Expert Tip from Plenful

With the 340B Rebate Model Pilot now approved for January 2026, Covered Entities (CEs) have many operational processes to review and evolve to meet new requirements. One critical area to prioritize, starting now, is establishing a rebate submission and reconciliation process that supports frequent and reliable reporting.

It’s important to consider the data source for these claims. The addition of 11 medical claim data fields to the existing prescription data fields requires CEs to be thoughtful about their approach to collecting and submitting claims data from a variety of locations and sources. Those with clean sites, internal claim qualification workflows, or with multiple TPAs should consider how automation like Plenful’s 340B Rebate Management solution can assist.

The frequency of claim submission is another factor. Delayed or irregular submissions can extend the time between drug purchase and manufacturer reimbursement, tying up funds that would otherwise support operations or patient services. To prevent this, organizations should aim for at minimum a weekly submission cadence. A regular cadence will allow your team to shorten reimbursement timelines and detect and resolve submission issues more quickly. It also reduces the likelihood that a claim will be disqualified due to submission after 45 days of dispense.

Finally, weekly reporting improves data visibility and ensures a steady revenue stream from rebate payments. Automated rebate reporting workflows, like what we’ve built at Plenful, will streamline the manual work required to prepare the required data elements and facilitate submission. Preparing systems and workflows now to support this cadence will help CEs enter the rebate era with confidence and control over financial performance.