Health clinics that quit the federal family planning program over new Trump administration anti-abortion rules may have to destroy or return tens of thousands of dollars of contraceptives and other medications.
Federal health officials confirmed to POLITICO that clinics might need to get rid of drugs, intrauterine devices and other treatments they bought at a discount while part of the Title X program, a long-standing requirement that’s catching some providers by surprise as they weigh whether to comply with new rules that, among other things, forbid abortion referrals.
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Many clinics are considering leaving Title X although they have a few more weeks to decide and are watching to see whether the courts halt or delay the rules.
Maine Family Planning, a network serving over 23,000 low-income patients and the only Title X grantee in the state, was one of the first in the country to announce it would withdraw from the program because of the new Trump rules. As a result, they may have to dispose of $80,000 to $100,000 worth of drugs, according to George Hill, the nonprofit’s president and CEO. “We can’t recycle it, we can’t donate it, there are very strict rules surrounding the transfer of drugs,” he said.
Hill originally said the nonprofit had to dispose of contraceptive supplies by the end of this month, but after this article was published the organization clarified that the actual date is still to be determined.
Title X clinics are eligible for a separate federal program known as 340B that allows health facilities serving low-income patients to purchase discounted drugs and devices. About 3,002 family planning clinic locations get discounts from manufacturers.
Clinic operators say they may have to return or destroy IUDs, hormonal patches, NuvaRings and birth control pills if they leave the federal family planning program. And since Title X also serves people who want to become pregnant, stocks of hormone treatments might have to be tossed as well.
The amount of discarded products could vary widely, since some facilities serve hundreds of thousands of patients every year and are constantly restocking.
The fate of those clinics’ drugs hinges on consultations with the Health Resources and Services Administration, the federal agency that administers the 340B program.
Some providers that are part of Title X may be able to keep some of the discounted medications if they’re also designated under 340B in other ways, such as by being federally qualified health centers or sexually transmitted disease clinics, according to an agency spokesperson.
But clinics lacking those certifications that leave the family planning program can’t keep the cheaper drugs or transfer them to other facilities, according to the discount drug program’s guidelines. The products must be “returned” to the wholesaler or drug manufacturer or destroyed following specific state laws for drug disposal. In some cases, clinics might be able to get a partial refund, according to the National Family Planning and Reproductive Health Association.
There isn’t a firm timeline for getting rid of the medications, but an HRSA spokesperson said it should be done “as soon as possible” and that facilities can’t dispense the cheaper drugs to patients once they no longer qualify for 340B.
Providers with “extenuating circumstances” can ask HRSA for “possible alternatives to this approach.” Hill of Maine Family Planning says his nonprofit is now checking if other arrangements can be made.
The Illinois Department of Public Health is the only other grantee so far to confirm it’s quitting Title X, and a department spokesperson told POLITICO that state officials are evaluating options and that “ensuring that patients have access to comprehensive reproductive health care in Illinois, including birth control and other drugs” is a priority.
The Oregon Health Authority, the only Title X grantee in the state, told clinics that it stopped using the federal program’s funds but is still a grantee. In an advisory sent to providers on Wednesday, it cautioned against purchasing additional supplies under the Title X-340B designation, encouraging clinics to begin buying drugs under other 340B designations, such as an STD clinic or a health center “whenever possible.” The state says it’s “considering next steps” in light of HHS’ recent guidance on overhauling Title X and is leading a multi-state lawsuit to halt the policy changes.
Some clinics contacted by POLITICO were unaware they may have to discard drugs and devices if they exit the program. Others, like the Boulder Valley Women’s Health Center, which is leaving Colorado’s Title X network, think they will be able to hold onto their current stocks since they remain part of the different federal program aimed at eradicating sexually transmitted infections.
“There’s a lot of confusion around this, and it’s hurting the very people meant to be served by the Title X program, who have the least access to care to start with,” said Lisa Radelet, the communications director of Boulder Valley Women’s Health Center. “There’s not clear guidance coming out from HHS, only very vague rumors and hearsay.”
The procedures for leaving Title X are contained in grant agreements and outlined when clinics ask about the protocol for withdrawing, according to Mia Heck, an HHS director of external affairs. Once an organization formally withdraws, its grant officers will give guidance on how to do so, including steps related to discounted drugs, she wrote in an email.
It’s possible more providers will soon face this dilemma. The Trump administration recently announced that they’re giving federally funded clinics two extra months to comply with its new rules, which are the object of multiple court challenges.
Though the new Title X rules took effect July 15, HHS announced last week that clinics have until Aug. 19 to submit an “action plan” detailing how they plan to come into compliance, then have until Sept. 18 to follow most major provisions.
Many providers that oppose the rules haven’t decided whether to leave, wagering the administration’s policy change will be frozen in court before the new enforcement deadline. Planned Parenthood, which currently serves about 40 percent of the approximately 4 million patients in Title X, is using its own emergency funds in lieu of federal dollars, but hasn’t formally quit.
“Most entities are trying to hold on as long as possible to see how things shake out from a legal perspective,” said Audrey Sandusky, the spokesperson for the National Family Planning and Reproductive Health Association.
Still, the clinics leaving the program insist that even the potential hardships of quitting Title X are preferable to living under the new rules.
“We were the first abortion clinic in the state,” said Radelet, of the Boulder Valley Women’s Health Center, which is giving up half a million dollars of funding. “There is no way we would stop referring for or providing abortions.”