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1. Call to Order

2. Chairs’ Report

   1. DelRay meeting - NACHC of the future: How to best support health centers

      1. CEO search

      2. Reorganization

   2. 340b Day at this conference is a result of this Subcommittee

   3. Sue Veer

      1. NACHC is at a point of Transformational Leadership - inspired to work beyond limitations for a shared vision

      2. We in a squeeze play with the pharmaceutical companies - the pharma companies are saying they will reimburse if they get information (?)

      3. HRSA is changing definition - from providing service to a patient in a location; now HRSA is saying “responsibility of care” regardless of site, useful when opening a new site.

3. Federal and State Policy Update

   1. Boehringer Ingelheim (?) - restrictions

   2. Is it time to part from the hospitals? Interests do not align. DISH hospitals are 70% of the program in terms of buying.

      1. What would the backlash from hospitals likely to be? NACHC would have to launch a PR campaign from grantee perspective. Message would be health centers need to move forward. NACHC was instrumental is growing the

      hospitals?

      1. 340b Conference.

      2. Issue: Hospitals and some FQHCs are linked in some cases, in which FQHC provides the primary care as an arm of the hospital. How would they be impacted?

      3. Is that language that we would be advocating for CHC-specific protections? We could go in with critical access hospitals, children’s hospitals, rural hospitals (America’s Essential Hospitals) the language would be general - prioritize CHC 3040b programs, recognizing that we would not have support from the hospitals.

      4. NACHC does a great job of doing one pagers with great bullet points - Pharma does a great job of that.

   3. NACHC has pharmacy legislation - introduce it in the Senate, because we already have something in the House that we do not want to slow down

      1. requires pharmaceuticals to sell 340b drugs at …

      2. refusal to ship drugs is a violation of 340b statute

      3. Codify Codifies existing 2010 contract guidance, giving HRSA some guidance authority (?)

   4. Information would exist on a neutral clearinghouse

   5. NACHC is working with the Ryan White program? grantees? as their interests are in alignment with NACHC

   6. Have 4 recommendations come forward to the NACHC Board on 340B- Health Policy Committee, Behavioral Health, Health Center Finance, Behavioral Health

4. Reports

5. Open Discussion

   1. Mary B - In Connecticut, can bill Medicaid rates and for the device itself. Illinois can bill for the device and the insertion.

      1. Cases - rule is regressive - if we (VFC) if we offer free Shingrix for example, to VFC then we have to offer to those who have insurance but not well insured - underinsured.

      2. Contraceptives

      3. Women’s reproductive health group with Sarah Rosenbaum - invite them to our next meeting to hear what they are doing.

   2. Vaccines

      1. the public is coming in now that they know they can get vaccines, CHCs are not reimbursed to give vaccines, nurses are giving vaccines and we also need them to do

      2. Regulations

      3. Temperature control (fridges $28,000)

   3. Do a survey or discussion on what our members want to look at:

      1. VFC

      2. Ask the CFOs What percent of your pharmacy spend is related to vaccines?

      3. work with other organizations - American Cancer Society on HPV

      4. Biggest spend: HPV, pneumoccocal

   4. Pharmacists as providers

      1. Are we seeing movement in states? (Vicki Young) maybe address through scope of practice?

         1. Montana has a .. through rule, Medicaid pays it as a standard visit, payors are doing pilots using the clinical pharmacist practitioner - over the last 8 years. Washington does this but it gets taken back (Jennifer). Not in the list of … providers so we have to hand the money back. Can keep commercial money but not federal money - Medicaid.

         2. How do we get MAs to do vaccines (not subcutaneous) as part of scope of practice, and then advance the idea of getting them paid for it. This way nurses are more free to work with complex patients.

         3. Sue Veer - Pharmacist doing wellness visits - counters from MDs, but if you…. then MDs can be supported. Pharmacist gets to keep the RBUs. Provider gets a portion.

         4. Kathy - NACHC will convene a meeting with CDC regarding pharmacists as providers Kathy and Sarah will convene (on vaccines? not pharmacists as providers?)

6. Recommendations to the Board

   1. NACHC will advocate to prioritize CHC-specific 340B protections and commit all needed resources to highlight our patient populations. Vote to bring this to the Board was unanimous.

   2. NACHC will continue to explore federal and state regulatory legislative strategies. to advance pharmacists as. providers for reimbursement.

      1. - to document which states are … pharmacists as providers (recommendation #2 - Jennifer has wording) It is already on the list from Jeremy Crandall - report out on the next meeting. Identify what states. Unanimous.

7. Next Meeting
   Community Health Institute (Policy and Issues Forum):
   Marriott Marquis, Washington DC March 8 – 11, 2023
   Committee Meetings: March 6 and 7th (likely March 6 at 8:30am Eastern)

   1. As part of NACHC Million Hearts work, NACHC? CDC? did a cross-walk with the formularies for all 50 states. Medication reconciliation team.

   2. Integrating clinical pharmacists into the team is like integrating behavioral health - it is an intentional effort.

8. Adjourn

Attendees

• Jennifer Kreidler-Moss

• Vicki Young

• Kema Alli

• Sue Veer

• Anthony Armstrong

• Hannah Rowell

• Mary Blankson

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• Rudy Williams , PR Consultant

• Montana PCA

• blue bag Collean (Lyman?)

• white sweater

• Ron Yee

• Coral blouse

Not present

• Nicole Thibeau

• Anthony Fortenberry

• Marisa Rowan

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