In late 2022, ProxsysRx’s team initiated 340B Program-Management support for a 198-bed, full-service, community and regional non-profit medical center located in the Northeast.
After weeks of laying all the necessary groundwork to manage its 340B program, we began actively submitting eligible prescriptions this past January. By the end of Q1, the hospital’s 2023 340B savings & revenue had surpassed its total for all of 2022. Below is a step-by-step accounting of how we managed to achieve those results.
Laying The Hospital’s 340B Program Groundwork
Like so many 340B-eligible health systems, the hospital simply lacked the in-house personnel (not to mention the technology) to actively manage a successful 340B program. Which explains why they had not updated their list of providers since 2021.
As a rule, ProxsysRx updates provider lists for the 340B programs we manage on a monthly basis. And so, our first order of business was connecting with all of the hospital’s eligible on-site providers. Which started with reviewing their most-recently-updated provider list, then determining which providers were still with the hospital, which ones weren’t — and which new providers needed to be added to the list. Start to finish, that process took two weeks.
Once we had a fully-updated provider list, we sent it to each of the three TPAs they use.
Requalifying eligible scripts
With the hospital’s updated provider list in its TPA’s systems, we set-about requalifying (with those TPAs) still-eligible scripts written by its providers. That process involved getting set-up, for auditing purposes, the necessary connections for requalifying scripts. Once that process was completed, the hospital’s 340B program began generating significant savings & revenue.
Retrieving eligible-script data
The hospital’s data team assembled and delivered the hospital’s historical 340B-program files. They set up the feeds, and our data team provided a template for “translating” that data into our 340B PRO software system. Once that process was working smoothly, the hospital’s script data came to our 340B team ready to be re-qualified. (BTW: We would be remiss if we didn’t mention the excellent work both data teams did in making this happen). We’ve now built a pipeline enabling the hospital to send us script data weekly.
Initiating weekly contact between our respective 340B teams
In January, ProxsysRx’s 340B team leader began conducting twice-weekly calls with the hospital’s 340B team leader. During Monday morning calls, he gets an overview of what’s going on from the hospital’s end — including any changes since their last contact, as well as any questions or concerns the hospital’s team might have.
“Most of the time,” he says, “she’ll have several questions and / or issues for us on Monday. By the time our Friday call rolls around, we’ve typically answered her questions and worked-out the issues — at which point, we’ll spend that call reviewing what we’ve done during the week.
“One important goal of our bi-weekly meetings,” he continues, “is to help her better understand all of the ins-and-outs of the 340B program. She was new to 340B when she started, but unlike me, she isn’t surrounded by seasoned 340B professionals all day every day. Over the course of just a few months, we’ve built a strong working relationship. We’ve earned her trust, and she’s come a long way, in her command of the program, in a very short time.”
Drawing on the combined expertise of ProxsysRx’s 340B team
Like every member of ProxsysRx’s 340B team, he’s quick to mention the privilege afforded him in the ongoing guidance and support of ProxsysRx’s Operations and Services VP Heather Brooks. “I doubt anyone anywhere knows more about the 340B program than Heather. In addition to her program expertise, she’s an exceptionally talented communicator — particularly in helping us consistently, and accurately, convey the right messages and information to our clients on complicated issues.”
Maintaining 340B team continuity
ProxsysRx launched its 340B management & support program in 2020 with a team of two. By June 2023, our team had expanded to 10 full-time professionals. (NOTE: Given the continued expansion of ProxsysRx’s 340B program, we’re always looking to add more talented professionals interested in joining our team!)
Working with the hospital’s 340B contract-pharmacy network
The hospital has a total of 110 contract pharmacies in its network — mostly retail, but also including specialty pharmacies and mail-order pharmacies, as well as an infusion clinic (CVS alone accounts for 56 of those locations); yet another reason why ProxsysRx’s 340B PRO software is so critical to our successfully managing the myriad details and data points involved in any health system’s 340B program.
“The hospital hadn’t updated designations for its contract pharmacy network since March 16, 2022, so that was another critical element to the success we’ve enjoyed.” With the advent of manufacturer restrictions — some limiting an eligible entity’s contract pharmacies to a single location within 40 miles of its primary campus, the team is carefully reviewing the options for designating that single pharmacy.
ProxsysRx recently opened a retail outpatient pharmacy on the hospital’s campus. And while working with our own pharmacies affords us any number of systemic advantages in managing a health system’s 340B program, he says, “We’re not going to designate it unless we determine conclusively that it would be the single most profitable pharmacy for the hospital’s 340B program.”
Celebrating the hospital’s 340B program success
“When we learned that the hospital generated more 340B revenue in the first quarter of this year than they did all last year,” he smiles, “well, you could say there were High Fives all around!”
Looking ahead to the hospital’s 340B savings & revenue future
“Given how far back we mined the hospital’s script data for requalification, we don’t anticipate sustained year-over-year increases of 400%. At the same time, we have enjoyed consistent success in generating exceptional year-over-year increases well into the second quarter. And at the end of the day, serving our clients to the absolute best of our ability is why we do this.”
ProxsysRx is here to help, if you have questions.
There are so many ways to optimize your 340B drug program savings & benefits, and overcome manufacturer restrictions, while still minimizing the likelihood of noncompliance. For more information, contact Howard Hall. C: 214.808.2700 | firstname.lastname@example.org