Updated: Sep 24, 2020
Financial challenges are the number one issue hospital CEOs face, according to The American College of Healthcare Executives (ACHE). Other top concerns for hospitals include increasing supply costs and limited reimbursements.
The complexity of the 340B program doesn't help. Some hospitals and clinics never reach their full savings potential… while some experience compliance issues.
That being said, it’s crucial now more than ever for your healthcare organization to reduce overall healthcare costs. Want to know how to optimize your 340B program?
Here are a few ways to stretch your dollars, maximize your savings, and remain HRSA compliant.
1. Carve-In Medicaid
Wait, what does carve-in Medicaid mean? You’ll include Medicaid patients in your 340B program. So, you’ll dispense 340B purchased drugs to Medicaid patients. However, carving-out of Medicaid excludes Medicaid patients from the 340B program.
This means Medicaid patients receive non-340B drugs. Carving-in models include Medicaid patients, while carving-out models exclude these patients.
There’s a caveat. Many hospitals in America haven’t made plans with the federal government to allow “carve-in” of contract pharmacy claims. Still, other states embrace how a “mandatory carve-in” will help prevent unchecked drug spend.
Does your state need you to “carve-out” Medicaid for contract pharmacies? Instead, think about carving-in Medicaid prescriptions for your contract pharmacies and your hospital.
Why? You’ll save money because 340B inventory is cheaper than Group Purchasing Organization (GPO) and Wholesale Acquisition Cost (WAC) pricing. Are you concerned about duplicate discounts?
Don’t be. Federal rules allow 340B discounts for Medicaid patients. You’ll need your NPI(s) and Medicaid provider number to register. Your state will work with you to prevent duplicate manufacturer rebates for drugs you already billed for.
2. Conduct a Gap Analysis
A gap analysis can help increase your 340B savings. You’ll pinpoint your current 340B program’s performance.
The collected data will help you recognize the differences between where you are now and where you want to be. Essentially, you want to close any gaps that could hinder the success of your program.
Consider these questions to start:
● Where are the gaps?
● How can you fill them?
● What’s your capture rate? How to improve your capture rates?
The simple truth is, even when using the best TPAs and counselors, 340B programs leak about 15% of highly profitable scripts to unaffiliated pharmacies. Therefore, use your gap analysis to uncover your hospital’s opportunities and increase your savings.
3. Reduce Your Costs
Hospitals and clinics contracting with multiple pharmacies must ensure drugs are purchased on the right account, whether that’s WAC, GPO, or 340B. Healthcare organizations shouldn’t violate the GPO Exclusion rule.
Split-billing solutions can help your organization to distinguish between 340B eligible scripts from non-340B eligible scripts after dispensing. How does this work? The split-billing system collects all patient transaction information.
Then, the system will ensure your pharmacy’s inventory is purchased on the right account.
Therefore, reducing the costs of drug purchases and promoting compliance.
Your split-billing solution needs to integrate with your healthcare organization’s existing systems seamlessly. What does a seamless split-billing solution look like?
A high-quality split-billing solution will:
● Reduce overall drug cost
● Maintain compliance
● Prevent drug diversion and more.
Outsourcing experts to oversee your 340B software will free up your time to focus on delivering quality care to patients.
There are many ways to optimize your 340B program savings. However, you don’t need to figure out all the nuances alone. Our team of 340B experts can come alongside you to create a customized solution for your organization.
Contact us if you’re interested in maximizing your savings today!