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 37 years in pharmacy, Ronnah Alexander has learned that in rural communities, small decisions can have enormous consequences. For the past nine years, she has led the 340B program at a clinic in Western Kentucky, where 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 thin margins, the 340B program is essential to maintaining 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 care following hospital discharges, and adapted to new manufacturer limitations by working with ESP Second Sight to maintain one dedicated contract pharmacy for each clinic location. This ability to adapt while continuing to meet patient needs underscores why 340B is critical for rural health centers.

One of the clearest examples of how Ronnah uses 340B savings to improve health outcomes is the clinic’s Continuous Glucose Monitoring (CGM) program. With specialized interpretation and prescribing support, the program reduced the proportion of patients with uncontrolled diabetes from 33% to 19% over two years. The CGM program shows how 340B savings translate directly into measurable improvements in patient health.

340B savings also support essential outreach services that rarely appear on a balance sheet but play a vital role in patients’ daily lives. These services remove barriers to care and help prevent avoidable complications, outcomes that are especially important in rural communities with limited healthcare resources.

Her team has also made a deliberate choice to continue partnering with independent contract pharmacies. In many rural areas, an independent pharmacy is more than a place to pick up medication—it is often the most accessible and consistent point of contact patients have with the healthcare system. These partnerships strengthen both local healthcare delivery and rural economies.

Even as 340B savings decline and drug prices continue to rise, Ronnah and her team remain focused on protecting patients. They have adapted their charity care program to prioritize medications that provide longer-term stability, but this has become increasingly difficult as some medications have grown prohibitively expensive or have been removed from 340B eligibility altogether. In response to growing community needs, the clinic also launched a Hepatitis C treatment and support program, reflecting the growing pressure on safety-net providers as restrictions expand.

Beyond her work inside the clinic, Ronnah is a trusted advocate 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 for patients as restrictions increase. Her advocacy is especially critical because Kentucky lacks contract pharmacy protections, leaving rural patients more vulnerable as manufacturer restrictions expand.

For Ronnah, the 340B program is not an abstract policy discussion. It is a practical tool that keeps people healthy, supports rural pharmacies, and helps families access care close to home. In a region where healthcare deserts are a constant threat, her work reflects exactly what the 340B program 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: