Find more value in your 340B data

How often you review your data and analytics depends on several factors, including how many claims you typically carve in, the size of the team supporting your program and how often you provide encounter files to your third-party administrators (TPAs). However, the 340B program is constantly changing, so you should regularly review your reporting and be ready to react quickly. Here’s the frequency we recommend:

Daily-to-weekly: Carved-in claims, carved-out claims and missing files

• We always recommend reviewing claims on a daily or weekly basis. This helps you understand which claims are carving in or out and flag issues we can help you resolve fast.

Monthly: Prescriber lists, clinic codes, financials, vouchers and self-audit results

• The Health Resources and Services Administration (HRSA) requires all participating 340B Covered Entities to perform regular self-audits of their program and maintain historical records of results. We recommend performing self-audits at least once per month. The audit tools in our 340B Clarity® portal can make regular self-audits easier and help you maintain a historical record. Self-audits should include reviewing your prescriber and clinic code lists to ensure the right claims are being captured. For example, if you opened a new clinic or changed address, we need to update our rules to account for that new information.

Quarterly: Office of Pharmacy Affairs Information System (OPAIS) records and necessary updates

• Usually, changes to your contract pharmacy network — including adding or removing pharmacies — can only be made during HRSA registration windows. Review your current information before each quarter to identify if changes are needed and develop a plan for making corrections. To support this review, we proactively send a quarterly client analysis a few weeks before the HRSA registration windows, giving you time to check the information and make decisions.

Yearly: Full program review of financials, methodologies, formularies, etc.

• Your TPAs should have most of this data readily available. If not, they should be able to pull it together for you. For example, we schedule client program reviews every 12-18 months and provide copies of all reports we present.
• Ad hoc reports: There may be times when you need one-time or recurring customized reports. These could include state-level opportunity analyses, Uniform Data System (UDS) reports, oddity for 340B, HRSA audits, financial reports or ad hoc expansion analyses. The cadence for these reports will vary based on the events that impact your Covered Entity. We’ll also provide ad hoc expansion opportunities if a different variable is introduced between quarterly reviews, such as a new prescriber list or methodology. We offer these reports at no additional cost. Once we understand which analyses you need, we’ll build the files and load them into the Report Center in the 340B Clarity portal. These reports are then available 24/7 and can be viewed, exported and shared with other business teams.

Manufacturer restrictions on the 340B program are top of mind for many Covered Entities. As the program continues to evolve, it’s important to find ways to create value and stretch resources amid these challenges.

Any time there’s a manufacturer action that affects your program, you should review several key pieces of information:

• Potential impact of National Drug Code (NDC) restrictions
• Opportunities to recover savings through data submission, if this strategy works for you
• Your contract pharmacy network and which stores may be optimal as designated contract pharmacies

This information will help guide you in deciding how to move forward and capture savings. Wellpartner® clients are able to access this information 24/7 on the 340B Clarity portal.

You should review potential program changes in a lower environment to understand their impact on details and claims. This helps avoid any potential compliance issues, such as diversion and duplicate discounts.

Covered Entities often tell us that vendors and partners can provide potential net savings but may not offer a way to complete this type of compliance check. That can create compliance risk.

Any time you wish to make a change in your 340B program, we can show you its expected impact. You have the ability to review each claim down to the penny and verify whether your carve-ins and carve-outs look accurate.

There’s no one-size-fits-all approach to 340B. That’s why we invested in a dedicated data science team that can support different entity types, sizes and needs. We provide: 

• Flexibility: We tailor our analytics to your needs based on the data you can provide. 
• Customization: We provide custom and ad hoc client analyses to help you optimize your 340B program. 
• Transition expertise: We have experience supporting transitions from other TPAs, so we know what to look for and often proactively address issues.

Because we work with 340B data every day, we understand how to turn complex questions into clear next steps.