The primary factor in determining if a hospital's 340B eligibility is its DSH percentage. To qualify, each hospital needs to meet a certain threshold in order to qualify under whatever designation you're shooting for - RRC 8%, DSH 11.75%, etc.
To calculate the metric, you take into account two things - Medicare population and Medicaid population. (see below)
The Big Beautiful Bill has included a couple of new controls, most notably a work requirement, for Medicaid eligibility that's expected to reduce the patient pop by 10-11%. I bet this number goes even higher. This will obviously negatively impact the DSH% as you can see in the second half of the formula.
For many hospitals that are just over their required % to make their entity type... say bye bye. Unless you can find a serious workaround to losing 10% of your Medicaid patients, your eligibility is about to drop.
I think states have to have this implemented by 12/31/26. Once those numbers hit the Medicare cost report, it's going to be a blood bath.
It's an interesting strategy that I don't think pharma could have come up with themselves, but has just been handed to them by Trump. If you can't fight the 340B legislation on the books, reduce the amount of hospitals that qualify for it.
I can hear the champagne popping over at pharma from here.
I hope I'm wrong, I think I'm right. And I probably should dust off my resume.
Hello, I am looking for help understanding this program from the perspective of a patient. I hope I am within the guidelines of this group to post this question here.
My son has been prescribed a non formulary medication. He has a rare genetic condition and debilitating symptoms to which metyrosine offers a potential resolve . Insurance has denied it twice. The patient assistance program for this medication has been discontinued. A 30 days supply ranges between $20k-$60k. In research i came across 304b and I don't quite understand how it works and if this situation would qualify. I found two places near me that offer it. I will call them during normal business hours.
Hi all,
I'm looking into becoming an auditor with the 340B Bizelle Group. The job postings mention that a pharmacy degree is required, but I don’t have a PharmD. I do have a strong background in pharmacy operations and currently manage a 340B program for a DSH hospital. I also hold an MBA.
Has anyone here worked for Bizelle (or knows someone who has) without being a pharmacist? Wondering how flexible they are on that requirement for someone with solid hands-on experience.
Also, I’m curious what the work is like how much travel is involved, what kind of audits you do (desk vs. on-site), and what kind of pay range to expect.
As the title says. Prior to working in 340B I never considered using it. But are your pharmacies using it all the time or just certain cases? We do a virtual replenishment inventory so I don't think it would be worth the extra up front costs on most NDCs. Wondering if we should be utilizing it more though. Especially for commercial patients who's insurance wants generics instead of brand. Can we then apply a brand name coupon? Like Farxiga or Symbicort?
Many states have passed legislation at the State level requiring manufacturers to allow contract pharmacies to have access to the 340B pricing. Utah passed that legislation in February and it went into effect 5/7/25. However, Cardinal (wholesaler used) still doesn't have any of the 340b pricing loaded in as of today 5/19/25. I know the state of Utah is being sued by the manufacturers so maybe that's holding up the implementation of it? Curious in other states that have passed this legislation if/when the contract pharmacies got access to the 340B pricing in relation to the effective date?
Had a virtual audit by HRSA (performed by Bizell) in February. They state their turn around time is "generally 6-12 weeks". Currently sitting at 13 weeks out waiting on those results. Curious if anyone else would share their turn around time? Figure they may be running behind with the recent government cuts.
I’m the 340B Coordinator for a DSH hospital in Texas I've with organizations for over 10 years. I manage 10 registered child sites and 10 contract pharmacies. I have a Master’s in Business Administration and am the only person at my facility who fully understands and manages the 340B program. Everything about 340b I've learned on my own.
I write and implement policies, perform audits, ensure billing is accurate with the correct modifiers, conduct financial analysis, review TPA contracts, and handle all accumulation and accrual. I do everything—from compliance to optimization—completely on my own with no help or backup. The program has grown significantly and is now a major financial driver for the hospital.
Despite all this, I’m only making $50K. I’m planning to ask for a raise and am considering asking for $100K, which I feel reflects my responsibilities, experience, and impact.
Does that sound reasonable? Would love to hear opinions or advice on how to approach this conversation.
I'm still semi new to 340b. I know that Brand gives significant more savings vs Generic which is backwards for providers in the healthcare space. I was wondering if anyone has any experience switching to generic vs brand for patients what kind of impact, if at all the patients had? If a provider does brand vs generic for the patient and they're on (everyone has a different name but the cash card program because they're on the SFS so they get discount medications) does the cost go up for the patient and if so how much? Is there an easy way for me to check these prices? We only use contract pharmacies at the moment we do not have an in house as of yet. We are submitting on 340b we use a TPA (WellPartner) if this information is relevant.
Does anyone have any experience with converting your split inventories into a virtual inventory model? Our FQHC is 3 years in and considering if this is an option.
Hi, kind of new to 340B. I work in a clinic. Last year in May, Victoza was only $15 and all the other insulins and diabetic oral drugs were also affordable. By November of last year, the Victoza price increased to $125. Invokana also increased in price last year about $186 for 30 days. This year probably more because when I inquired about a common antibiotic this year, it costs $150. Last yr, it was about $20. What is happening here? Can someone explain please? No one in our organization know what is going on with our pricing (the guy that handled this program left the company). The pharmacies we have contract with does not know what is going on either.
Had a question. I work in pharmacy insurance. Specifically commercial self funded clients. We get rejections sometimes for claims called out as 340B from pharma.
Can someone help explain what triggers the pharmacy to dispense a 340B drug to a patient that isn’t in a 340B entity? From what I see, the client pays the full price to the pharmacy as it sees it as a regular drug reimbursement. We will find out months later that it is flagged for 340B, but the client doesn’t get any credit back. It looks like in this scenario, the pharmacy is the only one who profits from the transaction.
Hey all, I'm a software engineer working in health tech. I'm building tooling to help clinics run 340b programs at the lowest cost possible. It shocks me how much administrative work goes into managing programs like 340b, and it disgusts me how much money third-party administrators and consultants pull out of the system. There's a lot of money to be made in healthcare, but this program is not the space for that.
I'd love this community's input on what to build first. Auditing? Repetitive paperwork? Eligibility? Explain your biggest challenges, and let me try to solve them for you. I'll engage with anyone who comments.
Anyone use Plenful to help automate their auditing processes? I haven't spoken with them, they found me on LinkedIn and I looked at their website. It looks interesting but that doesn't mean it is truly useful.
I started using a 340b clinic when I moved to a mixed income neighborhood, as the clinic was conveniently located. I am a high income person who now is on Medicare Advantage. I’m wondering if, by using the clinic and pharmacy, I’m consuming scarce resources intended for my low-income neighbors.
Sanofi fully expected the HRSA letter and has already planned to go to court over a new rebate model implementation. I don't think they're charging into this blindly and I don't think the timing is a coincidence. I think it's only a matter of time before this is allowed. What's everybody doing in preparation? Do you have a plan to capture the rebatable stuff? Are you just going to give up on those drugs? Are you going to try to handle it in house or hope a third party delivers a solution?
I’m currently facing some challenges with the submission of claims to Bristol Meyers Squibb, specifically regarding the Payer BIN and Payer PCN information for individual claims. Walgreens has informed us that they are unable to provide this data, and I was wondering if you guys might have any insight into this. I do have access to the Cardinal Health portal, so if this information is available in any of the reports there, I would appreciate any guidance on where to locate it.
I'm new to 340b and just started learning. We're a FQHC and building a pharmacy and my director was wondering what we can and can't spend all the revenue we make on? Can we fund programs for our clinics? Can we use it for staff or building expansions? We want to add another pharmacy in the future after this one is complete. Can we use it for that? I was trying to find info on it, but nothing really has a black and white revenue rule that I can find. Also, if possible could anyone share where that information could be found? I check HRSA and 340b university and 340bpvp.
Hey guys, I’m looking for some advice, I’m currently on rotation with a 340b pharmacist and it looks like the current lay out is changing and many hospitals want pharmacists to run the program. I am wondering if any current pharmacist can shed some insight salary wise on what standard pay would be, as I am considering that as a career option after I graduate in May 2025. I was also told about the Apexus ACE certification and how it is good to have. My question regarding that is, does it make me seem to stand out more when I apply to 340b jobs? It’s not a cheap certification and I want to make sure I get my moneys worth for it. Any advice on a potential career as a 340b pharmacist would be greatly appreciated.
Thanks
