In late 2022, ProxsysRx’s team initiated 340B Program-Management support for a 198-bed, full-service, community and regional non-profit medical center located in the Northeast.
After weeks of laying all the necessary groundwork to manage its 340B program, we began actively submitting eligible prescriptions this past January. By the end of Q1, the hospital’s 2023 340B savings & revenue had surpassed its total for all of 2022. Below is a step-by-step accounting of how we managed to achieve those results.
Laying The Hospital’s 340B Program Groundwork
Like so many 340B-eligible health systems, the hospital simply lacked the in-house personnel (not to mention the technology) to actively manage a successful 340B program.
As a rule, ProxsysRx updates Provider lists for the 340B programs we manage on a monthly basis. Once we had a fully-updated provider list, we sent it to each of the three TPAs they use.
Requalifying eligible scripts
With the hospital’s updated provider list in its TPA’s systems, we set-about requalifying (with those TPAs) still-eligible scripts written by its providers. That process involved getting set-up, for auditing purposes, the necessary connections for requalifying scripts.
Retrieving eligible-script data
The hospital’s data team assembled and delivered the hospital’s historical 340B-program files. They set up the feeds, and our data team provided a template for “translating” that data into our 340B PRO software system. Once that process was working smoothly, the hospital’s script data came to our 340B team ready to be re-qualified.
Initiating weekly contact between our respective 340B teams
In January, ProxsysRx’s 340B team leader began conducting twice-weekly calls with the hospital’s 340B team leader. “One important goal of our bi-weekly meetings,” he says, “is to help our contact at the hospital better understand all of the ins-and-outs of the 340B program. She was new to 340B when she started, and she's come a long way in her command of the program in a very short time.”
Drawing on the combined expertise of ProxsysRx’s 340B team
ProxsysRx’s team leader is quick to mention the privilege afforded him in the ongoing guidance and support of ProxsysRx’s Operations and Services VP Heather Brooks. “I doubt anyone anywhere knows more about the 340B program than Heather. In addition to her program expertise, she’s an exceptionally talented communicator — particularly in helping us consistently, and accurately, convey the right information to our clients on complicated issues.”
Working with the hospital’s 340B contract-pharmacy network
The hospital has a total of 110 contract pharmacies in its network — mostly retail, but also including specialty pharmacies and mail-order pharmacies, as well as an infusion clinic (CVS alone accounts for 56 of those locations); yet another reason why ProxsysRx’s 340B PRO software is so critical to our successfully managing the myriad details and data points involved in any health system’s 340B program.
With the advent of manufacturer restrictions — some limiting an eligible entity’s contract pharmacies to a single location within 40 miles of its primary campus — the team is carefully reviewing options for designating that single pharmacy.
ProxsysRx recently opened a retail outpatient pharmacy on the hospital’s campus. And while working with our own pharmacies affords us any number of systemic advantages in managing a health system’s 340B program, “We're not going to designate it unless we determine conclusively that it would be the single most profitable pharmacy for the hospital’s 340B program.”
Looking ahead to the hospital’s 340B savings & revenue future
“Given how far back we mined the hospital’s script data for requalification, we don’t anticipate sustained year-over-year increases of 400%. At the same time, we have enjoyed consistent success in generating exceptional year-over-year increases through the second quarter. And at the end of the day, serving our clients to the absolute best of our ability is why we do this.”
ProxsysRx is here to help, if you have questions.
There are so many ways to optimize your 340B drug program savings & benefits, and overcome manufacturer restrictions while still minimizing the likelihood of noncompliance. For more information, contact Howard Hall. C: 205.588.0946 | howard.hall@proxsysrx.com
ProxsysRx offers hospital systems proven solutions for optimizing pharmacy services’ positive impact on the continuum of care; solutions ranging from management of their 340B prescription-savings programs, Retail and Specialty Pharmacy operations, to Prescription Benefits program management, and patient financial assistance.
This post is related to:
340B Solutions, 340B Management Systems
