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TIP: For any covered entities with a contract pharmacy program, it is critical to review carve-out/ineligible claims data from your TPA system(s) to understand why claims are not qualifying in your 340B program.
Carved-out/ineligible claim data can reveal potential configuration issues or limitations within the TPA system. Examples can include entity-owned pharmacies that have had manufacturer restrictions being applied, prescribers or locations that are 340B eligible but are not configured correctly, excluded payers that should be eligible or claims that were not reprocessed after manufacturer pricing was restored.
Kristin Fox-Smith, Senior Vice President at Visante, can be reached at kfoxsmith@Visanteinc.com
