A Deeper Dive into Claims Submission Conditions

05/15/23 • 20 min

Several of the drug companies restricting 340B discounts on drugs dispensed at contract pharmacies have created policies that say they will restore the 340B prices if covered entities submit patient claims data. In this episode, we dive deeper into these claims submission conditions with Jesse Breidenbach, vice president of pharmacy at Sanford Health and a member of the 340B Health Board of Directors. Jesse shares best practices for navigating the challenges when drug manufacturers demand claims data.

Before the interview, we give an update on a drug company placing additional restrictions on its 340B pricing and recap a recent 340B advocacy event on Capitol Hill.

The Impact of Drug Company Restrictions

The restriction of 340B discounts has had a substantial financial impact on Sanford Health. Jesse shares how these restrictions have made it more difficult for Sanford to obtain 340B savings and use them to provide care to its patients.

Making the Decision to Submit Claims Data

Responding to companies whose policies require submitting patient claims data requires critical decision-making by hospitals. Jesse explains what is involved in submitting the data, how to decide if submitting is a viable option, and what steps hospital 340B teams need to take to prepare their data submissions.

What Happens After Claims Are Submitted?

Jesse explains how quickly discounts might be restored after submitting the claims, how consistently drug companies are keeping the 340B pricing in place, and the challenges hospitals face when dealing with discrepancies between claims.

Resources

Before the interview, we give an update on a drug company placing additional restrictions on its 340B pricing and recap a recent 340B advocacy event on Capitol Hill.

The Impact of Drug Company Restrictions

Making the Decision to Submit Claims Data

What Happens After Claims Are Submitted?

Resources

Previous Episode

The Data on 340B Contract Pharmacy Restrictions

A recent report from 340B Health includes data on how drug company restrictions on 340B hospital partnerships with community and specialty contract pharmacies have taken a toll on the health care safety net and the patients who rely on it. On this episode, we speak with the report’s author, 340B Health Vice President of Research and Policy Analytics Caroline Steinberg, to walk through the findings and discuss what they mean for 340B hospitals and their patients. Before the interview, we provide a news update on a federal appeals court case regarding a 340B non-discrimination law in Arkansas.

The Data Behind the Report

Caroline discusses the primary data sources for the report, including data from the federal government and survey results from 340B Health members.

Tip of the Iceberg

The report breaks down the amount of savings stripped from the health care safety net in 2021 from the five companies restricting 340B discounts for all of that year. Caroline uses this information to project the billions of dollars in annual lost 340B savings from the contract pharmacy restrictions. She also describes the patterns she found in the types of drugs that drugmakers are restricting.

The Toll on Patient Care

340B hospital survey data in the report uncovers how lost 340B savings from drug company restrictions affects patients’ access to services and their ability to obtain discounts on medications through contract pharmacies. Caroline discusses results from the survey that shed light on how drug company demands for patient claims data are diverting resources from patient care. She also shares individual stories from the report of harm to patient care.

Check out all of our episodes on the 340B Insight podcast website. You also can stay updated on all 340B Health news and information by visiting our homepage. If you have any questions you would like us to cover in this podcast, email us at [email protected].

Resources

Next Episode

Best Practices for Managing 340B Pharmacy Supply

340B hospitals must navigate the challenging world of pharmacy supply chain management, in which they must balance budget constraints while providing high-quality care to all their patients. In this episode, we explore best practices for how hospitals can manage the 340B pharmacy supply chain. Our guest is Ashley Covert, system director of pharmacy supply chain and contracting at Dartmouth Health.

Before the interview, we give an update on two problematic bills approved by the House Energy and Commerce Committee that would have adverse effects on 340B hospitals if they were to become law.

Pharmacy Supply Chain's Growing Prominence
The pandemic spotlighted supply chain management and its influence on health care delivery and patient care. Ashley emphasizes how hospital pharmacy leaders can ensure the efficient management of their supply chains and the timely provision of patient care by staying informed and actively engaged with industry developments.

Hospital Access to Medications
Supply chain challenges often are exacerbated by factors such as global manufacturing problems and staffing shortages. Ashley gives strategies that leaders can adopt to overcome these obstacles and ensure patients have access to medication.

Leveraging Data and Analytics
Ashley explains how pharmacy leaders can optimize their budgets and prepare for potential disruptions more effectively by adopting a data-driven approach to managing the pharmacy supply chain.

Check out all of our episodes on the 340B Insight podcast website. You also can stay updated on all 340B Health news and information by visiting our homepage. If you have any questions you’d like us to cover in this podcast, email us at [email protected].

Resources

Joint Statement from National Hospital and Pharmacist Associations on Harmful House 340B Legislation
House Committee Approves Problematic 340B Reporting Legislation

340B Coalition Summer Conference Registration