340B covered entities strive to ensure they are getting the maximum benefit out of the 340B program in order to help fund services for vulnerable patient populations. For health centers, this means setting up a robust contract pharmacy network.
Surprisingly, more than 70% of par8o’s 340B Referral Capture clients did not have a specialty pharmacy as part of its contract pharmacy network before partnering with par8o. For CEs that include referral scripts in their 340B programs, however, making sure that the contract pharmacy network includes a specialty pharmacy can be key to maximizing valuable 340B opportunity.
Why Do Health Centers Need Specialty Contract Pharmacies?
Specialty pharmacies tend to dispense drugs that are both high-cost and high-touch, meaning they are part of or require complex therapeutic regimens for diseases that require more comprehensive patient care, such as hepatitis, cancer, HIV, rheumatoid arthritis and Crohn’s disease. Retail pharmacies generally dispense medications suited for less severe illnesses, and/or require less instruction and patient management.
Given there is no hard and fast rule as to when a drug is considered specialty vs. not, you might see specialty medications dispensed at contract retail pharmacies. This would seem to make it redundant to also contract with a specialty pharmacy. While it’s a little confusing, even though some specialty prescriptions can be dispensed at retail pharmacies, others can’t – the payer has a lot to say about how and where a particular drug should be dispensed.
Further, while some specialty drugs can be dispensed at retail locations, others are required to be dispensed by specialty pharmacies making it worth your while to “cast a wide net” and include specialty pharmacies in your contract network, even if some of your specialty drugs are also dispensed at retail locations.
Why Specialty Drugs are Increasingly Important When Capturing Referral Scripts
Once a covered entity is committed to capturing referral scripts as a part of its 340B program, making sure a specialty pharmacy is part of a contract pharmacy network is even more important. This is because specialist providers are more likely to prescribe specialty drugs–the same providers that, unless you’re capturing referral scripts, are being excluded from claims capture based on ineligible NPI. For instance, referred-to rheumatologists are more likely to prescribe high-cost specialty meds than a typical PCP.
As many as 73% of par8o’s clients did not have specialty pharmacies in their pharmacy networks when first implementing par8o. After contracting with a specialty pharmacy, our clients see month-over-month savings growth of anywhere from 35.5% – 171.9%. The impact that can have on a health center’s 340B program can be significant.
Given par8o’s relationship with specific retail pharmacies, par8o can provide its clients with an estimated pro forma on specialty opportunity. This is what led to many of its clients expanding their pharmacy networks.