1 / 15

340 B Program and a Real World Case Study

340 B Program and a Real World Case Study. Louisiana Oncology Society November 29,2010 Lane Hooton ,Chief Operating Officer Cancer Centers of Southwest Oklahoma . Objectives. Define the 340B Program Define the Prime Vendor Program(PVP) What organizations can access 340B/PVP?

belita
Download Presentation

340 B Program and a Real World Case Study

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. 340 B Program and a Real World Case Study Louisiana Oncology Society November 29,2010 Lane Hooton ,Chief Operating Officer Cancer Centers of Southwest Oklahoma

  2. Objectives • Define the 340B Program • Define the Prime Vendor Program(PVP) • What organizations can access 340B/PVP? • What are the key requirements for the above? • How does 340B/PVP impact a business?

  3. Background • 1992 -Section 602 of Public Law 102-585, the “Veteran’s Healthcare Act” enacted Section 340B of the PHS Act • Manufacturers sign agreement with Secretary of Health and Human Services to cap prices • Section 340B is commonly referred to as the 340B Program, Section 602, or PHS Act

  4. Program Administration • Office of Pharmacy Affairs (OPA) http://pssc.aphanet.org • Pharmacy Services support Center (PSSC) http://hrsa.gov/opa • 340 B Prime Vendor Program (PVP) www.340Bpvp.com

  5. Prime Vendor Program(PVP) • 340b PVP provides additional savings to Disproportionate Share Hospitals • Mission is to improve access to the program • Participation is free for all eligible 340B participants • Contract to mange PVP is through Apexus Inc. • 13 national, regional specialty distributors • PVP adds approximately 2% to the overall discount

  6. What’s covered and why the big deal? • Outpatient prescriptions • OTC written by Rx • Clinic Administered drugs in eligible facilities • ER drugs • Drugs in other ambulatory settings (i.e. day surgery) • Not Covered- inpatient drugs, vaccines

  7. And the big deal is….? • DSH savings range from 22-40% less than any GPO • Average discount in oncology and using PVP is 27% • Only price lower is VA

  8. So who can access this program? • Family planning projects • Entities covered under the Ryan White Act • State operated AIDS programs • Black lung clinics • Hemophilia clinics • Native Hawaiian clinics • Urban Indian organizations • Disproportionate Share Hospitals (DSH)

  9. Facility Eligibility • Hospital owned or operated by unit of state or local government • Public or private NFP contracted with government to provide healthcare to low income individuals • DSH adjusted charity rate > 11.75%

  10. Patient Eligibility Requirements • 340B prohibits selling or transferring drugs to/for any patient not a patient of the covered entity • individual is a patient if entity owns or controls that person’s healthcare records • Individual must receive care from a provider either employed or under contract to the entity • Mere act of dispensing to a patient is not enough to establish the relationship

  11. Patient Requirements continued.. • Must be for an outpatient service • Provider is to be on the hospital’s CMS cost report • Others- common medical record, employed physicians, common protocols, common board of directors, QA processes

  12. Case Study-Cancer Centers of Southwest Oklahoma • Three hospitals in three markets • Build three new centers to expand/provide cancer care • Only one of three hospitals is DSH • Medical, Radiation Oncology, Lab in each • One Board of Directors • Private and employed doctors • New EMR for all

  13. Problem/Solutions-use 340B in all sites • Two hospitals are not DSH • Definition of a patient: • Outpatient • Employed physicians • Covered entity maintains medical record • First dose at covered entity

  14. So, what’s the financial impact?

More Related