Blog Posts

J&J Backs Off Rebate Plans for Now in Face of Strong Pushback

Release courtesy of 340B Health – On Sept. 30, Johnson & Johnson (J&J) announced it will cease implementation of a controversial plan to impose 340B rebates on hospitals next month after prompting widespread outcry and a government threat to cut off Medicaid and Medicare coverage for J&J drugs. But the drugmaker said it would continue to engage with the government on ways to increase 340B transparency, indicating that the issue of potential rebates is not off the table even if its initial rebate plans are on hold.

Last month, J&J said it would stop permitting wholesaler 340B chargebacks for Stelara and Xarelto purchases by disproportionate share (DSH) hospitals starting Oct. 15, effectively replacing upfront discounts with backend rebates. 340B Health immediately mobilized opposition, prompting responses by the Health Resources & Services Administration (HRSA), a bipartisan group of nearly 200 members of the U.S. House, and other stakeholders that pressured J&J to abandon its plans. Last Friday, HRSA warned J&J that it would begin the process of imposing unprecedented punitive actions if the company did not back off its plans by Sept. 30, including by ending Medicaid and Medicare Part B coverage of all J&J drugs. In the notice, J&J cited the HRSA threat to terminate J&J's pharmaceutical pricing agreement (PPA) as the reason why it is suspending its rebate plans.

For questions, please contact Lori Schilling, SUNRx Regional Manager, at lschilling@sunrx.com or 405-556-1659.

340B Referral Capture with Advanced Claims Capture

Have you received a recent notification that impacts your ability to capture referrals?

AuthorityRx is approved to work with Wellpartner to capture referral claims for CVS pharmacies. Their Advanced Claims Capture (ACC) solution helps significantly increase 340B savings through enhanced referral claims capture and by uncovering and resolving fallout claims. Continue reading here.

Authority Rx

SUNRx has acquired Authority Rx, a leader in the referral capture and manufacturer management industry. Advanced Claims Capture (ACC) is a TPA agnostic program that simply bolts on to your existing program and helps uncover any 340B claims that tend to slip through the cracks. ACC can help recover savings that you are losing due to the manufacturer restrictions. The best part is there is virtually no implementation, and you don't pay if we don't find claims above and beyond what you find. For more information and to request a demo of how ACC works, contact Adam Scott, Senior Director of Field Engagement.

340B Pharmacy Gateways

Over the past five years, gateways (aka HUBs) have become more common and more intrinsic in the workflows and processes of 340B Contract Pharmacy programs. As the number of contracted pharmacies continue to increase as 340B Covered Entities (CEs) try to maximize their 340B savings, this has created a more complex scenario for pharmacies with multiple stores, working with several CEs and many 340B TPAs. These contracted pharmacies wanting to be good partners with their CEs and TPAs, need help to manage all the various 340B relationships. Often, CEs are confused and frustrated by the existence and additional fees related to these gateways, and why they exist.

SUNRx hopes this blog will answer the frequently asked questions about gateways.

SUNRx 340B Webinar Series: 340B Regulatory Brief

This webcast is now on-demand, should you like to view it. Please use this link to enter the webcast. The link will expire on June 16, 2023.

The regulatory environment for 340B pharmacy is in a constant state of change, requiring eligible entities to be nimble and disciplined in the management of their program. Navigating the current ecosystem of 340B pricing limitations created by Big Pharma requires an understanding of the current regulatory environment. This webinar will provide insights that will support decisions that position your entity to maintain a compliant and optimized 340B pharmacy program.

In this session, we will share valuable insights for consideration in the management of your 340B pharmacy strategy.
We will cover:

How did we get here?
Current regulatory environment
Current state with drug manufacturers

What's So Special About Specialty Pharmacy?

Specialty pharmacy can be defined in many ways. Really, they are all correct as there is not one single source of truth for the definition. Specialty pharmacies do certain services for those patients that are chronically ill, covering a wide range of disease states and the costs of these medications can vary greatly. However, not all specialty pharmacies operate in the same way. Some specialty pharmacies can support all the disease states and service all 50 of the United States, while others might be more disease state focused or with just a regional ability to dispense. The differences in specialty pharmacies, the disease states they serve, and the associated definitions take on many shapes and sizes and is perhaps the reason it is so difficult to agree on one definition.

One thing that everyone seems to agree on is that specialty pharmacy is growing! The continued development of therapies for the chronic disease states has led to much of the growth in the specialty pharmacy segments. These new drugs often require a higher tracking of patient clinical data, side effects and outcomes, all of which fall into the services that specialty pharmacies are designed to support.

View the full blog.

Duplicate Discounts Under 340B Program

There are not that many core requirements within the 340B Statute. For being on its face, what appears a fairly "simple" program, it is instead turning into a mighty complicated program. One of two main requirements is "no duplicate discounts."

A "duplicate discount" is when a prescription (or administration) of a 340B priced outpatient drug is also subject to a pharmaceutical manufacturer's rebate under a Medicaid program. Purchasing a drug at a discount under 340B and the claim also being subject to a rebate under a state Medicaid program would subject the manufacturer to "two" (duplicate) discounts. Filling a prescription and billing a managed Medicaid plan is allowed so long as the state is aware, so they withhold that prescription from their rebate submission to the manufacturer. The opinion of manufacturers these days is that there are "rampant" duplicate discounts being paid out.

Read more here.

Protect Your 340B Covered Entity from Risk

The Indiana Hospital Association and SUNRx understand the importance of the 340B Drug Pricing Program and the value it brings to you. SUNRx has been a trusted TPA since 2006 and they’re here to help. SUNRx has had a partnership with Indiana Hospital Association and over 30 hospital associations across the country.

SUNRx maintains a vital security infrastructure, monitors security events, timely remediates security issues, and performs quarterly vulnerability scans and security posture analysis. They also maintain annual SSAE-18 SOC1 and SOC2 audits, which are performed by BDO.

Let SUNRx help you understand and simplify 340B! Please contact John Bretz for more information.

Optimize Your 340B Program and Stay Compliant

More than ever, it is essential to work with a 340B TPA who can support your entity regarding pharmacy expansion. Hospitals and FQHCs should regularly monitor their 340B program and evaluate for expansion opportunities to ensure their programs remain optimized and compliant.

We want you to know that SUNRx provides covered entity clients with:

Seamless access to Walmart, Kroger, Rite Aid, as well as many other large, regional, and independent pharmacies
Annual SOC-1 and SOC2 audits conducted by third-party auditor, BDO.

Of note, SUNRx services do not include charging a pharmacy minimum or switch fees.

In today’s world, it is increasingly important to work with a 340B TPA with a strong track record, great relationships with pharmacies and strong security infrastructure to protect clients and their data.

Please contact John Bretz for more information.

A 340B Discount Card Program Can Lessen the Healthcare Burden on the Uninsured

Hospitals and community health centers, including FQHCs (all, 340B Covered Entities) participating in 340B are not-for-profit and are required to provide a community benefit. The mission of Covered Entities (CEs) participating in the 340B program is to provide healthcare services to everyone regardless of ability to pay. In most cases, local government agencies have contracted with these CEs to care for low-income individuals who are not entitled to benefits under Medicare or Medicaid.

All 340B eligible hospitals and clinics (CEs) are burdened by the cost to provide healthcare to patients, without regard to their ability to pay for those services, and struggle to stretch these scarce resources when providing crucial services to their patients in their communities. Low-income patients that seek healthcare from these CEs usually can’t afford to pay the high cost of prescription medications and therefore run the risk of re-admissions to these entities due to lack of prescription adherence. These patients often frequent the emergency rooms of hospitals or have increased visits to the clinics because their health issues are not under control. This leads to increased healthcare costs and longer wait times for all patients.

Implementing and executing an effective program to provide access to affordable prescription medications is a foundational element to effective population health.

View the full blog.

Additional Resources

SUNRx 340B Solutions for Hospitals.pdf