Early cancer detection saves lives, but rural residents often struggle to find screening services close to home. Thanks in part to savings from the 340B Drug Pricing Program, the West Virginia University Health System (WVU Medicine) found an innovative answer to that problem: taking cancer screening services to rural communities.
Bonnie’s Bus Mobile Mammography Unit and LUCAS, a 48-foot tractor trailer housing state-of-the-art lung cancer screening technology, traverse the state to reach patients who live in the state’s remote communities, many of them served only by winding mountain roads that make travel exceptionally difficult, said Karen Famoso, the enterprise director for pharmacy compliance and business operations at WVU Medicine.
Named to honor a patient from rural West Virginia who died from breast cancer after a delayed diagnosis, Bonnie’s Bus has provided more than 34,000 screening mammograms and detected more than 200 cases of breast cancer since 2009, according to the health system. LUCAS, meanwhile, has screened over 5,800 West Virginia residents since 2021, identifying at least 85 lung cancers and 16 additional cancers.
But grants and private donations aren’t enough to cover the entire costs of these mobile screening services. In 2024, WVU used savings from the 340B program to cover a nearly $400,000 operating loss for both Bonnie’s Bus and LUCAS, said Famoso.
Spotlight on 340B
The federal 340B Drug Pricing Program plays a key role in helping safety-net providers reach underserved patients. But drug manufacturers are leading attacks on the program. In this series, ASHP is highlighting how health systems depend on savings from the program for critical programs and services.
“We wouldn't be able to treat the patients that we do without the 340B program,” said Famoso.
A community benefits report last year from the West Virginia Hospital Association cited Bonnie’s Bus and LUCAS as two services bolstered by savings from the 340B program. “The 340B Drug Pricing Program,” the report notes, “is a small program with big benefits for vulnerable patients and communities.”
That’s why attempts to undermine the program, led by drug manufacturers and pharmacy benefit managers, have a huge impact in communities like the ones served by WVU Medicine. “I am passionate about this because I know that with 340B, we're able to expand services,” said Famoso.
At some hospitals in her health system and others, the consequences of cuts can be particularly dire. “Without 340B, there are several of our hospitals that would not be able to be open any longer because their margins are so slim,” said Famoso. “The 340B program helps them keep their doors open.”
WVU Medicine and other health systems have been most recently concerned about plans by the Department of Health and Human Services (HHS) to implement a pilot to switch 10 340B medications over to a rebate model. A federal judge put that plan on hold after objections from ASHP and its partners. HHS withdrew the pilot but recently began soliciting feedback on a new potential rebate model.
A rebate model isn’t simply a different accounting measure. That change essentially requires organizations to float the up-front costs of 340B medications and wait for rebates that could be late — or never come at all, according to ASHP and the hospitals, health systems, and community health centers that have sent their objections to HHS.
WVU Medicine officials, in their comments to HHS, estimated the rebate model initially proposed by HHS would result in additional costs of $96 million a year, a figure that includes additional staff, legal fees, and new technological platforms. The program, WVU Medicine said, “will float revenue to manufacturers while tying up critical resources that could otherwise be used by covered entities to support patient care.”
Among the services programs at risk if HHS proceeds with a rebate model, the letter says, are Bonnie’s Bus and LUCAS.
That’s why ASHP continues its advocacy efforts against any changes, including a rebate model, that would limit 340B savings, said Tom Kraus, ASHP’s vice president of government relations.
“The rebate program proposed by drug manufacturers is not only unnecessary,” said Kraus, “it’s detrimental to patient access to care. Savings that should go toward helping patients are instead re-routed toward administrative overhead. We’ll continue to fight all efforts to undercut 340B, for the sake of our members and their patients.”
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