Local clinics ask county for written policy after hospital’s 340B specialty-pharmacy plan could require annual hospital visit

Representatives of Greenville Clinic and the county hospital discussed specialty-pharmacy access and 340B program rules at the Dec. 3 Washington County Board of Supervisors meeting, and clinic leaders asked the board to require a written policy before the county moves forward.

Gina Spratlin, identified in the meeting as the Greenville Clinic’s clinic administrator, told supervisors she had discussed the county’s proposed approach with hospital staff but had not seen a formal process in writing. She said independent local clinics are concerned that the hospital’s plan—under which patients taking certain high-cost specialty drugs would need to be seen by a hospital-employed physician at least once per year for prescriptions to qualify for 340B pricing—could divert patients from existing community providers. “If we don't have something in writing…we've seen this type of situation before. The diversion of patients can easily happen,” Spratlin said.

John Michael Deal, identified as the hospital’s pharmacy director, said the hospital was not trying to “steal patients” and described a proposal targeted at about 26 high-cost drugs. Deal said the hospital would ask patients to see a hospital physician one time per year, review the record, and then refer the patient back to their primary-care or specialty physician. “Those patients would come see one of our resident physicians one time, review that patient history, and then we refer them back out to their primary care doctors or their specialist,” Deal said.

Spratlin and other independent providers expressed concern about possible diversion to residents or other hospital-employed physicians and about how telehealth visits would be treated. Hospital staff said telehealth visits were discussed as a possible accommodation but that the practice and any telehealth process would need physician agreement. Both sides agreed that a written document describing the workflow and safeguards is needed before the program is expanded. The board directed staff to arrange a follow-up meeting for hospital leaders and independent clinics to draft a clear, written process and return it to the board for review.

Why it matters: The outcome affects how county employees and indigent patients access expensive specialty medicines and could change patient referral patterns among local providers. The 340B program (HRSA) permits covered entities to obtain discounted drug pricing under specific rules; meeting participants said HRSA rules require prescriptions to originate from the covered entity or its registered child sites.

Sources: On-the-record remarks by Gina Spratlin (Greenville Clinic) and John Michael Deal (hospital pharmacy director) during the Dec. 3 Washington County Board of Supervisors meeting.