Evaluating Contract Pharmacy
Evaluating Contract Pharmacy for your Entity
There are a number of variables that affect the actual 340B discount rendered through contract pharmacy relationships, including the percentage of Medicaid-paid prescriptions, the average cost of prescribed medications from the hospital, variations in 340B pricing, fee terms with the pharmacy, and a hospital’s final interpretation of eligible patients. We’ve found that hospitals are nevertheless able to assess the viability of contract pharmacy relationships.
- Maintain responsibility for care
- Employ physicians or have the ability to bill for their professional services
- Estimating benefit from volume of eligible prescriptions
If the 340B covered entity can assemble a list of NPIs of prescribers affiliated with the hospital per the Definition of a Patient, many pharmacies are able to readily compare their dispense data against that list. This provides reasonable accuracy in identifying the count of eligible prescriptions.
The accuracy of the provider list is not critical for a quality estimate, but it is useful to assure that the list is kept reasonably broad, including all prescribers who are likely to be writing prescriptions on the hospital’s behalf, including hospitalists, interns, nurse practitioners, and those professionals to whom patients are commonly referred. This will provide a fairly close estimate, but may include some prescriptions that might be excluded in practice.
This level requires simply a list of NPIs, in any format.
Vendor Fees – fees are based on work done, not on a percentage or your benefit.
Pharmacy Fees (See Pricing Model)