Proven Success in Delivering Results for a Compliant 340B Program
Our personalized approach to each and every client challenge ensures you receive the most effective and efficient solution. From small independent pharmacy operations to multi-million dollar projects with Covered Entities, we have a proven track record of providing quick and lasting success through expertise in a number of disciplines. Here are some examples of how we're delivering quantum leap returns to our clients.
Expanding Covered Entities Access to Medications without Additional Overhead Cost
Challenge/Goals Local FQHC needed to provide much needed around-the-clock access to medications for eligible patients in the community it served due to limited hours of operation of their in-house pharmacies. Process To help 340B participants (also known as “Covered Entities”)provide access to medications without the additional overhead cost and burden of extending hours of operations and staffing, the Health Resources and Services Administration (HRSA) allows 340B participants (also known as “covered entities”) to contract with outside pharmacies to dispense drugs to eligible patients. Contract pharmacies serve as an extension of the 340B provider and provide eligible patients access to discounted prescription drugs outside of the four walls of the FQHC. We advised the FQHC to partner with local pharmacies (independently owned and retail chains) that can support their uninsured pharmacy discount program to provide discounted prescription drugs to their uninsured population, have extended hours of operations including weekends, and provide other value added services such as medication delivery that would benefit their patients and further increase the ease of patients access to medications. Results We identified potential pharmacy partners based on the established criteria, followed by detailed volume and financial analysis to identify the best suited contract pharmacy partners. Based on our set criteria and analysis, the FQHC partnered with local chain pharmacies and expanded it reach of the 340B program from its five in-house pharmacies to over 90 contract pharmacy partners over a five year period. The community’s response to the the expanded pharmacy network and the additional services offered by the partner pharmacies has been extremely positive. In fact, the CE was able to meet the demand for better medication access through contract pharmacy partnerships without any additional overhead cost.
Reduction in Pharmacy Drug Spend
Challenge/Goals A Covered Entity was seeking additional cost savings to maximize pharmacy efficiencies, further stretch scarce federal resources and minimize pharmacy operational expenses. Process Section 340B(a)(4) of the Public Health Service Act specifies which covered entities are eligible to participate in the 340B Drug Program. To purchase drugs at the 340B price, covered entities must meet ongoing requirements such as prevention of 340B drug diversion and duplicate discount prohibition. During our analysis and review of the drug invoices, we realized that less than 20% of the annual drug purchase was from the 340B wholesaler account and over 80% of drugs were purchased from the retail wholesaler account. This drug spend pattern was unusual for a CE's in-house 340B pharmacy with over 90% of prescriptions filled written by the CE's providers, also noted that the CE was carving out Medicaid from its 340B program despite having Medicaid as its largest payer. An audit of the CE's 340B program Third Party Administrator (TPA) provider list was conducted and the discovery was made that some of the CE's providers were not listed on the 340B program Third Party Administrator (TPA) provider list which led to disqualification of these prescription claims from being replenished from the the 340B wholesaler account and receiving the 340B discount, in addition to this, carving out Medicaid from the program further disqualified many claims from receiving 340B savings. Results We were able to work with the CE's TPA provider which lead to requalification of missed 340B claims over 3 years, this led to accumulations of over $6 Million of 340B discounted drugs now made available for purchase instead of replenishing at the retail cost which reduced annual cost of goods per prescription from $86 to $67. We also advised the CE to carve in Medicaid at the next open enrollment. As a result in six months, total drug spend reduced by over $1 million, 340B spend increased to 74% (more savings), and retail spend reduced 26%.
Covered Entity Overcomes Challenges of Contract Pharmacy Non-Compliance
Challenge/Goals CE had gone several years without appropriate oversight for its large contract pharmacy network. Audit uncovered that nearly a third of the registered contract pharmacy locations did not have active dispensations, and several of the contract pharmacies were non-compliant with HRSA requirements as many had effective dates on the OPA website in advance of the Pharmacy Service Agreement (PSA) being signed. Process 340B Program contract pharmacy oversight can be challenging due to many contract pharmacies requiring exclusive split-billing vendors which means a large contract pharmacy network often involves multiple split-billing systems which are not designed to interface/integrate with each other. Upon our initial audit, we realized that there were numerous contract pharmacy locations that had no dispensing activity over the course of six months, or had low dispensing volumes (less than 15 dispenses total over a period of six months for non-specialty medications). Additionally, there were several contract pharmacy that dispensed medications prior to the OPAIS effective dates. Lastly, due to low volumes, it was determined that some of the contract pharmacies relationships and associated split-billing providers could be eliminated. Results In just six months, the team worked with the Covered Entity to make major changes to its contract pharmacy operations and develop a strategy that will set them up for long term success. Successfully supported CE on updating the OPAIS database to remove all locations with minimal to no volume over the course of six months. The team removed a number of contract locations after determining that were multiple barriers that would take several more months or longer to overcome. Also reviewed e-prescribing data and history to determine where prescriptions were going to identify best suited pharmacy partners, creating a focused contract pharmacy strategy.
Increase Organizational Financial Sustainability by Adding Ambulatory Pharmacy Services
Challenge/Goals Develop and implement a strategy and business plan for a new ambulatory pharmacy Process A non-profit outpatient opioid detox and urgent care center needed to add an outpatient pharmacy service line to serve its patients. Q5D team was brought on board and moved quickly to conduct a pharmacy assessment and review. Based on the assessment, Q5D helped transform pharmacy services into a business within the business, identifying ambulatory pharmacy services as an essential way to advance patient care while also improving financial results. Q5D developed and implemented a comprehensive business plan that included: Pharmacy build out, Licensing (State board, CDS), Computer software implementation and training, Operations compliance (policies and procedures, workflow design and optimization), contract with drug supplier, hiring and training of staff. Results Within 90 days of completing the pharmacy construction, Q5D had the pharmacy licensed by all required state and federal agencies, implemented a new pharmacy management system, trained staff, and had the pharmacy operational serving the community. This led to increased patient and staff satisfaction.
Expansion of Services by Adding New Clinic Sites
Challenge/Goals Help a FQHC navigate HRSA requirements for Add a site to scope, the successful completion and submission of the Add a site to scope document in EHB for HRSA approval. Process Navigating the UDS Mapper can be challenging. A local FQHC needed to expand services into two new locations to reach more eligible patients and provide more comprehensive services. Q5D was brought on board to help navigate the HRSA Add a site to scope process, gathering the required information and supportive documents required for submission of the completed document in EHB, navigating the UDS mapper to provide required evidence to support the request to add additional sites, and assisting the CE to submit the completed document in EHB. Results Q5D was able to assist the CE in completing the Add a site to scope document, utilize the UDS Mapper to provide the required evidence and justification for the two new sites, and ensure quick turnaround for the submission of the applications in EHB. The CE received approval upon the first submission of both applications due to the thorough responses and provision of detailed documentation including detailed maps as supportive evidence from the UDS Mapper done by the Q5D team.
Internal, Integrated Specialty Pharmacy Strategy Improves Patient and Provider Satisfaction and Patient Quality of Care
Challenge/Goals Start an internal specialty pharmacy to improve quality of care, reduce cost due to therapy failures, while increasing 340B savings to reach more eligible patients and provide more comprehensive services. Process A local FQHC needed to overcome low HIV medication adherence and low HEP-C therapy completion rates by creating their own internal and integrated specialty pharmacy to serve their HIV/HEP-C patient population. Q5D conducted a pharmacy assessment, reviewed the assessment with the FQHCs pharmacy and clinical providers to get their buy-in, then created a plan (included location of the specialty pharmacy, software, staff, training etc.) and workflow for the new specialty pharmacy. Q5D worked with the CE (within 6 months) to secure accreditation with Accreditation Commission for Health Care (ACHC) with a zero finding and successful completion of the accreditation process. Results Once we implemented the plan, there was an immediate improvement in continuity of care with a drop in number of patients lost to follow up. Increased medical staff satisfaction by 100%, increased patient satisfaction by 100%, and increased pharmacy HEP-C medication revenues by an average of over $1.3 million annually over 3 years. In less than 12 months, there was an increase in the number of patients enrolled in the specialty pharmacy program, with over 90% of patients enrolled initiating treatment and 100% completing treatment. SVR-12 return rate increased from less than 20% to 57%.
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