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TIP: Use a scorecard to monitor pharmacy partner performance and fees.
Create a quarterly scorecard that grades each contract pharmacy’s financial, operational, and compliance performance, and review it jointly with pharmacy and finance leaders to ensure every partnership supports the covered entity’s 340B program goals and long-term sustainability. Establishing a consistent review process not only reinforces accountability but also ensures that program leaders have clear, comparable insights into how each pharmacy partner contributes to the organization’s success.
Not all contract pharmacies perform equally, yet many entities manage them as if they do. Developing a standardized pharmacy partner scorecard introduces transparency and supports data-driven decision-making.
Your scorecard should evaluate both performance and fairness, using metrics such as claims processed, 340B savings generated, reconciliation accuracy, and fee percentage. Ranking partners by these measures help identify top performers, justify administrative costs, and flag underperforming relationships before compliance or financial risks emerge.
Conducting these reviews on a regular basis promotes accountability and ensures the 340B program continues to operate efficiently and in alignment with the covered entity’s overall mission.
At Ravin Consultants, we help covered entities implement practical tools, like contract pharmacy scorecards, to drive performance, compliance, and savings. Our proprietary 340B dashboard tracks key pharmacy metrics, offering clear, actionable insights that support strategic decisions. Whether you’re optimizing pharmacy partnerships, navigating manufacturer restrictions, or strengthening compliance, Ravin Consultants brings the expertise and technology to help your 340B program thrive.
Damion Wise is the Lead 340B Consultant at Ravin Consultants. He can be reached at damion@ravinconsultants.com
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TIP: Establish a rebate submission cadence with weekly minimums to protect cash flow.
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.
Tim L’Hommedieu is SVP of Pharmacy at Plenful. He can be reached at tim@plenful.com
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TIP: When preparing for the potential impact of the 340B rebate model, consider how it could affect three key core organizational elements.
In an ever-changing 340B environment, the 340B Rebate Model Pilot Program will be yet another adjustment for covered entities. When preparing for the potential impact of the 340B rebate model on their missions, covered entities (CEs) must consider how it could affect three core organizational elements: cash flow, 340B administration, and technology. This includes:
Cash Flow Impact
- As a result of the 340B rebate model, CEs will no longer receive the immediate 340B savings offered by the upfront discount model. They will need to purchase medications at Wholesale Acquisition Cost (WAC) and wait for a rebate. This delay in receiving discounts will negatively impact cash flow.
- The covered entity should complete a financial analysis to estimate the new WAC outlay versus the previous 340B costs. This will help leadership prepare should they need to build cash reserves or assess financing options.
Administrative Impact
- The 340B rebate model requires strict adherence to timelines (claims must be submitted within 45 days of dispensing). Missing these deadlines could result in forfeited rebates.
- CEs should ensure that they have systems in place to submit accurate and timely data to avoid lost rebates.
- CEs should develop internal policies and procedures to escalate manufacturer denials and keep track of pending appeals.
- CEs also should ensure that they have access to the real-time rebate status of a claim and regularly reconcile claims submitted with rebates paid.
Technology Impact
- In adhering to the 340B rebate model, CEs must regularly upload dispensing data on the manufacturer’s designated platform.
- CEs should meet with TPAs to ensure that a process is in place to upload all necessary data in a timely and accurate manner.
- CEs should confirm if they need to integrate new technologies into their existing systems to comply with manufacturer reporting requirements.
Mitchell Williams, 340B Director of Program Integrity at Avita Care Solutions, can be reached at mitchell.williams@avitacaresolutions.com
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TIP: Get prepared now for rebate hit with robust financial forecasting.
Unlike the current point-of-sale model where discounts are realized at the time of purchase, the rebate structure may introduce a significant lag between dispensing a drug and receiving reimbursement. This delay could affect how quickly covered entities recognize savings and may create short-term financial strain if not accounted for. By anticipating this gap, entities can better prepare their operations and avoid disruptions in budgeting, purchasing, or patient care.
Now is the time to build rebate timing into your financial forecasts and cash flow models. Work closely with your finance team to model different scenarios for payment delays and identify how they might impact working capital. Establishing reserve funds, evaluating lending options, adjusting procurement strategies, and engaging leadership early can help soften the impact of delayed reimbursements. Covered entities that proactively plan for cash flow shifts will be better positioned to maintain program stability.
Harrison Garrett is vice president of 340B Solutions at Cervey. He can be reached at hgarrett@cervey.com
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TIP: Compare your 340B net cost to the Maximum Fair Price (MFP) before submitting a rebate.
With MFP rebates soon to be part of Medicare Part D, the new considerations between the expected 340B rebate and relying on MFP can feel overwhelming. The easiest way to stay on top of it is to keep the process simple: compare your net 340B cost—including drug acquisition, TPA, and pharmacy fees—to the MFP. If 340B delivers the lower cost, submit the rebate. If not, let the MFP adjustment apply and avoid duplicate submissions.
340B covered entities should be aware that 340B prices are largely lower for the initial 10 MFP drugs. 340B, therefore, still presents significant purchasing benefits on these initial 10 drugs and should not simply be excluded. Taking this step not only reduces denials and streamlines reconciliation, it also helps protect your margin. Just as important, it creates a clear audit trail to support manufacturer reviews and potential appeals.
By building a quick cost check into your routine, you can minimize administrative burden while keeping your 340B program working to its full advantage.
Diana Sierra is Vice President, Contract Pharmacy Partnership at The Craneware Group. She can be reached at dsierra@craneware.com
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TIP: Take these six steps to build a strong data analytics foundation.
Data analytics is transforming healthcare, turning raw information into actionable insights that improve patient care, streamline operations, and support strategic decision-making. As healthcare organizations face increasing pressure to deliver value, reduce costs, and enhance outcomes, the ability to harness data effectively has become a critical capability.
Here are 6 steps to help get you started:
- Assemble the right team: Build a group with analytics expertise, workflow understanding, and commitment to data integrity and governance.
- Select effective tools and workflows: Invest in analytics platforms and processes that support structured, compliant, and reliable data collection.
- Emphasize data storytelling: Use dashboards, KPIs, and tangible examples to communicate insights and inspire organizational change.
- Tailor practical steps: Adapt analytics approaches to your organization’s current level, whether just starting out or scaling up.
- Invest in training and partnerships: Overcome resource and knowledge gaps through education and collaboration with data-savvy partners.
- Focus on actionable insights: Center analytics efforts on generating real-world, actionable findings that support your mission and improve patient care.
A Partner in Your Mission
At VytlOne, Our Mission is Your Mission. We identify your organization’s financial opportunity and create actionable insights to drive your mission forward.
Request your copy of our Pharmacy Growth Report to discover the hidden revenue potential of your in-house pharmacy today.
Clay Cooper is Director of Insights Execution & Innovation at VytlOne. He can be reached at clay.cooper@vytlone.com
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TIP: Maximize 340B savings by manually pulling in rejected and qualified claims.
Manually pulling in rejected and qualified claims in the TPA database is a critical step in capturing eligible 340B savings that may have been missed due to unmatched prescription data. Claims can fail to match automatically to an EMR (Electronic Medical Record) or ERX (Electronic Prescription) record due to discrepancies in provider documentation, timing issues, or data entry errors. By reviewing and manually adjudicating these claims, covered entities (CEs) can identify encounters that still meet 340B eligibility requirements but were not captured through automated matching. This practice ensures the entity maximizes its 340B benefit while maintaining program compliance.
Furthermore, this manual reconciliation process supports stronger audit preparedness and data integrity. By documenting the rationale for qualifying claims and ensuring proper linkage to eligible encounters, CEs can provide a defensible audit trail. It also helps identify patterns in rejected claims that may point to workflow or system issues, allowing for targeted improvements. Ultimately, consistently reviewing and processing unmatched claims manually helps optimize program performance while upholding the accuracy and accountability essential in 340B operations.
Sejal Patel is Senior Director of Client Success at Pillr Health. She can be reached at spatel@pillrhealth.com
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TIP: When a covered entity participates with 340B ESP™ to obtain 340B pricing restoration, it is critical to monitor manufacturer policies, ESP eligibility, wholesaler pricing, TPA settings, and data submission accuracy on a routine basis.
Consistent monitoring is critical to ensure uninterrupted access to 340B pricing when submitting data to 340B ESP™. Begin by reviewing manufacturer policies regularly—these can change frequently and are available through resources like the 340B ESP™ Resources page and the 340B Report. Be aware of any manufacturer-specific requirements, such as requirements to submit in-house retail pharmacy data. Keep in mind that manufacturers do not routinely notify CE’s when they are updating their pricing policy.
An eligibility file is available to download from the 340B ESP™ portal. The file is the source used for determining 340B pricing eligibility, so it is important to confirm that your contract pharmacies are appropriately listed as eligible and promptly follow up on any discrepancies. Once pricing eligibility is confirmed within 340B ESP™, track wholesaler pricing catalogs to validate pricing has been appropriately restored and identify any issues early. TPA (third-party administrator) settings should be reviewed routinely to ensure that appropriate blocks are in place and no contract pharmacies are improperly excluded from data submissions. Additionally, confirm that your submission balances in the 340B ESP™ portal accurately reflect the pharmacies you intend to include in data submissions. Validate that in-house pharmacies are listed accurately and that contract pharmacy data submissions are being applied accurately to balances.
Finally, be aware of relevant state-level laws that may impact contract pharmacy relationships and data sharing. A routine, comprehensive review of these areas helps protect your pricing and ensures compliance with evolving 340B program requirements.
Dani Stewart is 340B Program Director at Visante. She can be reached at astewart@visanteinc.com
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TIP: Optimize NDC selection by evaluating utilization, not just 340B accumulations.
When selecting a preferred National Drug Code (NDC) within a medication grouping (e.g., lisinopril 10 mg), many covered entities (CEs) focus solely on available 340B accumulations. While important, this can lead to suboptimal choices if historical utilization across all account types (340B, GPO, WAC) is not also considered.
Instead, analyze utilization patterns to calculate a weighted price for each NDC based on how often it’s used under each pricing category. This ensures you’re selecting the NDC that offers the best net value—not just the most 340B savings in isolation.
Additional considerations:
- It may still make sense to purchase the remaining 340B accumulations before transitioning to a new NDC.
- Factor in operational impacts—e.g., unit dose vs. bulk bottle, vial vs. syringe, or alignment with committed contracts.
- With most CEs managing over 4,000 medication groupings, manual optimization is not scalable.
That’s where a tool like Trulla Procurement adds value. Trulla automates NDC optimization by factoring in historical utilization, contract pricing, and operational preferences—giving pharmacy buyers data-driven recommendations at scale.
Matt Parker is Vice President of Trulla at SpendMend. He can be reached at mparker@spendmend.com
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TIP: Align charge capture and 340B strategy to unlock long-term sustainability.
In today’s margin-pressured environment, 340B savings alone aren’t enough. To build a truly sustainable operation, hospitals and other covered entities (CEs) should align their 340B programs with broader reimbursement and charge capture strategies. That means ensuring accurate documentation, optimizing coding workflows, and validating charges in real time.
CEs that unify 340B tracking with enterprise-level revenue integrity efforts are better equipped to reinvest savings, offset shortfalls, and expand access to care—even in high-need communities.
At The Craneware Group, we see this alignment as a critical differentiator for safety net hospitals and other 340B providers aiming to improve financial sustainability while maintaining compliance. It’s not just about protecting 340B—it’s about protecting your mission.
Chris Boles is Senior Vice President of Account Management at The Craneware Group. He can be reached at CBoles@craneware.com
