340B Optimization Services for Hospitals & Health Systems
A well-run 340B program needs the right information, personnel, technology and program partners, to optimize its benefits. Our unmatched program support and proprietary software gives you a single access point for all of your 340B data. It’s how we help your health system generate savings that maximize your ability to deliver on your mission of patient care and satisfaction.
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Maximize 340B Program Savings Without Compromising Compliance
If your hospital is 340B-eligible, you may be missing-out on significant value in retail and specialty prescription reimbursements. Consider this: a monthly refill of just one bestselling anti-inflammatory, prescribed and not applied for 340B reimbursement, will cost an eligible hospital as much as $6,700 more than it should legally pay. If your hospital is 340B eligible, you owe it to your health system, and your patients, to receive the full reimbursement.
VytlOne has generated over $500M in 340B revenue for the hospitals we serve
What Is 340B Optimization, And Why Does It Matter?
Your 340B program should be optimized for eligible savings. An optimized 340B program generates a net savings on every eligible prescription claimed.
Your 340B program should utilize proprietary software that keeps detailed records on every prescription your onsite retail, specialty pharmacies, and your contract pharmacies. Fill, enabling you to respond quickly and efficiently during an audit request.How VytlOne Helps You Capture More 340B Revenue
By tracking the journey of each 340B prescription through your health system using our proprietary Clearview analytics sofware, our team constantly improves its understanding of your pharmacy’s big picture. We identify patterns emerging in your 340B program and share those those patterns in easily-understood reports and a client dashboard, we can help you take steps to close the gaps in your 340B program.
A Brief Overview of What’s Included in Our 340B Support
- In-depth analysis of your hospital’s 340B savings opportunities and potential.
- Analysis of the potential clinical advantages your health system could offer patients by integrating a 340B program into your continuum of care.
- Contract Pharmacy Management:
- Review and analysis of your existing 340B contract pharmacy network (if you already have a 340B program), with recommendations for which pharmacy-relationships should be renegotiated or severed
- Identification of opportunities to build and/or expand your contract pharmacy network
- Full use of, and access to, our 340B PRO software system
- 340B TPA Services: Review, analysis and recommendations for your TPA relationships, and onboarding of all new TPAs into the software system
- Taking all necessary steps to get your contract pharmacies in-network with all appropriate PBMs
- Supporting your on-campus retail and specialty pharmacies with the VytlOne and Pharmacy Benefit Management services enables you to:
- Determine the margins they generate on prescriptions, ensuring they operate on a positive-revenue basis
- Drive the lowest possible costs for prescriptions
- Passalong your lower prescription costs both to your employees and, when possible, to your 340B patients.
- Working with your system’s IT professionals to establish all necessary prescription, patient and provider data-security protocols.
- Identifying, organizing and consolidating all of your 340B-related data to feed automatically into the 340B PRO software platform.
- Designating a dedicated 340B Team to manage every aspect of your 340B program — including:
- Development and direction of overall program strategy
- Training your providers to participate in your 340B program, and providing them ongoing program and clinical support
- Identifying providers not effectively participating in your 340B program
- Submission and management of all 340B prescriptions for reimbursement
- Constant monitoring of manufacturer restrictions, and making necessary adjustments in program management
- Twice-weekly meetings of our team with your 340B team, plus availability at all times for your questions and concerns.
We’ll review your records for 340B-eligible prescriptions: Present and Past.
Our proprietary software not only identifies current and past reimbursable prescriptions for you, it automatically applies for those reimbursements.
We’ll teach your prescribers easy-to-follow Best Practices
Clearview identifies prescribers in your system who aren’t taking full advantage of 340B savings and revenue. Frequently, the solution is simply familiarizing them with the prescribing procedures needed to ensure eligibility.
How do we keep clients compliant?
We know every prescription drug that’s 340B eligible, and we maintain a database that keeps VytlOne and our clients compliant at all times. Moreover, 340B PRO’s analytics document the entire journey of every prescription in your health system’s 340B program — no matter how many clinics, providers and pharmacies participate.
An unblemished record of performance
Since 2019, VytlOne has managed the 340B programs of 21 health systems, and not once has a client of ours ever been fined for a 340B violation.
How can we can optimize your 340B clinical and financial returns?
Meet VytlOne's 340B Team
Understanding the 340B Program: Covered Entities, Eligibility & Revenue Potential
What Is The 340B Drug Pricing Program?
The United States Congress created the 340B drug pricing program in 1992 to help nonprofit healthcare providers fill-in their revenue gaps, by providing them with access to prescription drugs at significant discounts.
As The American Hospital Association (AHA.org) noted in a March, 2023 Fact Sheet, “The program allows 340B hospitals to stretch limited federal resources to reduce the price of outpatient pharmaceuticals for patients and expand health services to the patients and communities they serve.”
For many of the hospitals VytlOne serves, 340B savings and revenue are the lifeline enabling them to pursue their missions of serving patients who lack the financial resources to pay for healthcare.How does the 340B program work for covered entities?
When a patient receives a 340B-eligible prescription from a covered entity, the health system is entitled to be reimbursed for the full market price of the prescription, but — by purchasing the drugs on the 340B catalog — pays only a small portion of the drugs’ costs.
340B covered entities are legally entitled to determine how they use their 340B savings. Many of the health systems we serve use the revenue generated by their 340B programs to provide a variety of healthcare services they would be otherwise unable to afford to offer.What is the legal definition of a 340B Covered Entity?
The Health Resources and Services Administration (HRSA) considers includes six categories of healthcare providers “covered entities” under the 340B Drug Pricing Program.
- Critical access hospitals
- Rural referral centers
- Children’s hospitals & cancer hospitals exempt from the Medicare prospective payment system
- Sole community hospitals
- Disproportionate share hospitals (DSH)
Healthcare facilities included in the 340B program.
Covered Entity Hospital Facilities include:
- Rural Health Clinics
- Federally Qualified Health Centers
- Community-based rehabilitation programs
- Psychiatric hospitals
- Long term/continuing care nursing homes
- Home infusion therapy centers
- Hospices
- Freestanding acute care general hospitals
- State mental institutions
- Indian Health Service facilities
A 2018 study by the U.S. Government Accountability Office (GAO), offers the following estimates, concerning 340B covered entities: 62% are rural and 38% are urban. 45% are general acute care hospitals and 45% are critical access hospitals.
Understanding the 340B program’s eligibility requirements for hospitals.
- To qualify for Covered Entity status under the 340B program, most hospitals must meet all of the following requirements. Rural Hospitals, however, are only required to meet only the first two.
- Government-controlled or government-owned hospitals
- Disproportionate Share Hospitals
- DSH hospitals, children’s hospitals and free-standing cancer hospitals meeting the first two criteria.
Understanding requirements for eligible drugs in the 340B program.
Which drugs are eligible for 340B price discounts?
The drugs available for discounted 340B prices are typically offered through a 340B hospital’s wholesaler unless, in the case of a specialty drug distributor, a particular manufacturer requires that certain medications be purchased through other channels. VytlOne’s proprietary software system tracks every prescription drug eligible for 340B savings.
What patients are eligible for 340B program discounts?
- They have an established relationship with the covered entity. For example, The entity maintains records of the individual’s care by the health system
- They receive healthcare from a provider who is either employed by the 340B health system, or is under contract or some other arrangement for example, through referrals for consultation,) with the 340B health system. In all cases, responsibility for the care remains with the covered entity
- They receive health services for which grant funding has been provided to the covered entity.
340B Best Practices Every Health System Should Know
How to ensure 340B program compliance.
With VytlOne you get full 340B compliance support, including, when necessary, HRSA audit preparation. Below is an abbreviated checklist of tips for ensuring compliance with 340B program requirements. For the complete list, please reach out to us to discuss your compliance strategy.
- You should have detailed 340B policies and procedures in writing, and they should be consistent with your health system’s existing policies and procedures.
- You should ensure that your provider files are accurate at all times. This includes National Drug Code crosswalks and location maps for all of the 340B contract pharmacies in your network.
- You should use software that’s been specifically developed to manage your 340B program.
- You should conduct regular checks on your inventory management and tracking procedures, to ensure that you’re always in compliance.
- You should also conduct internal audits of your health system’s 340B program on a regular basis.
VytlOne maintains a policy of aggressively pursuing 340B savings for every prescription that’s worth pursuing. We don’t chase after prescriptions whose market price is too low to justify the effort needed to generate the eligible savings.
A 340B program that is optimized generates net savings from every 340B-eligible prescription claimed.Maintain an active Meds-to-Beds prescription delivery program
Time and time again, we’ve seen that 340B health systems that don’t offer meds-to-beds patient-support believe that the service is simply too expensive to staff and administer. But that’s not true. For example, VytlOne implemented a meds-to-beds program in a single Mississippi hospital, and in its first 12 months of operation our team filled over 18,000 discharge prescriptions. As a result, the hospital’s pharmacy revenues increased 125%, and its readmissions were reduced by 79%.
Implement an effective readmission reduction program
Meds To Beds is just one component of a well-executed, effective readmission reduction program.
For Further Reading:
Build and own an onsite 340B specialty pharmacy.
There’s a reason that every one of our blog posts recommends that every 340B health system have its own on-campus specialty pharmacy. To learn how VytlOne can help you build, fund and prepare a successful specialty pharmacy for accreditation, visit this link.