How does 340B reimbursement work?

How does 340B reimbursement work?

The federal 340B Program is a drug price control program that allows qualifying providers, generally hospitals, specialty clinics and their associated outpatient facilities serving uninsured and low-income patients in rural communities, to purchase outpatient drugs from manufacturers at discounted prices.

How does a 340B contract pharmacy work?

What is 340B Contract Pharmacy? In order for an eligible entity to purchase a drug at a 340B discount, it must dispense that drug to the patient. The 340B regulations also allow a covered entity to contract with a pharmacy to distribute the covered entity’s drugs on the hospital’s behalf.

How do pharmacies make money on 340B?

Participation in the 340B program shifts a pharmacy’s profit source from dispensing spreads to per-prescription fees paid by a 340B-qualified entity. In some cases, the pharmacies share in the profits generated by 340B prescriptions, which raises further questions about who benefits from the program.

What makes a claim 340B eligible?

In order to be eligible, the patient must receive health care services other than drugs from the 340B covered entity (although a sole exception exists for patients that are part of an AIDS drug purchasing assistance program that has ties to the government).

What is a 340B claim?

The 340B Program enables covered entities to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services. Manufacturers participating in Medicaid agree to provide outpatient drugs to covered entities at significantly reduced prices.

What is 340B specialty pharmacy?

The 340B specialty pharmacy. Page 1. 1. A lot has changed since 1992, when Congress passed Section 340B of the Public Health Service Act requiring drug producers to provide certain safety-net healthcare providers with discounted outpatient drugs.

Is CVS a 340B pharmacy?

CVS continues to increase its participation in the 340B program. This means that half of all CVS locations are now 340B contract pharmacies. The company’s growth has been facilitated by CVS Health’s acquisition of Wellpartner, a provider of 340B contract pharmacy services.

Are all drugs 340B eligible?

According to the 340B statute, FQHCs (and other covered entities) may only provide 340B purchased drugs to individuals who are “patients” of the entity. As a result, policymakers often talk about the “patient definition” as the tool for determining eligibility for 340B drugs.

What is the 340B Drug Pricing Program?

The 340B Drug Pricing Program accounts for less than 3% of all drug purchases in the United States. Yet according to the Government Accountability Office, 340B program participants can save 20-50% off drug costs, all without costing the taxpayers a dime.

Can a pharmacy be listed as a 340B covered entity?

Pharmacies are not eligible 340B covered entities and therefore, should not be listed as a child site with a 340B ID in the database. It should then be determined whether it is appropriate for the pharmacy to be added as a “ship to” address for the actual covered entity in the database.

How do I participate in the 340B program?

To participate in the 340B Program, eligible organizations/covered entities must register and be enrolled with the 340B program and comply with all 340B Program requirements. Once enrolled, covered entities are assigned a 340B identification number that vendors verify before allowing an organization to purchase 340B discounted drugs.

What are the different types of 340B pharmacy models?

Types of 340b models In-house pharmacy model-Covered entity owns the drugs and pharmacy, assumes fiscal responsibility for the pharmacy and pays the staff. Contract pharmacy model-Covered entity owns the drugs, contracts with the pharmacy to provide pharmacy services, but does not manage the pharmacy or pay staff.

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