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The upcoming rebate model pilot program is already reshaping how covered entities think about claims workflows. Many teams are starting to realize that what worked yesterday won’t necessarily support tomorrow’s requirements. Claim visibility, automation, and reconciliation are all about to matter a lot more.
And the truth is simple: your TPA’s capabilities will play a big role in how smooth—or stressful—this transition feels.
As you evaluate readiness, here are seven questions worth asking.
1. Can your TPA eliminate the hours spent on manual claims submission?
Manual uploads don’t just drain time; they create backlogs and increase the chance of missed opportunities. Automation frees up staff and reduces the friction that tends to build when volume scales.
2. Does the system automate daily claims submissions from different care settings?
The rebate model pulls in more than the traditional outpatient world. Mixed-use claims, physician-administered drugs, and contract pharmacy settings all matter. A TPA that can bring these sources together automatically will help you stay ahead.
3. How does the TPA prevent claims fallout from catalog or pricing changes?
It’s not uncommon for claims to fall out simply because pricing shifted in their wholesaler’s catalog at the time of claims qualification processing. Under the rebate model, 340B pricing is no longer available for the included NDCs, and more advanced financial logic is required.
4. Will you be able to see rebate-rejected claims in real time?
Rejected claims can be hard to trace without the right visibility or the need to access multiple platforms. Reporting that flags what went wrong—and why—gives your team actionable insight instead of guesswork.
5. Can the TPA help avoid unnecessary WAC purchases?
Effective January 1, 2026, manufacturers will remove 340B pricing from drug catalogs, which means entities will need to be more intentional about automatic replenishment for the affected drugs. Since the affected drugs must now be purchased at WAC pricing, this could increase up-front drug spend significantly if the proper safeguards are not in place. Smart purchasing controls can reduce that risk and protect financial performance.
6. Will reconciliation files from Beacon integrate seamlessly?
Financial auditing is not new to 340B, but the rebate program adds a multiplier effect and creates an entirely new workflow that entities will need to adapt to. Seamless integration could be the difference between hiring dedicated FTEs and protecting your 340B program savings.
Under the 340B Rebate Model, 340B covered entities will now receive payments from a third party provider, and reconciliation files will be provided for all transactions. Seamless integration will matter more than ever as reconciling and auditing claims and payments from multiple TPA sources will now be required, and could be a very manual process.
7. Does the TPA reconcile every claim and payment?
A lot of money will move through rebate activity, and small discrepancies will add up quickly. Strong claim-level reconciliation gives you confidence that everything ties out correctly.
Why these questions matter
The transition to the rebate model represents a monumental operational shift for covered entities. Evaluating TPA readiness now can reduce financial losses later. Organizations that prioritize rebate-ready automation, visibility, and reconciliation will likely experience a smoother transition and stronger financial outcomes.
PharmaForce has taken proactive steps to ensure minimal disruption to 340B capture via advancements to its 340B TPA solution suite, including its dedicated manufacturer reporting platform, ClaimsConnect. Learn more at our 340B Rebate Model Pilot Program page. By taking early steps now, covered entities can enter 2026 with greater clarity, confidence, and control.
Anthony Velasquez is chief product officer at PharmaForce. He can be reached at avelasquez@thepharmaforce.com
