What is sub 340B pricing?
The 340B ceiling price refers to the maximum amount that a manufacturer can charge a covered entity for the purchase of a 340B covered outpatient drug.
What is 340B split billing?
Split billing is the process of separating the inpatient (IP) and OP hospital charges from 340B-eligible areas. Effectively, this method identifies all of a CE’s OP charge codes and uses them to identify drug replenishment opportunities at 340B pricing.
What is the average 340B discount?
According to the Health Resources and Services Administration (HRSA), the federal agency responsible for administering the 340B program, enrolled hospitals and other covered entities can achieve average savings of 25 to 50 percent in pharmaceutical purchases.
How are 340B cost savings calculated?
Step 1: Calculate 340B savings by reviewing the purchase history report from the 340B account and identify the unit price for each NDC when purchasing those NDCs at 340B price and GPO price. 340B savings will be equal to the GPO total minus the 340B total.
How is the 340B ceiling price calculated?
The 340B ceiling price is calculated by taking the Average Manufacturer Price (“AMP”) and subtracting the Unit Rebate Amount (“URA”). Manufacturers submit the AMP and URA amount to the Center for Medicare and Medicaid Services (“CMS”). The HRSA then uses that data to calculate the ceiling prices.
How often is 340B ceiling price calculated?
quarterly
Overview: The 340B OPAIS pricing component captures pricing data from manufacturers and CMS and then calculates and verifies 340B ceiling prices through a quarterly process.
How does 340B billing work?
The federal 340B Program is a drug price control program that allows qualifying providers, generally hospitals, specialty clinics and their associated outpatient facilities serving uninsured and low-income patients in rural communities, to purchase outpatient drugs from manufacturers at discounted prices.
What is Apexus 340B?
The 340B Prime Vendor Program (PVP), managed by Apexus™, is a contract awarded by the Health Resources and Services Administration (HRSA), which is responsible for administering the 340B Drug Pricing Program. The 340B Prime Vendor Program is a voluntary program for covered entities and manufacturers alike.
What is federal ceiling price?
Federal Ceiling Price (FCP): The maximum price manufacturers can charge for FSS-listed brand name drugs to the Big 4 — VA, DoD, PHS, and the Coast Guard — even if the FSS price is higher. FCP must be at least 24 percent below the non-Federal average manufacturer price. FCP prices are not publicly available.
How does 340B reimbursement work?
Who sets 340B pricing?
manufacturers
Because manufacturers are responsible for setting appropriate 340B ceiling prices, they are responsible for the conduct of business partners with whom they contract.