Best Practices For A Successful 340B Specialty Pharmacy

Below are selected excerpts from an in-depth roundtable discussion outlining how eligible health systems can ensure the success of their onsite specialty pharmacies. To watch videos of that discussion, organized by topic, Click Here. You can also find a curated transcript of the entire discussion here.

Reach-out to manufacturers for partnership opportunities

Bringing a drug to market requires a lot of research, and many manufacturers want active patients on their research medication. Even after a drug is available on the market, manufacturers need data demonstrating how it improves patient outcomes. Specialty pharmacies can partner with manufacturers to provide them that data.

Identify prescriptions you can fill before accreditation

While accreditation can take 6 months to a year, you can actually start filling some 340B prescriptions on Day One. ProxsysRx helps the health systems we support find prescriptions they can fill immediately, as we work towards their accreditation. We also manage the process of getting them in the networks with the PBMs to be able to fill prescriptions.

Establish processes to uphold reporting guidelines

While you need to meet reporting guidelines at all times, it’s especially important to have your processes in place if you're filling prescriptions before you're accredited — which can take six months to a year. As you're filling prescriptions and getting in the PBM networks, ideally, you're perfecting the processes, procedures and policies needed to become accredited.

Maintain phone-call metrics

When you become accredited, you have to keep certain metrics for your phone calls. Specialty pharmacies must have someone in the pharmacy, every single hour it’s open, available to answer phone calls promptly. In a ProxsysRx specialty pharmacy, “promptly” means within 30 seconds; which ensures that our patients always have access to a pharmacy professional who can answer their questions — and make sure they're getting the appropriate care. 

Ensure patient satisfaction 

Patient satisfaction surveys are also required, and they’re required by independent third parties — to ensure that you uphold the very high standards set for specialty pharmacies. Our specialty pharmacists also work closely with providers, to make sure they know what it takes to ensure that patients know we (and they) care about their outcomes, and that they have the access to the appropriate medication.

Integrate specialty pharmacy technology with the health system’s

You’ll need a technology platform, like ProxsysRx’s, that can pull all the data — and create the necessary outlooks and outputs. Data you can then report back, not only for accreditation, but also to the payers — the PBMs. That way, when you get your specialty pharmacy In Network for a patient’s PBM, you can bill for the patient’s care. You also have to report a lot of metrics to your PBMs, and to the manufacturers, to get access to their medications.

Integrate specialty pharmacy with 340B

Your 340B eligibility is important to the impact a specialty pharmacy can have on your health system. Your 340B and specialty teams both need to understand the best practices for working within your hospital’s 340B program. A well-managed 340B program that’s integrated with your retail pharmacy can generate millions of dollars in revenue while your specialty pharmacy is being built.

Avoid negative reimbursements

One of the easiest ways to cause negative reimbursement is not paying attention to the 340B status of a particular dispense. Especially if you're a DSH hospital, where you're subject to the GPO prohibition — in which case, you’ll be hit with purchasing the drug at Wholesale Acquisition Cost, rather than on the 340B account, if it doesn't qualify. 

Performing prior authorizations

Many PBMs will not pay for prescriptions right out of the gate, so there are a lot of hurdles you have to jump for payors, in order to get drugs covered. Even after a 340B specialty drug is covered, the copay can be very high — sometimes thousands of dollars. 

Securing copay assistance for specialty drugs

Most patients can't afford copays that high, so you need to know all the available options for copay assistance. There are manufacturer programs, and other assistance programs — including charity care and 340B pricing options. 

ProxsysRx is here to help, if you have questions. 

For more information on how to build and fund a successful specialty pharmacy, or for more information on any of the pharmacy-support services we offer, contact Howard Hall. C: 214.808.2700 | howard.hall@proxsysrx.com