As a thought leader and go-to resource in pharmacy solutions for the nation's safety-net providers, Apexus developed a solution to streamline the process of returning in-eligible discounts to manufacturers. The pilot program launched in 2018 and successfully refunded over $5 million to more than 200 manufacturers with minimal impact on day-to-day processes at covered entities and manufacturers.
THE RESULTS
The new Covered Entity Refund Service (CRS) solution's streamlined process quickly resolved 340B refund issues, significantly reducing the impact on day-to-day processes for both the covered entity and the manufacturer.
THE PARTICIPANTS
Apexus partnered with five health systems encompassing eight hospitals across the country, in addition to working closely with several manufacturers.
THE CHALLENGE
To remain in compliance with the 340B Drug Pricing Program, covered entities must pay refunds to manufacturers when an ineligible 340B discount error is identified. Before CRS, the process of returning these funds was difficult and time consuming because of:
- The difficulty of accessing historical drug pricing information for covered entities.
- Manufacturer contacts for refunds not publicly available.
- Lack of statutorily defined process to govern the refunds of ineligible 340B discounts.
- No industrywide standard process to submit refund offer information.
THE SOLUTION
Apexus developed tools to create a streamlined and efficient process of refunding ineligible 340B discounts through the creation of:
A database of current and historic WAC prices and NDC codes.
An accurately maintained database of manufacturer contacts.
A consistent calculation methodology for refund amounts.
Standardized communication templates accepted by all manufacturers.