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Implementing for Success

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How to Optimize Your 340B Partnerships from the Start

After 30 years of serving vulnerable populations, the 340B Drug Pricing Program has grown considerably in scale and complexity. While it is arguably one of the most successful public/private partnerships in healthcare history, 340B is facing policy obstacles and headwinds that can make administering a program more challenging for covered entities than ever. This includes manufacturers limiting discounts to a single contract pharmacy and excluding high-cost drugs from the program. 340B administration is also complicated by perennial regulatory updates from CMS that impact the program directly and indirectly.

For these reasons and more, it can often make sense for covered entities to seek the expertise and assistance of a 340B vendor to reduce the complexity and optimize the savings from 340B.  When you are working with partners, it’s important to ensure you are setting yourself up for success and the greatest return on your investment from the start. The implementation and onboarding process

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Unlocking Greater 340B Savings

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How to capture claims and savings that are often missed

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The 340B program serves as a lifeline for many communities, allowing them to provide critical services to vulnerable, underserved patients. But unfortunately, the industry faces a spectrum of challenges, from mounting drug manufacturer restrictions to incomplete referral claims capture, which hinder a covered entity’s ability to optimize their 340B program.

To help covered entities broaden the reach of their 340B program, SUNRx, a leading 340B technology solutions company, recently acquired AuthorityRx, including the automated Advanced Claims Capture (ACC) solution. By combining the technology and expertise of the companies, SUNRx is able to provide entities greater resources to serve patients and communities.

Today, when a patient of a 340B entity visits a referral provider, the entity often loses the potential savings associated with their 340B program. In the past, identifying referral claims and other missed claims with traditional referral capture models has been a complex, often manual process that results

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340B Outlook from Capitol Hill, Federal Courts, and the States

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Monday, January 29 from 8:45 – 9:50AM PST, Marriott Marquis San Diego Marina

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Get the latest developments in the 340B program with some of the most respected experts in the field. Verity Solutions will be hosting this lively panel discussion again where you will get an up-to-the-minute report on hot button topics related to the policy, compliance, and regulatory aspects of the 340B program.

Among the topics to be covered:

· Developments on 340B contract pharmacy restrictions, state laws, and litigation

· Update from Washington, D.C., and the states on 340B legislative activity

· 340B provider reporting and transparency

· Future of 340B patient definition considering Genesis federal court ruling

Topics will be updated for any late-breaking news, and there will be opportunity

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Unlocking the TRUE POTENTIAL of 340B

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Embracing your pharmacy program within the 340B framework

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Primary care organizations often view themselves as a “Medical Home” for their patients, focusing on resolving patient health problems through their medical services. However, a significant challenge for providers lies in the inability to monitor and influence a patient’s behavior in the time between medical visits. Surprisingly, pharmacy professional services, designed to address this need, remain underutilized and are rarely integrated into medical workflows.

Understanding Pharmacy Professional Services

Pharmacy professional services can be defined differently by practice setting, but they encompass a range of activities performed by pharmacy resources to improve the outcomes of medication therapy. Essentially, these services eliminate barriers to drug therapy failure which can be categorized into three main buckets:

  1. Poor access or affordability
  2. Educational gaps
  3. Clinical effectiveness and side effects

Despite the pressing need for addressing these barriers, the current primary care infrastructure does not fully integrate these aspects into a multidisciplinary approach. However, this is

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3 Things Hospitals and Grantees Need to Know about the Genesis Decision

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Potentially more eligible claims, but care is required.

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The much-awaited decision in the Genesis Health Care patient definition case in federal district court in South Carolina provides 340B hospitals and federal grantees welcome re-affirmations of the importance of the vital safety-net care they provide as well as Congress’s intent to support that care through the 340B program. Although the court limited its decision solely to the Genesis health center, and its decision is potentially subject to appeal, the ruling provides a strong indication that future courts reviewing attempts by HRSA to enforce an overly-restrictive “patient definition” could similarly reject the agency’s restrictions.

Here are 3 things hospitals and grantees need to know regarding their 340B programs from the Genesis decision:

1. Hospitals and grantees should revisit their 340B prescription eligibility criteria.

For more than a quarter century, HRSA relied upon informal guidance to interpret the otherwise undefined term “patient” in the 340B statute to restrict prescriptions 340B hospitals and other

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