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Surgical protocol reduces opioid use for breast reconstruction patients

Breast cancer surgeries can be quite painful, so a team at Houston Methodist West Hospital has worked to develop pain management protocols that help some patients while reducing the use of narcotics.

Dr. Candy Arentz, a breast surgical oncologist, and Dr. Warren Ellsworth, a plastic surgeon, have been using an enhanced recovery after surgery (ERAS) protocol with non-narcotic medications and nerve blocks to lessen pain and the need for narcotics in reconstructive surgeries.


A DIEP flap reconstruction uses tissue and fat from the abdomen and other areas to reconstruct the breast after a lumpectomy or a mastectomy. Ellsworth said the reconstruction can be beneficial because it can look more natural than implants and can last the rest of a patient’s life. But it can be more painful because of the extra incisions. He recognizes that opioid overuse is an issue and said that is just one reason why he and Arentz are working to reduce opioid use.

“We have also, I would say, across the entire house of medicine known about this opioid overuse, opioid dependence and all these challenges that our narcotics impose on our patients, not only the basic side effects of narcotics like nausea, vomiting, constipation, but of course, the dependency,” Ellsworth said.

The ERAS protocol helps patients with pain starting the day before the surgery. “So it prepares their body for the surgery and the pain that could occur, and then we continue the pain control throughout the surgery and then of course postoperatively and have found a significant reduction in the use of narcotics because of this protocol,” Ellsworth said.

As Arentz and Ellsworth were coming up with the protocol, Ellsworth consulted with plastic surgeons at the University of Pennsylvania and Stanford University, modeling the Methodist West protocol after their programs. But according to Ellsworth, Methodist West is the first in the Houston area to make the non-narcotic protocols a priority with their patients in the area of DIEP flap reconstructions.

Ellsworth said starting ERAS required bringing in others in the hospital on board, including the head of anesthesiology so that anesthesiologists could administer nerve blocks, or long-lasting numbing injections into patients’ nerves, and the head of the ICU (intensive care unit) because the new protocols were a big change in pain management. Arentz said it required patient buy-in as well.

“It starts with our conversations in clinic and assuring the patients that they will have decreased pain afterwards than probably what they were expecting,” Arentz said, adding that the protocol is done without using IV medications, which is what most people expect when they are going to have surgery.

Arentz and Ellsworth had planned to start using ERAS in February or March, but COVID-19 shifted it back some. So they started in April. Ellsworth said that all

MD Anderson’s hurricane checklist for breast cancer patients

Many Houston-area residents experienced at preparing for hurricane season have likely already stocked their home with basic supplies such as extra batteries, a first-aid kit, rain gear and a 7-day supply of non-perishable food and water among other essentials needed to weather a severe storm and its aftermath. But breast cancer patients should be aware to also have additional supplies on hand, especially as Texas continues to face new challenges created by the COVID-19 pandemic, making it more important than ever to plan ahead.



a person riding a wave on a surfboard in the water: In this file image, a GOES-16 GeoColor satellite image taken Saturday, Sept. 19, 2020, and provided by NOAA, shows Tropical Storm Beta, center, in the Gulf of Mexico. A hurricane watch is in effect Saturday for coastal Texas as Tropical Storm Beta gains strength. A storm surge watch and a tropical storm watch are also in effect for the area during an exceptionally busy Atlantic hurricane season. (NOAA via AP)


© Associated Press

In this file image, a GOES-16 GeoColor satellite image taken Saturday, Sept. 19, 2020, and provided by NOAA, shows Tropical Storm Beta, center, in the Gulf of Mexico. A hurricane watch is in effect Saturday for coastal Texas as Tropical Storm Beta gains strength. A storm surge watch and a tropical storm watch are also in effect for the area during an exceptionally busy Atlantic hurricane season. (NOAA via AP)


“Cancer patients are often at greater risk of contracting an infection. So, try to get everything you need early on, to avoid the last-minute crowds in stores,” Marian Von-Maszewski, M.D., associate medical director of Critical Care at MD Anderson said. “It’s almost impossible to maintain adequate social distancing in those situations. And that could prove to be more dangerous than the storm itself.”

Von-Maszewski shared recommended hurricane preparation measures for cancer patients in a recent article published by the MD Anderson Communication Department. First off, breast cancer patients are advised to include an adequate supply of face masks, gloves and hand sanitizer.

“Evacuation could pose a risk,” Von-Maszewski said. “Face masks will be especially important if patients have to stay in crowded shelters.”

Flood water and other standing water are also a potential source of infection and breast cancer patients are advised to add mosquito spray to guard against insect bites, and antibiotic cream and bandages to cover any open wounds to their hurricane supplies.

Plan ahead for a hurricane during the COVID-19 pandemic

Plan ahead and be sure to maintain at least a two-week supply of any current medications. Make a list of all your current medications and their dosages, and talk to your doctor about what to do if you have to miss a dose or treatment. In addition, prepare a dedicated cooler with ice packs or frozen water bottles for medications that need to be kept refrigerated. Research the location of the nearest emergency room and how to get there. Call your insurance company in advance to be sure which ones are covered by your policy. Remember to keep your car’s gas tank full, too, in case you need to seek medical attention or quickly evacuate.

Organize your medical information in one place

It’s possible you won’t immediately be able

Study: Medicines, frequent counseling helps cancer patients quit smoking

Oct. 13 (UPI) — A program that included telephone counseling sessions and one of two smoking cessation drugs was 50% more effective than telephone consultations alone at helping cancer patients quit smoking, a study published Tuesday by JAMA found.

Among cancer patients who underwent treatment with four bi-weekly and three monthly counseling sessions by telephone and either bupropion, marketed as Wellbutrin, or varenicline, marketed as Chantix, for up to six months, 35% were able to successfully quit smoking, the data showed.

But only 22% of the cancer patients who underwent treatment with the telephone counseling sessions had successfully quit after six months, according to the researchers.

“Counseling plus medication is the state-of-the art tobacco treatment for cancer patients,” study co-author Elyse R. Park told UPI.

“Smoking cessation assistance should be an integral part of cancer care and sustained tobacco support can be effective for cancer patients who smoke,” said Park, an associate professor of psychiatry at Harvard Medical School.

More than 34 million adults in the United States smoke, and some 16 million are living with smoking-related diseases, including cancer, according to the Centers for Disease Control and Prevention.

Up to 20% of cancer survivors continue to smoke, despite the fact that quitting improves prognosis with the disease, research suggests.

For their study, Park and her colleagues evaluated smoking cessation treatment programs in 303 adults recently diagnosed with breast, gastrointestinal, genitourinary, gynecological, head and neck, lung, lymphoma or melanoma cancers.

Roughly half — 153 — underwent “intensive” treatment for smoking, with telephone counseling and their choice of bupropion or varenicline, with the rest receiving “standard” care, with telephone counseling only, for up to six months, the researchers said.

Both bupropion and varenicline have been approved for smoking cessation treatment by the U.S. Food and Drug Administration.

The most common adverse events in the two treatment groups were nausea, rash, hiccups, mouth irritation, difficulty sleeping and vivid dreams, and all were more common in the patients who received “intensive” care, the researchers said.

“Nausea is a side effect of varenicline, so [its use] should be monitored for patients who are experiencing nausea from their cancer treatment,” Park said.

In addition, patients on tamoxifen for breast cancer should not take bupropion, or receive a reduced dose, because of interactions between the two drugs, she said.

Source Article

COVID On The Rise In UK As More Patients In Hospitals Than In March

KEY POINTS

  • England’s emergency nightingale hospitals will be used again in the north of the country to provide extra capacity for local health services amid a steep rise in COVID-19 infections, The Guardian reported
  • Jonathan Van Tam, England’s deputy chief medical officer, argued that infection rates are rising fast in northern England due to the fact that the COVID infection rate never dropped as far as it did in the south during the summer
  • Prime Minister Boris Johnson implemented new COVID-19 restrictions for specific England regions, where infection rates are spiking

COVID-19 admissions are rising in the U.K., with a growing number of elderly people needing urgent treatment. According to the Guardian, England’s emergency Nightingale hospitals will be used again in the north of the country to provide extra capacity for local health services amid a steep rise in infections.

Stephen Powis, national medical director of NHS England, said that temporary hospital establishments used at the height of the pandemic will be reopening and can accept patients within a few weeks. 

This is the first time any of England’s seven Nightingale hospitals have been brought back into service after being placed on standby as infection rates dipped during the summer months.

Prime Minister Boris Johnson implemented new COVID-19 restrictions for specific England regions, where infection rates are spiking. 

Jonathan Van Tam, England’s deputy chief medical officer, argued that infection rates are rising fast in northern England due to the fact that the COVID infection rate never dropped as far as it did in the south during the summer.

Powis, speaking alongside Van Tam at a press conference, said that there were now more coronavirus patients in England hospitals than before national restrictions were introduced on March 23.

Hospitals in the northwest and northeast had seen a significant increase in COVID-19 patients requiring intensive care in the past four weeks, he said. “If infections continue to rise, in four more weeks they could be treating more patients than they were at the peak of the first wave.”

“Pandemic fatigue” has set in across Europe, with France and Spain seeing a surge. Madrid has become a COVID hot spot.

In the U.S., 54% of rural counties are seeing a sharp uptick in COVID cases, according to the Daily Yonder, which covers rural America.

Source Article

Patients getting slammed by surprise costs related to COVID-19

COVID-19 can do more than torment patients physically. It also clobbers some financially.

Even though many insurers and the U.S. government have offered to pick up or waive costs tied to the virus, holes remain for big bills to slip through and surprise patients.

People who weren’t able to get a test showing they had the virus and those who receive care outside their insurance network are particularly vulnerable. Who provides the coverage and how hard a patient fights to lower a bill also can matter.

There are no good estimates for how many patients have been hit with big bills because of the coronavirus. But the pandemic that arrived earlier this year exposed well-known gaps in a system that mixes private insurers, government programs and different levels of coverage.

“There are in our system, unfortunately, lots of times when people are going to fall through the cracks,” said Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms.

More than 7 million people have had confirmed cases of COVID-19 since the virus started spreading earlier this year in the United States, according to Johns Hopkins University.


Alarming spike of COVID-19 cases across the U…

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The vast majority of those patients will incur few medical costs as they wait for their body to fight off mild symptoms. But patients who visit emergency rooms or wind up hospitalized may be vulnerable financially.

No test, no coverage

Melissa Szymanski spent five hours in a Hartford, Connecticut, emergency room in late March and wound up with bills totaling about $3,200.

The problem: The 30-year-old elementary school teacher couldn’t get a test even though she was fighting a fever and her doctor wanted a chest X-ray. At the time, the hospital was limiting tests, and she didn’t qualify.

Szymanski was never diagnosed with COVID-19 at the hospital and her insurer, Anthem BlueCross BlueShield, said she would have to pay the high deductible on her plan before coverage started.

The bill left her flabbergasted.

“I was surprised that I got a bill because it just so clearly seemed to be COVID,” said Szymanski, who also shared her story with the nonprofit Patient Rights Advocate.

Szymanski later got a blood test that showed she had the virus, and she’s working to reduce the bill.

Medicaid picked up all costs

Mary Lynn Fager also got sick in late March from a suspected COVID-19 case, and she has not received a single bill. Fager spent four days in a hospital on oxygen and has had several doctor appointments.

She eventually asked someone at the hospital about the cost, and they said she shouldn’t receive any bills. Fager had lost her job in March and qualified for New York’s Medicaid coverage program. She said it picked up all the costs.

“I couldn’t believe it,” she said. “Even when I couldn’t breathe, that was in the back of my mind the whole time I was there. I was thinking about the hospital bills.”

Separately, the federal government has

Ontario reports record-high 939 new patients on Friday, leading to new restrictions [Video]

On Friday, Oct. 9, Ontario reported a record-high 939 new cases of COVID-19. The update is part of a worrisome trend that has been developing in Canada’s most populous province, which has led to Premier Doug Ford announcing new restrictions for its three three hotspots.

For more on today’s top stories and the spread of the novel coronavirus across the country, please refer to our live updates below throughout the day, as well as our COVID-19 news hub.

18,784 active COVID-19 cases in Canada: 177,600 diagnoses, 9,583 deaths and 149,233 recoveries (as of Oct. 9, 11:00 a.m. ET)

  • Alberta – 2,097 active cases (19,718 total cases, including 283 deaths, 17,338 resolved)

  • British Columbia – 1,394 active cases (10,066 total cases, 245 deaths, 8,398 resolved)

  • Manitoba – 863 active cases (2,344 total cases, 27 deaths, 1,454 resolved)

  • New Brunswick – 24 active cases (225 cases, 2 deaths, 199 resolved)

  • Newfoundland and Labrador – 4 active case (277 total cases, 4 deaths, 269 resolved)

  • Northwest Territories – 0 active cases (5 total cases, 5 resolved)

  • Nova Scotia – 3 active cases (1,089 total cases, 65 deaths 1,021 resolved)

  • Ontario – 5,652 active cases (57,681 total cases, 2,997 deaths, 49,032 resolved)

  • Prince Edward Island – 3 active case (61 total cases, 58 resolved)

  • Quebec –  8,572 active cases (834,094 total cases, 5,936 deaths, 69,586 resolved)

  • Saskatchewan – 143 active cases (2,012 total cases, 24 deaths, 1,845 resolved)

  • Yukon – 0 active cases (15 total cases, 15 resolved)

  • Nunavut – 0 active cases (no resident cases)

  • CFB Trenton – 0 active cases (13 total cases, 13 resolved)

Ontario sees record-high increase, leading to more restrictions

Ontario reported a record-high 939 new daily cases of COVID-19, which has prompted Doug Ford’s provincial government to impose new restrictions on hotspots Toronto, Peel Region and York.

It’s the 12th straight day the province has exceeded the 500-case mark. Ontario’s daily case count continues to increase, breaking its own record on four occasions over two weeks. Before the recent stretch, the province had not reported more than 500 cases since May 2.

Of the most recent 939 cases, 336 were identified in Toronto, 150 in Peel, 126 in Ottawa, 68 in York, 59 in Halton, 40 in Hamilton, 32 in Durham, 28 in Simcoe-Muskoka and 24 in Middlesex-London. The remaining 25 public health units reported fewer than 20 cases, while nine of them reported no new patients at all.

The latest patients were identified after the province completed 44,914 tests. The 2.1 per cent positivity rate is the highest it has recorded since June 7.

There are 358 new cases among those 20-39 years old, the most of any age group. There are 266 new cases among those 40-59, 156 among those 19 and under, and 153 involving those who are at least 60 years old. Twelve of the patients involve long-term care residents and 12 involve health-care workers.

In K-12 schools across Ontario, there are 56 new cases of COVID-19. That includes 32 among students, nine among

Nurse who traveled to treat COVID-19 patients donates her kidney to toddler

Taylor Pikkarainen, a traveling nurse, spent over two months this spring on assignment in New Jersey helping to save the lives of patients with COVID-19.

Pikkarainen, 27, then returned to her home state of Minnesota to save the life of a young boy by donating her kidney.

“It just feels really great that he’s healthy and happy,” Pikkarainen told “Good Morning America” of Bodie, who will turn 2 in December. “It’s amazing and I’m very, very grateful.”

PHOTO: Taylor Pikkarainen, 27, poses with Bodie Hall, 20 months, to whom she donated a kidney.

Taylor Pikkarainen, 27, poses with Bodie Hall, 20 months, to whom she donated a kidney.

Taylor Pikkarainen, 27, poses with Bodie Hall, 20 months, to whom she donated a kidney.

Pikkarainen found out about Bodie’s need for a kidney earlier this year through her sister-in-law, who is a close friend of Bodie’s mom, Gloria Hall.

Bodie was born with congenital nephrotic syndrome, a life-threatening condition that causes your body to discharge too much protein in urine and ultimately progresses to kidney failure, according to M Health Fairview University of Minnesota Masonic Children’s Hospital, where he underwent the transplant in July.

One of Bodie’s four older siblings also has the syndrome and required a kidney transplant five years ago; Hall was the donor. Because Hall had already donated a kidney and her husband, Bodie’s father, was not a match for their son, the family put out a plea for a kidney donor.

Once Pikkarainen heard about the need, she knew almost immediately she wanted to be Bodie’s donor.

“I was sitting there and just quickly looked up the side effects for me as a donor, for giving up a kidney,” she said. “There’s always a risk with surgery but there was no increased risk for kidney disease or kidney failure, having one kidney versus two.”

“And within half an hour I was signing up,” she continued.

Hall, who lives in a town neighboring Pikkarainen, said she remembers the exact moment she received a call “out of the blue” in February that her son finally had a kidney donor.

“I guess the biggest feeling was … of relief because it really was the thing hanging over our heads,” said Hall, who did not know at the time that Pikkarainen was the donor. “We knew it was the point where he needed to have the surgery and we obviously couldn’t have the surgery without a kidney donor.”

Bodie spent one month in the hospital after his birth and has had to undergo frequent infusions to help boost his kidney function. He has also relied on a feeding tube since the age of seven months, according to Hall.

PHOTO: Bodie Hall interacts with nurses while hospitalized for a kidney transplant in Minnesota.

Bodie Hall interacts with nurses while hospitalized for a kidney transplant in Minnesota.

Bodie Hall interacts with nurses while hospitalized for a kidney transplant in Minnesota.

Pikkarainen said she thought about remaining anonymous as Bodie’s donor, but then decided to tell the Halls by sending a letter and a stuffed animal for Bodie.

She also met Bodie in person for the first time a few days before the transplant,

Pandemic Delays Treatment, Threatening Patients and Research

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

The COVID-19 pandemic has taken a severe toll on patients with retina diseases, according to leading European specialists who took stock and exchanged tips on innovative responses to the crisis at the virtual European Society of Retina Specialists 2020 Congress.

The number of new patients with neovascular age-related macular degeneration decreased by an average of 72% after the onset of the pandemic, said Adnan Tufail, MBBS, MD, from Moorfields Eye Hospital in London, citing findings from a survey he and his colleagues conducted at three treatment centers in the United Kingdom.

A delay in treatment initiation of 3 months could cause an increase of more than 50% in the number of eyes with age-related macular degeneration with 6/60 vision or worse, the survey team estimates, and a 25% decrease in the number of eyes with driving vision over a year.

Significant declines in the number of patients presenting to the hospital for retina treatments were also reported in France and Spain.

“The problem was that patients were afraid to go to the hospital for the injections in their eyes,” said Cesare Mariotti, MD, PhD, from the University of Ancona in Italy.

The overall drop in patients going to the hospital for treatment — roughly 80% across Asia, Europe, and the United States — posed challenges for research, as well as for patients, said Susanne Diehl, PhD, from Novartis in Bavaria, Germany. “Trials will be delayed, approvals will be delayed, and innovation will come to the market delayed.”

Mobile Injection Units

One inventive response to the crisis was to form a mobile intravitreal injection clinic so patients, particularly seniors, could receive treatments in their homes, said Anat Loewenstein, MD, MHA, from Tel Aviv University in Israel.

That service required a lot of infrastructure to set up, and a physician was delegated to review all patient charts to identify those who did not need to be examined before an injection was administered.

It would not be feasible to continue over the long term, but patients loved it, she told Medscape Medical News. “You can’t imagine how people were grateful and happy and were begging us to do that.”

Crews on the mobile units wore masks, face shields, gowns, and gloves, and were tested periodically for COVID-19, Loewenstein reported.

And an entire floor of an office building that wasn’t being used during the pandemic was donated by WeWork, the coworking company, so that Loewenstein and her colleagues could set up a satellite injection clinic, complete with an optical coherence tomography (OCT) machine, for patients not comfortable visiting the hospital.

The strategy in France was to issue a press release and information sheets to reassure patients that they could safely come to the hospital for treatment, said Laurent Kodjikian, MD, PhD, president of the French Society of Ophthalmology.

“Despite that, about 20% to 30% of the patients didn’t come,” said Jean-Francois Korobelnik, MD, from the University Hospital of Bordeaux

ASH Releases Clinical Practice Guidelines on the Use of Preventive Anticoagulation in Patients with COVID-19

ASH Releases Clinical Practice Guidelines on the Use of Preventive Anticoagulation in Patients with COVID-19

PR Newswire

WASHINGTON, Oct. 8, 2020

Evidence-based recommendations will inform prevention of COVID-related blood clotting

WASHINGTON, Oct. 8, 2020 /PRNewswire/ — Today, ASH released new guidelines to help clinicians prevent serious blood clotting complications affecting COVID-19 patients. The recommendations suggest that clinicians should use a standard prophylactic anticoagulant dose over higher doses to prevent clotting in patients who have been hospitalized with COVID-19, including those in intensive care.

American Society of Hematology logo.
American Society of Hematology logo.

Abnormal blood clotting has been reported as a complication associated with increased risk of death in patients with COVID-19, particularly hospitalized patients. The guidelines address both critically ill hospitalized patients – people who are ill enough to require intensive care – and acutely ill hospitalized patients – people who require monitoring and treatment in the hospital but not intensive care. It is common for clinicians to administer anticoagulants to these patients upon admission to try to prevent formation of blood clots; however, there is uncertainty regarding the right dose to give. For both acutely and critically ill patients, the guidelines suggest the use of a standard prophylactic dose of anticoagulation upon admission to the hospital. The use of higher doses of anticoagulants is not recommended, as it may pose greater risk for serious bleeding that outweighs potential benefits. However, the guideline panel highlighted the importance of individualized decision-making and acknowledged that a higher dose of anticoagulants may be appropriate in patients judged to be at especially high clotting risk and low bleeding risk.

“COVID-19 is the most important public health problem of our lifetime, with more than one million deaths worldwide. Data suggest that abnormal blood clotting plays an important role in why patients die or get very sick from this disease. Thus, it is important that these patients be given anticoagulants to try to prevent clots, and data available right now suggest that standard dosing provides the best balance of benefits and risks,” said ASH President Stephanie Lee, MD, of Fred Hutchinson Cancer Research Center. “Equipping clinicians with evidence-based guidelines that focus on the prevention of clotting has the potential to save lives.”

In June 2020, ASH formed a multidisciplinary, internationally representative panel to develop the guidelines. The panel was chaired by Drs. Adam Cuker, of the University of Pennsylvania; Holger Schunemann, of McMaster University; and Reem Mustafa, of University of Kansas Medical Center. The panel urgently examined all available evidence, including early reports from observational studies. Development of these guidelines, including systematic evidence review, was supported by the McMaster University GRADE Centre, a world leader in guideline development. At this time, the best available evidence is very low quality, and the recommendations are framed with conditions, explanations, and a call for more research. The systematic reviews and recommendations will continue to be maintained and updated, especially as better evidence from randomized clinical trials becomes available.

“The development of these guidelines

New Analysis Shows Contract Pharmacies Financially Gain From 340B Program With No Clear Benefit to Patients

New Analysis Shows Contract Pharmacies Financially Gain From 340B Program With No Clear Benefit to Patients

PR Newswire

WASHINGTON, Oct. 8, 2020

WASHINGTON, Oct. 8, 2020 /PRNewswire/ — Today, the Berkeley Research Group (BRG) published an analysis of historical trends in 340B contract pharmacy arrangements. The findings conclude that the growth in the number of these arrangements is fueling explosive growth in the program at large and driving the 340B program farther and farther away from its original intended goal of providing discounted medicines to safety-net entities treating uninsured and vulnerable patients. 

New Analysis Shows Contract Pharmacies Financially Gain From 340B Program With No Clear Benefit to Patients
New Analysis Shows Contract Pharmacies Financially Gain From 340B Program With No Clear Benefit to Patients

Congress created the 340B program to help safety-net providers, including certain qualifying hospitals and federally-funded clinics, access discounts on prescription medicines for low-income or uninsured patients. In 2010, a Health Resources and Services Administration (HRSA) policy opened the door to allow all 340B entities to contract with an unlimited number of for-profit retail pharmacies (e.g., CVS, Walgreens) to dispense 340B medicines. While this policy may have been intended to improve patient access to needed medications, it had the misguided effect of creating an opening that allowed for-profit vendors, pharmacies and pharmacy benefit managers to exploit the program and make a profit on 340B sales – sales intended to benefit low-income and vulnerable patients.

“It is clear that contract pharmacies have leveraged market power to drive unprecedented program growth and siphon money out of the program and away from vulnerable patients,” said Stephen J. Ubl, president and chief executive officer of the Pharmaceutical Research and Manufacturers of America (PhRMA). “I urge lawmakers to consider the results of this analysis and pursue policies that ensure the 340B program benefits vulnerable patients rather than just line the pockets of for-profit corporations.”

Key findings from the analysis show that many retail pharmacies and other third parties have taken advantage of and financially benefited from the 340B program’s contract pharmacy arrangements:

  • 340B covered entities and their contract pharmacies generated an estimated $13 billion in gross profits on 340B purchased medicines in 2018, which represents more than 25% of pharmacies’ and providers’ total profits from dispensing or administering brand medicines.

  • Following HRSA’s expansion of the contract pharmacy program in March 2010, contract pharmacy participation grew a staggering 4,228% between April 2010 and April 2020.

  • While over 27,000 distinct pharmacies participate in the 340B program today, over half of the 340B profits retained by contract pharmacies are concentrated in just four pharmacy chains – Walgreens, Walmart, CVS Health and Cigna’s Accredo specialty pharmacy.

Analysis after analysis shows there is explosive growth in the program, but there is little to no clear evidence that this growth has benefited low-income and vulnerable patients. Even the New England Journal of Medicine found no evidence that expansion of the 340B program has resulted in improved care or lower mortality among low-income patients.

These new findings build upon a mounting body of evidence from the Government Accountability Office