BUFFALO, N.Y. — For some patients in New York state, getting health care services is not as simple as making an appointment at a family practice.
“Even still today, I’m experiencing where other providers treat me a certain kind of way because they know my history,” Evergreen Health patient Liza Periera said.
Pereira contracted HIV nearly three decades ago through the use of intravenous drugs. Today she’s living with the virus, under control she says, thanks to the care she’s received at Evergreen Health.
“If I didn’t have people like Evergreen and the services they provide, right, I wouldn’t be sitting here having this conversation with you,” she said.
Pereira said she needed much more than medication. Evergreen helped her with things like housing, food and counseling.
“Having Evergreen here to help me to deal with me as a person, to talk to me, to let me know that these services are available if I ever, God forbid, needed them again, it’s a livesaver. They have literally saved my life.”
The 340B medicaid program allows community health organizations to purchase prescription drugs at a discount and be reimbursed for the retail price. Evergreen CEO Michael Lee said the difference, about $14 million annually for his organization alone, pays for those other wrap-around services that also include things like transportation and dental.
“All those things play into a patient’s care and those are things that are either under-reimbursed by the current health care system or not reimbursed at all by the payers,” he said.
In April, a policy put in place under former Gov. Andrew Cuomo is set to take effect in which the state will now handle the prescription purchasing, and in the process, take the financial windfall. Lee said while the state is promising to make sure their costs, continue to be covered there is no guarantee.
“The reality is, it’s December. We’re looking at April,” he said. “There’s nothing in place. There’s no mechanism in place. There is no pot of money, and by the way, the Department of Health doesn’t have the authority to just say we’re going to create this pot of money in perpetuity. It’s subject to annual appropriations that would have to be a budgetary thing.”
Evergreen is preparing for a potential fiscal cliff in which it may have to cut hundreds of jobs and scale back services in a few months. Community health organizations are pushing for the state to delay implementation until all sides can come together to develop a long-term solution.
“We absolutely need some breathing room to figure this out,” he said.
Pereira said she’s scared.
“Not only does it affect me, it affects my family. It spills over into the community,” she said.
Lee points out Evergreen, like these other organizations, is a safety net specifically aimed at helping the most underserved segments of the community.
“The State Fiscal Year 2021 Budget delayed the transition of pharmacy services from managed care back into fee-for-service to April 1, 2023. The transition is expected to result in a more efficient pharmacy reimbursement process, better consumer experience and higher rebates from drug manufacturers. The 340B program is a Federal Program that is not being eliminated. The Department of Health is working with the impacted groups and is committed to ensuring a smooth transition,” a Department of Health spokesperson said.
The governor’s office has not yet provided comment.