340B covered entities are worried that Humana may begin widespread rejection of claims for prescriptions filled with 340B drugs, and may begin auditing 340B claims more aggressively.

Providers Worried About Humana’s 340B Claims ID and Data-Reporting Conditions

Health insurance company Humana has begun sending pharmacy provider agreements for 2022 to 340B-participating pharmacies, with claims-identification and data-reporting conditions that some 340B providers say are unsettling. They say the agreements are to be signed and returned within 30 days of receipt.

The agreements bind providers and their participating pharmacies, understood to mean 340B contract pharmacies, to identify 340B-purchased drugs using National Council for Prescription Drug Programs (NCPDP) submission clarification code 420-DK field with a value of 20. Providers also must give Humana, upon request, “data used for 340B eligibility and reconciliation information.” The agreements also set provider reimbursement for 340B-purchased drugs significantly below wholesale acquisition cost.

Health insurance company Humana has begun sending pharmacy provider agreements for 2022 to 340B-participating pharmacies, with claims-identification and data-reporting conditions that some 340B providers say are unsettling. They say the agreements are to be signed and returned within 30 days of receipt.

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