340B-eligibility can mean potentially millions of dollars in retail and specialty prescription reimbursements annually. Below are a few of the program’s key requirements.
Covered Entities
The definition of “covered entities” includes six categories of hospitals:
• Disproportionate share hospitals (DSHs)
• Children's hospitals and cancer hospitals exempt from the Medicare prospective payment system
• Sole community hospitals
• Rural referral centers
• Critical access hospitals
Eligibility requirements
Hospitals in each of the categories must be (1) Owned or operated by state or local government, (2) A public or private non-profit corporation which is formally granted governmental powers by its state or local government, or (3) A private non-profit organization that has a contract with a state or local government to provide care to low-income individuals who do not qualify for Medicaid or Medicare.
Patients covered under 340B
Covered entities can dispense 340B-eligible prescriptions to individuals who (1) Have an established relationship with the covered entity, such that the entity maintains records of the individual's care; (2) Receive care from a professional employed by the covered entity, or under contract or other arrangement (e.g., referral for consultation) with the covered entity, such that responsibility for the care remains with the covered entity; and (3) Receive health services from the covered entity that are consistent with the services for which grant funding has been provided to the entity.
How can ProxsysRx optimize your health system’s 340B savings revenue?
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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
