Financial challenges are the number one issue healthcare facility CEOs and CFOs face, according to many sources. Other top concerns include things like increasing supply costs, labor shortages, and limited reimbursements.
Covered entities already have enough to worry about, however, the 340B Drug Program provides a very important source of funding for those Covered Entities and their patients. But the complexity of the 340B program definitely provides unique challenges and concerns. Because of this, some covered entities never reach their full savings potential… and have compliance issues.
That being said, it’s crucial now more than ever for your healthcare organization to reduce overall healthcare costs and increase savings wherever possible.
You may ask yourself; How do I ensure my 340B is getting the most benefit?
We get it, really we do. So here are just a few ways to stretch your dollars, maximize your 340B savings, and still remain HRSA compliant.
1. Review your prescriptions against your capture rate
Wait, what does this mean?
Reviewing the total number of prescriptions written by your providers compared to the total number of prescriptions captured within your 340B Program is probably the best place to start reviewing your program's missed opportunities.
Working with the data of prescriptions not captured in 340B, you can start to identify why each prescription was considered ineligible.
After you've done this, you can consider some questions like:
● Where are the gaps?
● How can you fill them?
The simple truth is, even when using the best TPAs, 340B programs leak an average of 20% of highly profitable scripts to unaffiliated pharmacies. Use this gap analysis to uncover your hospital’s opportunities to increase your savings.
2. Start 340B ESP Submission
Why should I really have to give my data to drug manufacturers through this system?
To make a long story short, because there is a lot of 340B savings potential contained within the claims. With a current list of 30 drug manufacturers currently restricting 340B prices at contract pharmacy locations, and 17 of those requiring data to be submitted through 340B ESP to get 340B pricing, this could really give your program a boost in today's 340B universe.
While each and every covered entity and their 340B program is different, with 9 manufacturers restricting pricing across all entity types (and they are some of the largest name manufacturers such as Eli Lilly, Bausch, Gilead, and AstraZeneca), we have seen as much as 70% of a program's prescriptions affected by these restrictions. And for the time being, there appears to be no end in sight.
The identification and submission of data to 340B ESP can become an operational and time burden on staff, but between better TPA capabilities and utilizing external contracts, the burden can be greatly lessened.
3. Consider Referral Capture
In many cases, a covered entity may refer a patient to a non-340B facility or location, while maintaining responsibility for the patient's care. In this situation, there could be an opportunity to capture a patient's prescription within your 340B Program with some additional steps and support.
In order to meet HRSA's guidelines, the patient must receive care from a provider who is either employed by, or provides care under a contractual or other arrangement, such that the responsibility of care remains with the covered entity. Best practice states that the electronic health record (EHR) of the patient includes the eligible providers' referral order (from an eligible location) as well as the summary of the diagnosis and care provided by the referee provider or facility.
Approximately 30% of a covered entity's contract pharmacy potential benefit can lie in referral prescriptions. That can be even higher with specialty prescriptions.
4. Use a Contractor
Covered entities in today's healthcare systems are facing huge challenges with labor shortages. Many facilities have no choice but to have their 340B program managed by non-specialists like a CEO, CFO, Pharmacy Director, etc. This can create multiple challenges as we discussed in an earlier post.
Contracting with an external consulting firm, like Optimal340B, can be beneficial for your 340B Program, and therefore your facility, in many ways:
Spend less time away from your main focus by not having to manage day-to-day 340B problems
Get customized, accurate, and aggregated financial reporting done for you
Have an expert review your program for missed savings potential and then they'll work to realize those savings
Fulfill your HRSA requirement for 3rd Party/external audits
So much more!
One of the biggest things about looking to an external contractor for managing your 340B Program is that often, you can get access to an entire team of experts for around the cost of one equivalently experienced in-house employee. Plus you get to avoid the hassles of the mounds of paperwork, filing taxes, tracking hours, etc. that comes with hiring internal employees.
There are many ways to optimize your 340B program savings. However, each of these methods can be time-consuming, require specialized knowledge, and can be difficult, but you don’t need to figure it out alone.
Our team of 340B experts work alongside you to create customized solutions for your organization.
Reach out to us to see how we can help you. Call us or email our CEO to schedule a call.
1-866-OPT-340B(678-3402) or Lyssa@optimal340B.com
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