What does 340B carve-out mean?

340B Health is aware some states require covered entities to carve-out. “Carve-Out”: A commonly used term to describe a covered entity’s decision not to use 340B discounted drugs for Medicaid patients if such drugs are subject to a potential Medicaid rebate claim by a state Medicaid agency.

What does Medicaid carve-out mean?

Medicaid managed care financing
A carve-out is a Medicaid managed care financing model where some portion of Medicaid benefits—dental services, pharmacy services, behavioral health services, etc. —are separately managed and/or financed. The MCO then sub-contracts with another organization (an MBHO) to manage behavioral health services.

What is GPO in 340B?

In order for disproportionate share hospitals (DSH), children’s hospitals (PED), and free-standing cancer hospitals (CAN) to participate in the 340B Program, entities must attest they will not “obtain covered outpatient drugs through a group purchasing organization or other group purchasing arrangement.” This is known …

What is true about preventing duplicate discounts?

42 USC 256b(a)(5)(A)(i) prohibits duplicate discounts; that is, manufacturers are not required to provide a discounted 340B price and a Medicaid drug rebate for the same drug. Covered entities must have mechanisms in place to prevent duplicate discounts.

Is 340B Medicaid?

Section 340B of the Public Health Service Act requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to health care organizations that care for many uninsured and low-income patients.

How does 340B billing work?

How Does 340B Drug Program Work? If your facility is eligible, you apply and get approved for the 340B Drug program. Once enrolled, your facility can purchase outpatient medications at discounted “340B” drug prices. Drug manufacturers are required to discount prescriptions for 340B-approved facilities.

Which is an example of a carve in service?

In contrast, Outpatient Substance Use Disorder services were the most likely to be carved in. Inpatient Mental Health services are more often carved out than Substance Use Disorder services, but more often carved in than specialty mental health services.

Is Apexus a GPO?

A group purchasing organization is an organization created to leverage the purchasing power of entities to obtain discounts from vendors based on the collective buying power of the GPO members. The Apexus portfolio is not considered a GPO.

What does 340B cover?

Hospitals use 340B savings to provide free care for uninsured patients, offer free vaccines, provide services in mental health clinics, and implement medication management and community health programs.

What qualifies a patient for 340B?

In order to be eligible, the patient must receive health care services other than drugs from the 340B covered entity (although a sole exception exists for patients that are part of an AIDS drug purchasing assistance program that has ties to the government).

Who is eligible for 340B pricing?

Only “outpatients” are eligible to receive prescription drugs at 340B discounted prices because the program is an outpatient program. In 1996, HRSA issued guidance for an individual to qualify as a patient of a 340B facility.

What is the 340B program, how does it work?

The 340B Program simply allows eligible health care providers that serve a large number of low-income patients to purchase medications at a special discount from drug makers. That savings can, in turn, be used by these eligible providers to fund services and care for their patients, and at no cost to taxpayers.

What is the 340B Drug Pricing Program?

340B Pricing/Covered Outpatient Drugs. Overview: The 340B Drug Pricing Program is a federal program that requires drug manufacturers participating in the Medicaid drug rebate program to provide covered outpatient drugs to enrolled “covered entities” at or below the statutorily-defined ceiling price.

What is the 340B PvP distribution network?

The 340B Prime Vendor Program (PVP) distribution network includes distributors of all sizes and types to accommodate the specific needs of entities, from the largest disproportionate share hospitals (DSHs) to the smallest grantees. This ensures that distributors can provide the covered entities access to PVP discounts while meeting their customers’ unique distribution needs.