AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |
Back to Blog
340b program overview4/29/2023 The covered entity has established a relationship with the individual, such that the covered entity maintains records of the individual’s health care and.This has caused confusion all across the nation. States may also treat 340B rules differently from what is expected under national statutes.Weigh difficulty of pursuing rebates on the back end value of supplemental rebates state’s up-front reimbursement rate, etc.State must evaluate potential for budget savings.State may elect to forgo Medicaid rebate and reimburse for 340B drug at 340B acquisition cost plus, dispensing fee/admin fee.Medicaid billing procedures do not have to be followed if the 340B drugs are billed to a Medicaid managed care organization or are billed and paid by Medicaid as part of a capitated or bundled rate.They must bill at invoice price to avoid duplication. The rationale for covered entities adjusting their Medicaid billing practices is the need to protect manufacturers from a ‘double dipping’ problem.Covered entities must change how they bill 340B drugs to Medicaid to avoid duplication.As a result of Section 1002 of the Medicare Modernization Act (MMA), manufacturers may offer 340B hospitals deep discounts on inpatient drugs without adversely affecting the companies’ “best price” used to calculate their Medicaid rebates and 340B prices.As you will see Medicaid drugs need to identified also in DSH hospitals. Thus, inpatient and outpatient drugs must be segregated within the covered entities. Medicaid reimbursement is a challenge, however.Covered entities that bill patients, commercial insurance,or government payers for patients’ drugs can make money by using 340B drugs.Covered entities that provide free or reduced price/sliding scale drugs to indigent or low-income patients can save money by using 340B drugs.340B law does not require covered entities to provide their discounts to patients or 3rd party purchasers.Actual 340B prices may be significantly lower than Medicaid “net” priceģ40B Offers Savings/Revenues for Safety Net Providers.Covered entities can negotiate prices lower than the “ceiling” price on their own or through a statutorily-chartered “Prime Vendor” program.Impact of DRA Medicaid pricing changes. ![]() Impact of Medicare Part D best price exemption.340B “ceiling” price = rough Medicaid “net” price (or AMP – mandatory rebate amount under SSA §1927(c)).Providers are expected to purchase all of their outpatient drugs through a 340B program, but can ‘carve out’ Medicaid.Qualified providers must apply for 340B status.340B Program administered by the Office of Pharmacy Affairs (OPA) in the Health Resources and Services Administration (HRSA).Public and non-profit DSH hospitals that have indigent care contracts with state/local governments.Federally-qualified health centers (FQHCs) and “look-alikes”. ![]()
0 Comments
Read More
Leave a Reply. |