A Deeper Dive into Claims Submission Conditions

Several of the drug companies restricting 340B discounts on drugs dispensed at contract pharmacies have created policies that say they will restore the 340B prices if covered entities submit patient claims data. In this episode, we dive deeper into these claims submission conditions with Jesse Breidenbach, vice president of pharmacy at Sanford Health and a member of the 340B Health Board of Directors. Jesse shares best practices for navigating the challenges when drug manufacturers demand claims data.Before the interview, we give an update on a drug company placing additional restrictions on its 340B pricing and recap a recent 340B advocacy event on Capitol Hill.The Impact of Drug Company RestrictionsThe restriction of 340B discounts has had a substantial financial impact on Sanford Health. Jesse shares how these restrictions have made it more difficult for Sanford to obtain 340B savings and use them to provide care to its patients.Making the Decision to Submit Claims DataResponding to companies whose policies require submitting patient claims data requires critical decision-making by hospitals. Jesse explains what is involved in submitting the data, how to decide if submitting is a viable option, and what steps hospital 340B teams need to take to prepare their data submissions.What Happens After Claims Are Submitted?Jesse explains how quickly discounts might be restored after submitting the claims, how consistently drug companies are keeping the 340B pricing in place, and the challenges hospitals face when dealing with discrepancies between claims. Resources340B Health Contract Pharmacy InfographicBayer Is Latest Company to Tighten 340B Restrictions340B Health Hill Day Features Advocacy for Introducing Contract Pharmacy Bill340B Coalition Summer Conference 2023 Registration