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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Express Scripts’ New 340B Rules Will Have Big Impact on Contract Pharmacy and Drug Reimbursement, Providers and Consultants Say

340B covered entities fault Express Scripts for not communicating with them more effectively about changes in its 340B claims identification and reporting requirements, which the entities consider to be major.

340B covered entities say they are deeply concerned about pharmacy benefit manager Express Scripts’ (ESI) requirements, effective Monday, governing what pharmacies in the PBM’s network must do when they identify that a previously submitted claim is 340B-eligible. Last night, ESI told

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Becerra Reconfirms Strong Support for 340B During Finance Committee Hearing

HHS Secretary-designate Xavier Becerra said he "absolutely" would commit himself to ensuring the 340B program's strength, in response to a question from Sen. John Thune (R-S.D.) | C-SPAN

Xavier Becerra, President Biden’s pick to be the next U.S. Health and Human Services (HHS) Secretary survived his U.S. Senate Finance Committee confirmation hearing yesterday, with a GOP foe of his nomination grudgingly predicting the panel would vote to confirm

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Express Scripts’ New 340B Claims ID Requirement Has Covered Entities Worried

The 340B Coalition told Express Scripts that covered entities cannot comply with its new 340B claims submission and identification requirement absent "a massive investment of financial and human resources." | Shutterstock

Pharmacy benefit manager Express Scripts late yesterday began notifying 340B covered entities by email that, effective March 1, it “will require a new identification method for submitting and identifying 340B eligible claims.”

A health system 340B program manager said this

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HHS-Designate Becerra May Face 340B Questions Today During First Nomination Hearing

HHS-Secretary designate Xavier Becerra could face questions about the 340B program today during his first of two Senate nomination hearings this week.

The U.S. Senate Health, Education, Labor, and Pensions (HELP) Committee this morning is holding the first of two Senate committee hearings this week on President Biden’s nomination of California Attorney General Xavier Becerra to serve as U.S. Health and Human

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