Introducing ProxsysRx’s 340B Program ROI Calculator
The 340B program has often been described, and with good reason, as a black box. There are dozens of factors impacting an individual hospital’s relative success or failure in generating positive returns from a program.
ProxsysRx has optimized dozens of 340B programs — generating tens of millions in savings & revenue for the health systems we serve — and the most common question we receive from interested hospitals is, “What’s our 340B network realistically worth?”
The truth is, we can’t fully evaluate your health system’s 340B program potential until we know (and carefully analyze) the medications you’re prescribing to the patients within your network.
However, our 340B ROI Calculator will give you a reasonably accurate preliminary idea of your retail prescription network’s value. It was developed using the data we’ve generated for the hospitals and health systems we serve, and you’ll get an instant estimate by entering 3 just three variables.
Broad considerations in determining your 340B drug program revenue potential
In the broadest sense, 340B revenue is driven by your providers, the prescriptions they write, and your patients. If you aren’t entirely sure whether or not your health system is 340B eligible, Click Here to read our blog post on the topic.
The other key consideration in determining your health system’s 340B drug program ROI potential involves the concept of Optimizing your program for savings and revenue, as opposed to Maximizing it. The simple explanation is that the 340B savings of many medications simply isn’t worth the time and effort to claim them in your 340B program.
We’ve published two articles on the topic — one examining the concept of program optimization itself, and the other exploring the impact contract pharmacy relationships can have on program optimization.
The missing ingredient: 340B-eligible specialty medications
In 2019, Medicare defined a “specialty drug” as any medication costing more than $670 monthly. In 2020, specialty drugs accounted for roughly half of the overall prescription drug market’s expenditures. That’s a significant increase from just five years earlier — when specialty drugs were 29% of total expenditures. What’s more, according to Acentrus Specialty, a specialty pharmacy consulting firm, 8 out of 10 new drugs approved by the FDA in 2020 were specialty drugs. In short, specialty drugs constitute the fastest-growing and largest part of the prescription-drug market.
Where your health system’s mission is concerned, the number one benefit of contracting with a specialty pharmacy is the significantly increased potential for generating savings and revenue, and for passing-along those savings to patients in need. Some covered entities generate as much as 600% in specialty pharmacy revenue from 340B drugs as they do in traditional retail / outpatient or contract pharmacy 340B revenue.
Today, 340B covered entities can acquire many specialty drugs for as little as one cent.
Many other specialty drugs — including Epclusa, Harvoni, Imbruvica, Iressa, Gilenya, Revlimid and Stelara — offer 340B discounts of 70% to 100%.
That said, before contracting with a specialty pharmacy as a 340B pharmacy for your health system, it’s important that you know and understand its insurance relationships — the reason being that insurance companies dictate which specialty pharmacies can dispense 340B-eligible drugs.
340B-eligible retail specialty medications
There are also a number of “retail specialty drugs”, medications which your in-house retail pharmacy — and your health system’s 340B retail contract pharmacies — can dispense. The 340B ROI potential for those drugs can also be significant. ProxsysRx recently conducted an in-depth analysis for a Southeastern health system’s Retail Specialty drug prescriptions. Click Here to review the 340B revenue potential we projected for that health system.
What’s particularly interesting about the projections is that Retail Specialty Prescriptions constitute just 6% of the hospital’s total number of prescriptions written, but generate 46% of its 340B prescription revenue.
The unconscionable 340B program impact of 340B ESP
340B ESP is a website which, it claims, “allows 340B covered entities and pharmaceutical manufacturers to work collaboratively to resolve duplicate discounts.” In truth, the alleged “service” is nothing less than an utterly brazen, unlawful ploy by drug manufacturers to avoid extending the 340B program discounts they are legally obligated to offer eligible hospitals and health systems — by placing exorbitant, and unnecessary, reporting burdens on entities submitting claims for 340B savings.
We’ve published three separate articles on 340B ESP:
340B ESP. Why It’s Wrong, And How Hospitals Can Deal With It.
340B ESP ‘Terms Of Use’ Set The Tone For The Spurious Demands It Places On Covered Entities.
Avoid These Six Common Errors When Reporting 340B-Eligible Prescriptions Through 340B ESP
So what is your health system’s 340B drug program revenue potential?
If you’re interested, we’d love offer you a no-cost analysis of your prescription network — to give you a more accurate projection of your hospital’s 340B drug program ROI potential, and to recommend ways you can capture the most possible savings and revenue.
To learn more, contact Howard Hall. C: 214.808.2700 | howard.hall@proxsysrx.com
