by admin | April 19, 2011 8:52 pm
April 19, 2011—Pharmacy benefit managers (PBMs) and third-party payers will soon be able to flag prescriptions filled with 340B discounted drugs more easily due to new claims submission standards[1] developed by the National Council for Prescription Drug Programs (NCPDP).
Although the change is expected to please PBMs and payers, hospitals and others that depend on 340B savings worry that it could lead to cuts in their reimbursement.
The newest version of NCPDP’s Telecommunication Standard, released on March 24, makes it possible to identify 340B claims both retroactively and at point of sale. Although it is set to take effect on January 1, 2012, NCPDP has advised parties not to use its newest external code list, which includes the codes to identify 340B claims, until October 15, 2012.
The new standard does not require pharmacies and PBMs to identify 340B claims. Software developers, however, will need to build the ability to identify 340B prescriptions into their products in case trading partners want that capability.
PBMs’ Complaints
NCPDP created the standard in response to PBMs’ complaints that they could not collect rebates from pharmaceutical manufacturers. Some manufacturers give PBMs rebates in exchange for their drugs’ being placed on the PBMs’ formularies. Since PBMs are currently unable to differentiate 340B claims from others, some manufacturers have refused to pay rebates on all claims to avoid being subjected to both a 340B discount and a rebate on the same drug. The NCPDP standard will help PBMs identify 340B prescriptions and collect rebates on non-340B claims.
NCPDP’s 340B Task Force is creating a reference guide that parties can use to implement the 340B portion of the telecommunication standard. Safety Net Hospitals for Pharmaceutical Access (SNHPA), which represents hospitals enrolled in 340B and participates in the task force, persuaded it to include language in the guide explaining that Congress created the 340B program to help providers stretch scarce resources and that adequate reimbursement is needed to achieve that mission.
SNHPA has been monitoring NCPDP’s 340B work closely because it is concerned that greater identification of 340B claims could lead to lower reimbursement rates from PBMs. Some PBMs, it says, offer rates that effectively force hospitals to pass along their entire 340B savings. The hospital group says it is working on solutions to the problem of declining 340B reimbursement rates.
Source URL: https://340bemployed.org/new-standards-will-make-it-easier-to-flag-prescriptions-340b-status/
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