What are 340B acquired drugs?

The 340B Drug Pricing Program allows certain hospitals and other healthcare providers to purchase drugs and biologicals (other than vaccines) that are administered in a hospital outpatient department from drug manufacturers at discounted prices.

How does 340B drug pricing work?

The federal 340B Program is a drug price control program that allows qualifying providers, generally hospitals, specialty clinics and their associated outpatient facilities serving uninsured and low-income patients in rural communities, to purchase outpatient drugs from manufacturers at discounted prices.

Is 340B only for Medicaid?

Section 340B of the Public Health Service Act requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to health care organizations that care for many uninsured and low-income patients.

What entities are eligible for 340B?

Eligible Organizations

  • Federally Qualified Health Centers.
  • Federally Qualified Health Center Look-Alikes.
  • Native Hawaiian Health Centers.
  • Tribal / Urban Indian Health Centers.

HOW DO 340B pharmacies make money?

340B covered entities and their contract pharmacies generated an estimated $13 billion in gross profits on 340B purchased medicines in 2018, which represents more than 25% of pharmacies’ and providers’ total profits from dispensing or administering brand medicines.

How do you bill 340B drugs?

Discarded drugs that were acquired through the 340B program should be billed with both the “JW” modifier (used to report the amount of drug discarded) and the appropriate 340B modifier.

What is 340B revenue?

340B hospitals can generate profits by prescribing drugs to patients who have private insurance or Medicare. Consequently, these providers can generate 340B profits by pocketing the difference between the discounted price that they paid for the drugs and the higher reimbursement paid by insurers and patients.

How do I enroll in 340B program?

To register, you must have a 340B Office of Pharmacy Affairs (340B OPAIS) user account. Visit the 340B OPAIS site and select “help” in the upper right hand corner of the page.

How do I get 340B certified?

340B Operations Certificate Exam Process

  1. To enter into the Apexus Advanced 340B Operations Certificate Program, you can: a.
  2. Take the Operations Certificate Entrance Exam. a.
  3. Register and pay for the program.
  4. Operations Certificate Baseline Exam.
  5. Watch 340B Operations Certificate curriculum modules.
  6. Take the Exams.

Who is a 340B patient?

The 340B statute states that “entities must not resell or otherwise transfer” 340B drugs to ineligible patients. Refer to the patient definition guideline on how to minimize risk for diversion.

HOW DO 340B pharmacies work?

The 340B program mandates that pharmaceutical manufacturers provide outpatient drugs to certain healthcare entities—known as eligible covered entities—at significant discounts. A covered entity can purchase and dispense 340B drugs through internal or external (contract) pharmacies.

What are drugs included in the 340B Drug Pricing Program?

What drugs are included under the 340B Drug Pricing Program? A: There is no designated formulary for the 340B Program. A manufacturer must offer all covered outpatient drugs at or below the 340B ceiling price. The term covered outpatient drug is defined in section 1927 (k) of the Social Security Act.

What does JG stand for in 340B program?

Billing Guidance Effective January 1, 2018, applicable facilities must append the appropriate modifier to furnished outpatient drugs acquired under the 340B Program. Modifier JG indicates drug or biological was acquired with 340B drug pricing program discount

What is the ceiling price for 340B drugs?

When the 340B ceiling price calculation results in an amount less than $0.01, the 340B ceiling price will be $0.01. For more information, please visit the 340B Ceiling Price and Civil Monetary Penalties final rule (82 FR 1210, January 5, 2017) at: https://www.gpo.gov/fdsys/pkg/FR-2017-01-05/pdf/2016-31935.pdf.

What are the reimbursement rates for Medicare 340B?

As of January 1, 2018, Medicare reimburses drugs purchased through the 340B Drug Program at a rate of the Average Sales Price (ASP) – 22.5%. Drugs purchased through the 340B Program do not have appeal rights; requests for an appeal will be dismissed.