How One Leading 340B Services Company Has Taken Action to Stay Ahead of the Contract Pharmacy Restrictions Game

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As the dispute with drug manufacturers over 340B contract pharmacies drags on, Sentry Data Systems has unveiled a suite of resources and capabilities to help covered entities decide on their next steps. It’s no coincidence that this has happened as Sentry integrates more closely as part of The Craneware Group.

As recent surveys have shown, the manufacturer exclusions on 340B contract pharmacies are taking an ever-growing bite out of the finances of our nation’s safety net hospitals and clinics. Meanwhile, covered entities are feeling the pressure to submit to the manufacturers’ demands to hand over contract pharmacy claims data to regain 340B pricing, even as the evidence we’ve seen suggests most participants are proceeding slowly after taking a wait-and-see approach — and they’re not always “all in.”

Sentry isn’t waiting. We’ve taken action to ensure our customers are educated and armed with information and other resources to make their own decision about whether to submit data. Our first steps were to help our customers understand the impact of the exclusions, so they could make informed decisions.

Like covered entities, we did our research. We spoke with the marketplace early on — whether to 340B ESP, the third-party platform several manufacturers are using to receive and validate claims data from covered entities, or directly to the manufacturers to learn how the processes work and what it means for covered entities — before deploying new capabilities to benefit our customers. We then made some important modifications to the Claims Report function in Sentrex, our contract pharmacy management platform, to make it easier for covered entities that choose to provide data to the manufacturers.

The changes allow users to slice and dice the claims data so they can be more selective about what they share and omit based on the various manufacturer requirements. It also helps them easily meet the minimum biweekly reporting requirement, or report more frequently. Once customers make their desired settings, they can automate the reports, so each subsequent report is scheduled to auto-generate, and they only need to review it for changes.

Other updates to the Claims Report include new fields that are helpful for both data reporting and analysis:

  • The government ID assigned to the covered entity, a requirement of 340B ESP
  • The type of event that makes a claim 340B-eligible (such as UB04, ADT, eRx, etc.)
  • The date of the associated event
  • The 340B drug cost

We have also learned from early adopters who have sent contract pharmacy claims data and are sharing those learnings with our customers through webinars and ongoing communications.

Next, came software functionality. As the manufacturer requirements have evolved, we adapted our software rules engine to account for new “look-back” periods implemented by certain manufacturers to less than 45 days, sometimes well before a claim’s eligibility may ordinarily be known. Our product and development team created new algorithms that will help covered entities meet these new requirements. While many see these manufacturer requirements as unlawful, the new code in our software will protect the covered entities from machine learning techniques the manufacturers are using to remove covered entities that do not comply with their requirements.

Reporting functionality also led to a need for education. We’ve moved quickly to assemble a library of guides and resources, including:

  • Manufacturer and advocacy update webinar recordings
  • A manufacturer court case summary
  • A rundown and timeline of the different reporting models deployed by manufacturers
  • A crosswalk of the Sentry Claims Report to the minimum necessary data required by 340B ESP
  • A cheat sheet to help covered entities know how each manufacturer’s impact date affects how they will view claims and what options they have depending on their decision to submit data or designate one or more contract pharmacies
  • A summary chart listing what covered entities need to know for each manufacturer that has enacted exclusions, including pharmacy designation, third-party portal, pharmacy requirements, look-back windows, NDCs affected and more
  • A covered entity submission form, including a definition guide and list of steps needed to open a case with Sentry to remove a manufacturer exclusion

Laser focused on 340B

These customer-focused efforts are happening amid a great deal of behind-the-scenes work to integrate the people, processes and technology to make The Craneware Group- a powerful software company.

As a combined software company, 340B is a key pillar in our product portfolio and strategy. We’ve invested more than $21 million to date in the current fiscal year in R&D and innovation. Some of this innovative work includes updates to the Audit Manager application, which helps users conduct mock audits and review random claims for compliance; and the previously mentioned updates to the Sentrex Claims Report. 

Sentry’s 340B applications, taken together with Craneware, an expert in clinical analytics and value cycle solutions, and Agilum, a provider of real-time pharmacy data analytics, make The Craneware Group a concentration of intellect, skill and experience across the healthcare finance and 340B continuum. Through the partnership, we’re excited to bring our combined value cycle, pharmacy analytics and 340B offerings to more customers to transform the business of healthcare.

As the new software capabilities illustrate, Sentry’s focus on helping our customers build and manage a successful 340B program won’t change. Our 340B products and functionalities will continue to advance and bring new innovations, even as our customers will see cosmetic branding changes as we work the new Craneware Group branding into the look and feel of Sentry products.  

We’ll be debuting our new rebrand as part of The Craneware Group at the 340B Coalition Summer Conference in August. You can learn more about The Craneware Group’s solutions and Sentry’s new data capabilities by scheduling a meeting with us at the conference.

Lisa Scholz is Senior Vice President, Industry Relations at Sentry. She can be reached here.