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Should I Stay or Should I Go? Third Party Administrators

Third Party Administrators (TPAs), also called claims processors or vendors, have an incredibly valuable role in 340B. Without them, 340B would be a much more arduous and time-consuming program to run. (Imagine doing all of that reporting and matching yourself).

A TPA's main job is to sort and match data from Covered Entities and Contract Pharmacies to determine 340B eligibility but they also can place orders on behalf of your 340B, and they should be your first line of defense with maintaining compliance in your 340B Program through their settings.

However, not all TPAs are the same, and from time to time you should ask yourself: Are there other TPAs with capabilities that better align with your facility’s resources and needs?

Just a few examples of questions to ask about your current TPA, as well as any that you’re interested in, are:

  • Do you get the level of service and support that you need from your current TPA?

  • Is your TPA able to use your EHR system(s) and integrate seamlessly?

  • How easy is it to update things like a provider panel in your current TPA

  • Do you have visibility into all of the settings and data you’d like to see?

  • Does your current TPA have a user-friendly interface.

    • Can you schedule reports to be automatically pulled & delivered to you?

    • Can you customize what you see in the reporting, so you don’t have to sort through unnecessary data?

  • How does your current TPA prevent mismatches?

    • Can they track missed opportunities with ‘near-misses’ such as ‘Bob’ vs ‘Robert’?

  • Do they provide compliance tools for you that are easy to access and use?

  • Do the fees they’re charging you make sense?

    • are there other TPAs with the same or better functionalities, but are more reasonably priced?

  • Does the ordering system work for you and your contract pharmacies?

These are all things to ask yourself and to review. We recommend asking yourself questions such as these once annually and especially before your TPA contract renewal. That way you have time to review what other options are out there that might better align with your facility, your goals, and your needs.

Because all TPAs are not equal we can’t specifically say one TPA is, across the board, better than another. The simple fact that each facility’s wants and needs are just as different as they are similar, makes the choice a very individualized one.

Sometimes you can’t help but have to stay with specific TPAs, such as with pharmacy chains like CVS, Walgreens, and Wal-Mart, but that doesn’t mean you should be limited on your reporting options. In fact, Optimal340B has a solution to consolidate multiple TPAs reporting into one easy-to-use platform with powerful analytics and auditing tools.

If you need help, don’t know how to review these items, or want to learn more about the Optimal340B OnDemand reporting portal, reach out to us today. Call us at 1-866-OPT340B(678-3402), submit a request on our website, email us at or find us on LinkedIn.

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