Tag: Industry Insights

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We are pleased to again bring you Visante’s Top 10 issues in pharmacy for 2023. For 2022, our Top 10 items (Pharmacy Org Structure, 340B Program, Vertical Integration & Marketplace Restrictions, Drug Prices & Supply Chain, Infusion Services, Drug Shortages, Pandemic, Economy, Election, Social Justice) all turned out to be very relevant and many of these items again made the list for 2023.

To say that 2022 was turbulent would be a significant understatement! With the pandemic, economy, election and social justice issues driving national concerns, including pharmacy, coupled with the more pharmacy-specific elements, it was an extremely challenging year for pharmacy and healthcare in general. However, despite the magnitude of the challenges, we observed pharmacy programs all over the country stepping up and meeting these challenges head-on. Pharmacy programs demonstrated innovation, creativity, commitment to purpose, and a tremendous work ethic in supporting their patients and their organizations and should be justifiably proud of their

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The 340B statute was written as a drug pricing program that outlines specifically what manufacturers are required to charge qualified covered entities for their drugs based on a defined formula. The intent of the 340B program is to help these safety net entities stretch their scarce resources to maintain and enhance services in underserved areas and reach more eligible patients.

Though the statute is silent on how much these entities should charge their patients for their drugs or the delivery mechanisms used to get pharmacy services to their patients, there is increasing scrutiny on these areas from manufacturers and other opponents of this vital program.

The Issues Surrounding 340B Pricing

Although it is not a requirement of the statute, many falsely point to 340B prices not being passed on directly to patients as a blatant misuse of the program. There are numerous reasons this was

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Cloudmed routinely analyzes aggregate data to identify 340B program trends and patterns that can provide useful client insights regarding referral prescriptions. Our 340B team observed two calendar years of data across more than 230 covered entity sites to understand which drugs, therapeutic classes, and medical specialties account for the largest savings realized through referral prescriptions within the contract pharmacy domain.

Top Level Findings

Hepatology And Hematology/Oncology Medications Account For Most Savings

In both CY 2020 and CY 2021, hepatology and hematology/oncology medications consistently account for more than 50% of the top ten medications realized within referral management.

Hepatology medications HARVONI, EPCLUSA, and SYPRINE – drugs used to treat hepatitis and liver disorders – were consistently ranked across both 2020 and 2021. The capture of neurology medications indicated for treating multiple sclerosis and

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Pop Quiz: Which of these statements are false?

1. The United States spends more on health care than any other developed nation. But when compared to 11 other high-income countries, the U.S. ranks last for access to care, health equity, and health outcomes. Case in point: Despite significant advances in HIV prevention and treatment in the last 40 years, profound, persistent disparities in access to this care have surfaced.
   
2. The U.S. health care system has particularly failed specific populations that routinely face barriers to care including stigma, provider access, and financial obstacles. For example, studies show that almost a sixth of LGBTQ+ adults in the U.S. report having experienced discrimination in a health care setting.
   
3. Community health centers (CHCs) bridge the health care gap for groups facing health disparities, serving over 30 million Americans. While 92% of CHCs report utilizing 340B drug discount program savings to increase care access for the underserved, the program is at

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340B providers are facing an unprecedented number of challenges. 340B program managers are forced to react to these changes every day. Having access to clear and understandable data and developing strong relationships with partners in the 340B supply chain are critical to running an effective program. 340B leaders should consider the individual pieces of each 340B program, what relationships exist for each piece and why it is important to get what is needed from these partners to run the program optimally and effectively.

Evaluating Your Partners

340B program managers should look at the partners with whom they routinely work to make their program function. First and foremost, it is important to know which locations within the covered entity is eligible. Eligible locations, providers and patients lay the foundation for the 340B program and assist in determining with which partners to work. Contract pharmacy relationships, drug access, and patient plan utilization are a few key elements to

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Let’s get this right out on the table: At Avita, we believe health care is a human right.

Polarizing politics aside, as an advanced, civilized society, we have an ethical obligation to care for the medical needs of every U.S. citizen compassionately and equitably, regardless of their race, gender, sexual identity, or ability to pay. It’s a principle our covered entity partners fight for daily, not to mention a pivotal reason behind the creation of the 340B program: Together, we must use every resource at our disposal to serve the underserved—forming a “safety-net” that catches patients who might otherwise fall through the cracks—and empower them to unlock the full potential of health.

But the truth is that alleviating the nation’s massive health equity crisis will take both introspection and innovative thinking from every single player in the industry, including 340B service providers, covered entities, drug manufacturers…the list goes on and on. Earlier

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Alas, after much deliberation, your covered entity has decided to submit data to 340B ESP. As you embark on this journey, you may be asking yourself: Now what?!?  

As someone who has operated a large 340B program at a DSH hospital and now has the privilege to consult many covered entities as they tackle 340B challenges, I know that making a decision and then operationalizing that decision can be quite the task! Many of our covered entity clients have decided to start submitting claims data to 340B ESP. While assisting our clients in navigating these uncharted waters, The Alinea Group has developed insights we want to share with the covered entity community. 

Initial Upload

The first step in getting access to 340B pricing is to upload an initial set of claims. This can be a difficult task, as many Third-Party Administrators (TPAs) have blocked these claims from qualifying as 340B claims once pricing for these

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When large drug manufacturers began restricting 340B drug discounts for contract pharmacies in 2020, Coastal Bend Wellness Foundation (CBWF) decided to pivot from a co-located pharmacy to entity owned. By doing so, the Community Health Center, which provides services to several rural counties in south Texas, would avoid the restrictions placed on contract pharmacies and continue to benefit from the 340B program.

At the time, CBWF had already partnered with Maxor 340B to design a turnkey, on-site pharmacy and run the day-to-day operations. Overall, the partnership with Maxor 340B was helping CBWF:

• Enhance their quality of patient care
• Optimize data transparency and accuracy
• Improve financial performance
• Gain access to specially trained pharmacy staff
• Integrate medical and pharmacy information for patients and providers

When CBWF decided to operate as a wholly-owned pharmacy, Maxor 340B embraced the opportunity to collaborate and make the transition as seamless as possible.