How the 340B Program Protects Rural Kentucky’s Healthcare Lifelines—and the Patients Who Depend on Them

How the 340B Program Protects Rural Kentucky’s Healthcare Lifelines—and the Patients Who Depend on Them

After 30 years in pharmacy, Ronnah Alexander has learned that in rural communities, small decisions can have enormous consequences. For the past eight years, she has led the 340B program at a clinic in Western Kentucky. Patients often travel long distances for care, independent pharmacies serve as critical community anchors, and every dollar must stretch as far as possible. In a region where clinics operate on tight margins, the 340B program is essential for rural healthcare access and allows health centers like Ronnah’s to keep care local and affordable.

When drug manufacturer restrictions began threatening her clinic’s ability to serve patients, Ronnah and her team acted quickly. They expanded services to support more patients, including referrals and hospital discharges, and worked within new drug company restrictions using  ESP Second Sight to maintain one dedicated contract pharmacy for each clinic location.

This kind of flexibility shows why the 340B program is essential for rural health centers. One of the clearest examples of how Ronnah uses 340B savings to improve health outcomes is the clinic’s new Continuous Glucose Monitoring (CGM) program. With specialized interpretation and prescribing support, the program helped reduce the proportion of patients with uncontrolled diabetes from 33% to 19% over 2 years. The CGM initiative demonstrates the direct patient benefits made possible by 340B savings.

Those 340B savings also fund essential outreach services that rarely appear on a balance sheet but make all the difference in a patient’s daily life. These elements can be highlighted visually:

Ronnah has also made a deliberate choice that reflects her deep connection to the region. The clinic continues to partner with independent contract pharmacies. In many rural areas, an independent pharmacy is more than a place to pick up medication. It is a lifeline, and often the most frequent point of contact patients have with the healthcare system. These partnerships demonstrate how 340B supports independent pharmacies and helps the clinic retain long-time pharmacy employees, strengthening both local economies and healthcare access.

Even as 340B savings decline and drug prices increase, Ronnah and her team work tirelessly to protect patients. They have adapted their charity care program to prioritize medications that support patients for longer periods. This work has become more difficult as some medications have become prohibitively expensive or disappeared from the 340B program altogether. To meet growing community needs, they also launched a Hepatitis C treatment and support program. These challenges reflect the broader pressures facing providers as 340B contract pharmacy restrictions continue to evolve.

Beyond her work inside the clinic, Ronnah is a trusted voice for 340B across Kentucky. She meets regularly with state and federal lawmakers to explain how the program works, why it matters, and what is at stake as restrictions increase. Her leadership helps policymakers understand the real-world impact of 340B on Kentucky patients, especially in rural areas where options are limited, and travel distances for care can be long. Her advocacy is especially important because Kentucky still lacks contract pharmacy protections, leaving vulnerable patients at greater risk as manufacturers expand restrictions.

For Ronnah, the 340B program is not an abstract policy. It is a tool that keeps people healthier, supports rural pharmacies, and ensures families across Western Kentucky can access care close to home. In a part of the country where healthcare deserts are a constant threat, her work shows exactly what 340B was created to do: stretch limited resources and strengthen entire communities.

Defend 340B and Strengthen Healthcare Access

The 340B program helps clinics like Ronnah’s deliver lifesaving care, protect rural pharmacies, and keep healthcare accessible for the patients who need it most.

See below for ways you can protect 340B and improve health outcomes in your community: