The 340B program is challenging to implement and requires the participation of drug manufacturers, pharmacy benefit managers, wholesalers, and pharmacies in addition to the 340B-covered entities themselves. Making the program work requires coordination among these various stakeholders, including the exchange of detailed patient and sales information, patient and product tracking, accurate price reporting, and audits.
There could be several loopholes that may lead to loss of money in the process. Let’s understand what are –
👉 Poor Data Management — Healthcare organizations have various data sources, like clinic and hospital EHRs and billing systems. Ensure all data is sent to the TPA and automate delivery to avoid delays. Daily data delivery is preferable for contract pharmacy scenarios. Refrain from relying on manual processes; automate and monitor for failures. Understanding the importance of timely data delivery is crucial.
👉 Not examining data for completeness — Hospitals often depend on IT resources or vendors unfamiliar with the 340B program, risking data quality. It’s crucial to emphasize the importance of quality data. Even in scenarios where the covered entity is closely linked with local providers and pharmacies, prescription matching still needs to be improved. This issue is common in rural areas; urban settings also face challenges.
👉 Inefficient data management by TPA — Understanding your prescription matching rate is crucial for maximizing 340B savings. Track both matched and unmatched prescriptions regularly. While some TPAs may not share details on unmatched prescriptions, pharmacies can offer valuable insights. Evaluate business rules to address gaps and ensure every reason is fulfilled.
👉 Business segment complications — The 340B program’s complexity extends to interactions with other business lines, like managed care and Medicaid. Discounts applied at purchase can lead to overlap with these invoices, complicating tracking. Oversight errors can occur, especially as Medicaid rebate data lacks entity details.
Conclusion
The 340B program presents significant challenges that demand careful navigation and proactive management. Addressing issues such as poor data management, incomplete data examination, and inefficient TPA practices is essential to maximize savings and ensure program success. Moreover, understanding and mitigating business segment complications are vital steps towards optimizing program efficiency. By fostering collaboration among stakeholders and implementing robust processes, organizations can overcome hurdles and unlock the full potential of the 340B program to benefit patients and communities.