caucus

Latino Commission on AIDS

Legal Action Center

National Black Leadership Commission on Health (Black Health)

National Working Positive Coalition

NEW Pride Agenda

New York Transgender Advocacy Group (NYTAG)

NYC Pride and Power

NYS Harm Reduction Association

Oni Blackstock, MD, Health Justice

PFLAG NYC

Pride Center of Staten Island

Pride Center of Western New York

Reclaim Pride Coalition

Rochester Area Task Force on AIDS

SAGE

Sakhi for South Asian Women

SOAR Institute

Translatina Network

The Institute for Family Health

The Lesbian, Gay, Bisexual & Transgender Community Center

The Queens Lesbian and Gay Community Center, DBA: Queens Pride House

TOUCH (Together Our Unity Can Heal)

Trillium Health

Uche Blackstock, MD, Advancing Health Equity

Upper Hudson Planned Parenthood

VOCAL -NY

W.A.V.E – Women Appropriating Visibility and Empowerment

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