TIP: Accurately tracking and loading drug prices into the ESP system can be the difference maker when it comes to maintaining compliance and ensuring maximum savings.
If you’re a covered entity who contracts with outside pharmacies, it’s important to start with the basics. Equip yourself with these tips to troubleshoot any price loading roadblocks you may encounter, and ensure pricing is loaded as quickly and efficiently as possible.
First, if pricing has not been loaded, it may cause a claim to be ineligible when using “winners only” logic. Be sure to send these ineligible claims to 340B ESP so pricing can be loaded. Second, the HIN number can be another problem area to watch out for. The HIN number is required by manufacturers for each contract pharmacy location. If there’s no HIN number, the manufacturer may forgo loading the price.
Lastly, different manufacturers have different policies and load prices based on varying criteria. For example, Eli Lilly and Pfizer claims must be uploaded on a store-by-store basis. Pricing is restored one contract pharmacy location at a time as a claim with one of their NDCs gets uploaded to 340B ESP. Know your manufacturer’s policy to avoid any hiccups!
Larry Crowder, Vice President of 340B Solutions at Cervey, can be reached at email@example.com