The Intersection of PBM Solutions and 340B Drug Discount Status: Ensuring Market Competitiveness and Affordable Healthcare

Ben H.

Ben H.

Jul 21, 20233 min read

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The Intersection of PBM Solutions and 340B Drug Discount Status: Ensuring Market Competitiveness and Affordable Healthcare

Introduction:

In the world of healthcare, finding effective solutions that balance market competitiveness and affordable patient care is paramount. Two key factors in achieving this delicate balance are the utilization of Pharmacy Benefit Manager (PBM) solutions and maintaining the 340B drug discount status. While these might appear as separate entities, there are common points that connect them, ensuring optimized performance and cost-saving opportunities for hospitals and patients alike.

The Role of PBM Solutions:

Aligning with a PBM, such as AffirmedRx, offers numerous benefits for healthcare organizations. By partnering with a PBM, hospitals can ensure market competitiveness and have a reliable ally that consistently monitors their plan's performance. Whether you are directly working with a PBM or procuring their services, the aim is to build your business while minimizing the hassle. Some advantages of partnering with a PBM include straightforward contracts, flexible and powerful technology, complete audit rights, data ownership, transparent pricing, and white-glove service.

Unique Insight: Creative Partnerships and Future of Pharma & PBM Relationships:

One unique aspect of partnering with a PBM like AffirmedRx is the opportunity for creative partnerships that redefine the future of rebate contracting. By removing the Group Purchasing Organization (GPO) layer, hidden fees are eliminated, enabling hospitals to optimize cost savings. Additionally, this opens up possibilities for innovative collaborations between pharmaceutical companies and PBMs, fostering a mutually beneficial relationship that drives the future of the industry. AffirmedRx also provides insights and data at no additional cost, contributing to the development of the future of Pharma & PBM relationships.

Maintaining 340B Drug Discount Status:

While PBMs offer substantial benefits, hospitals must also navigate the complexities of maintaining their 340B drug discount status. The 340B drug discount program allows eligible hospitals that treat low-income and uninsured patients to access significant drug discounts, reaching up to 50%. However, recent concerns have arisen due to the Health Resources and Services Administration's (HRSA) silence on the program's status.

Challenge: HRSA's Removal of Guidance:

The HRSA's removal of guidance from its website, which was issued in June 2020 during the COVID-19 pandemic, has raised concerns among hospital outpatient clinics. This guidance allowed 340B-eligible hospitals to prescribe discounted drugs for patients seen at off-site clinics before those clinics were officially registered with the Office of Pharmacy Affairs Information System and listed on a Medicare cost report. The removal of this guidance creates uncertainty and potential risks for hospitals, as they may lose their 340B drug discount status.

Actionable Advice:

In light of these challenges, hospitals must take proactive steps to safeguard their 340B drug discount status and optimize their partnership with PBMs. Here are three actionable pieces of advice to consider:

  • 1. Stay Informed and Advocate: Hospitals should stay updated on any changes in 340B drug discount program guidelines and actively advocate for their interests. Engaging with trade groups and industry associations that represent their concerns can help ensure their voices are heard.
  • 2. Seek PBM Partnerships with Transparent Pricing: When selecting a PBM partner, hospitals should prioritize those with transparent pricing models. Understanding the pricing structure and any potential hidden fees is crucial for maximizing cost savings and avoiding financial pitfalls.
  • 3. Leverage Technology for Compliance: Investing in robust technology solutions can help hospitals maintain compliance with 340B program requirements. Implementing systems that streamline the registration process, track drug usage, and provide comprehensive reporting capabilities can mitigate risks and ensure eligibility for drug discounts.

Conclusion:

By recognizing the interconnectedness of PBM solutions and the 340B drug discount program, hospitals can navigate the complexities of the healthcare landscape more effectively. Partnering with a PBM such as AffirmedRx provides hospitals with a competitive edge while maintaining a focus on cost-saving measures. However, it is essential for hospitals to actively monitor changes in the 340B program and leverage technology and advocacy to protect their interests. By doing so, hospitals can ensure the provision of affordable healthcare while optimizing their financial performance.

Resource:

  1. "PBM Solution | AffirmedRx", https://affirmedrx.com/solutions/ (Glasp)
  2. "HRSA silence on 340B drug discount status worries hospitals", https://www.modernhealthcare.com/supply-chain/340b-drug-discount-program-faces-uncertainties-amid-hrsa-silence (Glasp)

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