What is your 340B Eligibility?

The 340B Drug Discount Program is a US federal government program created in 1992 that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices. The intent of the program is to allow covered entities to stretch scarce federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.

So, how do you know if your facility is, in fact, eligible for 340B reimbursements?

Firstly, there are multiple categories of providers eligible to participate in the 340B program.

• 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 (CAH)
• grantees

For further information, please click here.

There are Four Categories of 340B eligibility:

(Each category must be met for a 340B claim to be eligible for reimbursement.)

1. The Provider. They must be a federal grantee or non-profit organization contracted to provide services on behalf of the government. And must be registered on the OPA database.
2. The Prescriber. The prescription must be written by an employed or contracted prescriber. This must also be written from within an eligible provider location (that meets 340B eligibility) that is registered on the OPA database.
3. The Pill. The drug itself must also meet several criteria before being eligible to meet 340B eligibility. The medication must be prescribed for OUTPATIENT use only. The drug must be on the 340B formulary. The prescription must be filled at one of the covered entities registered 340B pharmacies. There must also be no dual discounts, i.e. it cannot be paid for by Medicaid.
4. The Patient. Must have an established relationship with health records maintained by the covered entity.

340B program requirements can be difficult to wrap your head around. Luckily, CaptureRx’s 340B management software takes the hassles out of managing your 340B administration requirements. For more information, please contact us by clicking here. 

If 340B eligibility is still confusing, see https://www.340bhealth.org/members/340b-program/overview/ for further information.

And if you’ve already determined that you are 340B eligible, you should consider reading our ‘understanding 340B compliance‘ article as an appropriate next step.

From all of us at CaptureRx, we thank you for reading this content. 

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