Opposition to Express Scripts’ 340B Claims ID Requirement Grows

U.S. Rep. Abigail Spanberger (D-Va.) said her successful amendment today to a spending bill sends big pharma the message "Stop hiking drug prices on consumers and discriminating against our 340B providers and pharmacies."

Correction, Tuesday March 16, 4:00 p.m. EDT—Earlier today, we reported that during a March 16 webinar, advisers to 340B covered entities said that U.S. Rep. Abigail Spanberger (D-Va.) had written to pharmacy benefit manager Express Scripts (ESI) about its new

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FQHCs Fiercely Oppose Trump’s 340B Insulin Pricing Rule in New Round of Comments

HRSA received 200 comments on the Biden administration's proposal to delay until July 20 the effective date of a controversial rule on how much health centers can charge low-income patients for insulin and injectable epinephrine.

Federally qualified health centers and their trade groups are adamantly opposed to implementing a Trump administration rule to require health centers to provide insulin and injectable epinephrine to low-income patients at the price the centers pay for those drugs under

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Medicare’s 340B Drug Reimbursement Cuts in 2019 Were Exacerbated by Change in Drugs’ Payment Status

A change in Medicare Part B payment status for "an unusually high" number of drugs in 2019 led to "substantially" lower payments to 340B hospitals, congressional Medicare advisers said this week.

Medicare Part B drug payments to 340B hospitals “declined substantially” in 2019 because the payment status of “an unusually high number of drugs” changed that year, congressional Medicare advisers said in a report yesterday.

The change—from “pass-through status” to “separately

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Biden Nominates Veteran Capitol Hill Aide to be HHS Assistant Secretary

Melanie Egorin, a veteran Democratic congressional health care adviser, has been tapped to be the next HHS Assistant Secretary for Legislation.

President Biden has nominated Melanie Egorin, a veteran Democratic congressional health care adviser, to serve as U.S. Health and Human Services (HHS) Assistant Secretary for Legislation.

If confirmed, Egorin would be a top deputy to Xavier Becerra, whose nomination to

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Utah Might Soon Outflank Express Scripts’ New 340B Requirement

Utah lawmakers have passed and sent to the governor a bill that would forbid insurers or their PBMs from forcing federally qualified health centers to include modifiers on claims identifying drugs as being 340B purchased, Medicaid claims excepted.

Pharmacy benefits manager Express Scripts’ (ESI) new pharmacy reporting requirement for reclassifying a previously submitted prescription drug claim as 340B-eligible “applies to the extent not prohibited by law,” the PBM says in an FAQ on its website.

ESI’s statement in

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State Activity to Rein in PBM Discrimination Against 340B Entities Heats Up

Tennessee is one of at least six states weighing legislation to forbid PBM discrimination against 340B covered entities.

At least six states have introduced or passed bills in recent weeks that would forbid pharmacy benefit managers from discriminating against 340B covered entities regarding reimbursements and other practices.

The bills range from 340B-specific legislation to broader bills to address

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Biden Wants to Delay 340B Health Center Insulin Rule Again, to July 20

Stakeholders have from today through March 14 to comment on the Biden administration's proposal to delay a controversial Trump administration about the cost of insulin at 340B health centers until July 20. | Shutterstock

The Biden administration proposes once again to push back, this time from March 22 to July 20, the effective date of the Trump administration’s controversial final rule to require health centers to provide insulin and injectable epinephrine to low-income patients

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Biden Names Health Care Advisers with Strong Ties to Hill Democrats

The White House plans to release a revised administrative dispute resolution process for the 340B program this month.

Two health care policy experts with ties to congressional Democratic chairs influential on 340B matters have gone to work for the Biden White House.

Elizabeth Jurinka, most recently chief health adviser to Senate Finance Chair Ron Wyden (D-Ore.), on

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Providers Worried About Humana’s 340B Claims ID and Data-Reporting Conditions

An Alabama health system is suing Humana over past reduced 340B rates paid by its Medicare Advantage plans.

Health insurance company Humana has begun sending pharmacy provider agreements for 2022 to 340B-participating pharmacies, with claims-identification and data-reporting conditions that some 340B providers say are unsettling. They say the agreements are to be signed and returned within 30 days

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N.Y. and Calif. 340B Pharmacies Get Reprieve From Medicaid Cuts

New York State and California’s nationally watched efforts to transfer their pharmacy programs for low-income individuals from Medicaid managed care to Medicaid fee for service (FFS)—both scheduled to take effect on April 1—have been temporarily placed on hold. The states

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