Lisa Sandoval, PharmD, cares deeply about making healthcare more accessible to patients – her husband of 30 years is from an immigrant family, and she has seen firsthand the struggles and poor health outcomes that can result from not understanding the healthcare system. When she started at One Community Health (OCH) in 2024 part-time, she knew she needed to thoroughly understand the 340B program. She had worked as a retail pharmacist and as a clinical pharmacist in a critical access hospital for decades but had not delved deeply into the details of the program in those roles. Even as a seasoned pharmacist of over 20 years, it took her months to determine how money was flowing through the program. In 2024, pharmaceutical manufacturers also started to erode the 340B program’s benefits to patients and health centers. While the intention of the 340B program is to make medications more affordable for patients and to help health centers serve underinsured and uninsured, fewer patients were benefiting from the program due to its restrictions and additional reporting. Lisa’s focus has been to learn the program and optimize OCH’s processes with these new requirements, so that she is able to still transfer the benefits of the program to our patients.

In recent years, we have seen drug manufacturers create more and more arbitrary rules to restrict access to the 340B program. To date, OCH has relied on relationships with pharmacy benefit managers (PBMs) for 340B drug pricing. Unfortunately, the reliance on PBMs has diluted the savings to our patients. Lisa Sandoval, PharmD has played a large role in advocating for 340B improvements in Oregon. She traveled to Salem three times in 2024 to deliver testimony to committees and speak with legislators. In her testimony, she championed legislation to combat manufacturer restrictions. In advocating for protections for and improvements to the 340B program Lisa’s message has been simple – access to vital medications makes people healthier and happier. People can work, take care of their families, and enjoy their lives.

As she has advocated for improvements and safeguards for the 340B program, Lisa has also worked on in-house solutions. As a direct result of the manufacturer restrictions, some OCH patients are forced to drive much further to purchase medications (e.g., as far as 50 miles roundtrip), and some no longer have affordable options at all. Because certain medications can only be distributed by certain contract pharmacies, patients have been unable to afford common, life-saving medications like insulin. Lisa has spent the past six months preparing to open OCH’s first in-house pharmacy. With our own pharmacy, we will be able to offer 340B discounted medications and patients can get medications immediately after their appointments, improving adherence and reducing delays.

Lisa Sandoval has been effective collaborator and communicator, championing clinical and retail pharmacy at OCH. She quickly understood the complexities of the 340B program and was able to use her retail and clinical pharmacy knowledge to work with OCH’s data analytics and clinical teams and grow the net revenue of the contract pharmacy program. Consequently, OCH’s net 340B revenue increased by over $1 million in 2024. She also presented the pharmacy business case to organizational leaders encouraged them to make the in-house pharmacy investment and hire a retail and clinical pharmacy team. Lisa began as a part-time employee and was recently promoted to Pharmacy Director. Dr. Sandoval worked alongside OCH’s grants team to secure funding from the Roundhouse Foundation for a pharmacy locker in our Hood River location. In-house pharmacies have less restrictions on 340B medications, so, purchasing medications in The Dalles and delivering them to pharmacy lockers will allow us to offer discounts to our patients in Hood River County and Washington state. Lisa has also found a great deal of support from the OPCA pharmacy peer group. The support she has received from other health centers has been instrumental in her ability to improve medication access for patients.

OCH patients have been unable to afford life-saving medications like the common long-acting insulin Lantus since recent contract pharmacy 340B restrictions went into place. With our own pharmacy, opening in The Dalles in April 2025, OCH will offer 340B medications that patients have been unable to access. Patients will now be able to use their long-acting insulin and won’t have to try to cobble together coupons or skip groceries or gas to afford it. Consistently controlling blood sugar improves morbidity and mortality, allowing people to live healthier, happier lives. Not only is Lisa overseeing the opening of OCH’s first pharmacy and improving 340B revenue and program functioning, but she has also built a clinical pharmacy program. Pharmacists are now available in clinic for medication consults with patients and providers. Pharmacists can sit down with a patient who brings in a bottle of mixed medications and help sort them into a pill box. It is hard to overstate how large of an impact these three areas will have on the Gorge community. The pharmacy team can provide direct counseling, ensuring patients understand their medications. Pharmacists can also provide immunizations, so OCH’s will have greater capacity to support immunizations and other medication-based public health interventions (e.g., opioid overdose prevention). Furthermore, in-house pharmacies have not been subject to as many manufacturer restrictions as contract pharmacies, so now the 340B program will serve as a more dependable revenue source.

Submission written by Michele Guerrero, Communications Manager, One Community Health