With Community Health Centers' funding facing challenges from pharmacy benefit managers, some state lawmakers are getting involved.

The centers are a nonprofit safety net created by Congress in 1965 to provide health care services to medically underserved communities both urban and rural. They are the medical home for 600,000 Missourians.

They are funded by private insurance and Medicaid, federal government grants, and the 340b drug-pricing program. Under 340b, drug manufacturers agree to discount drugs to safety-net providers in exchange for their drugs being covered by Medicare and Medicaid.

Until recently, insurance companies and pharmacy benefit managers reimbursed the retail price, and the health centers were able to pocket the difference with the mandate they use the money to reach more eligible patients and provide more comprehensive services.

Colleen Meiman, a national policy adviser for state associations of Community Health Centers, said in recent years, the benefit managers have changed their approach.

"What has happened in the past five to 10 years or so is that the PBMs have figured out, 'Wait a second, you're a health center. You're eligible for 340b, we know you're paying less for drugs than everybody else, so we're going to reimburse you less for drugs,' " Meiman explained.

Meiman pointed out 22 states have passed laws against 340b workarounds. A bill to make these practices illegal died in committee in the Missouri Legislature last term.

Meiman noted for decades, the financial stability of Community Health Centers has relied in part on 340b savings, and pharmacy benefit managers are exploiting a loophole.

"Just because you just recently figured out that there's this loophole in the law, and you can get your hands on our savings, does not negate the fact that those savings are critical to keeping the primary-care infrastructure safety net in this country running," Meiman contended.

She added over time, the benefit managers' tactics have evolved to avoid providing 340b drug access in the first place.

"You'll see 'Oh you dispense 340b drugs, pharmacy? We're not going to let you into our preferred network,' is a favorite approach," Meiman stressed. "'We're not going to cover 340b drugs anymore', so there's many different ways of instead of just paying them less, just keep the patients from getting the 340b drug in the first place."

Community health centers serve as the medical home for more than 30 million Americans of all ages.

After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.