By Peyton Brien
The rise in prescription drug prices compounded with the still present pharmaceutical supply chain issues have become a tough pill for most Americans to swallow. The federal government’s initiative to reduce drug prices and increase drug availability known as the 340B Drug Pricing Program initially brought relief in allocating prescription drugs but has been consistently met with criticism questioning its efficacy. These criticisms range from high drug prices and drug shortages to a lack of transparency in the pricing and rebate practices of PBMs.
No doubt, access to affordable and effective prescription drugs is essential for maintaining the health and wellbeing of employees, but with over 40% of the workforce classified as “working poor,” access can easily become a barrier to adherence. Additionally, employers are voicing growing concerns about the issues associated with PBMs and the pharmaceutical industry in the United States. The high cost of prescription drugs, lack of transparency in pricing and rebate practices, and inadequate access weigh heavily on the rising cost of benefit plans.
The Trifecta of Drug Troubles
High drug prices result in increased healthcare costs for employers and employees leading to decreased productivity at the workplace while adding to external stressors that are often out of the employees’ control. The lack of transparency in pricing and rebate practices makes it difficult for employers to make well-informed decisions in regard to employee healthcare plans. And yet, the average working American relies on their employer as the gatekeeper for access to pharmacy fills when it comes to drug spending, especially if they are using an employer-sponsored health plan.
This is where 340B can lend a helping hand if employers know how to take advantage of this program. It is also why Prism Health Group, one of the nation’s leading pharmacy auditing and consulting organizations, has created a process to make a seemingly complex undertaking a smoke and easy one to understand. When dealing with the federal government, companies are subject to complying with a raft of regulations and audits, and many companies are not prepared to ‘pass’ the audit. Then, they find themselves facing allegations of misuse from the federal government.
Adhering to the federal government’s regulations and passing their audit is a critical component of participating in the 340B Drug Pricing Program. This program provides discounts on outpatient drugs to certain healthcare providers, including hospitals and clinics that serve low-income and uninsured patients. To become eligible for the program, healthcare providers must meet specific criteria and comply with federal regulations.
While adhering to these regulations and passing audits can be challenging, it is essential for healthcare providers that want to participate in the program. Failure to comply with regulations can result in disqualification from the program and potential significant financial penalties.
Prism Health Group’s team offers personalized insight into optimizing the employer relationship in maintaining compliance with the efficient utilization of the 340B Drug Pricing Program.
Accessing High Cost-Prescription Drugs for Way Less with 340B
Prism Health Group’s 340B consulting suite of services are aligned with the government's mission designed to help stretch federal resources as far as possible by assisting health system partners to maintain compliance with government regulations optimizing the health system’s ability to access high-cost prescription drugs for way less. When asked about the efficacy of Prism Health Group’s approach to the 340B Drug Program, Jordan Hytken, Senior Strategic Account Executive at Prism Health Group, states:
“At Prism, we tailor our solution to the specificity of each client, covered entity eligibility designation and 340B life cycle. Whether we are facilitating procurement by bringing a client to RFP or building out a 340B program from infancy and everything in between, our focus is to minimize 340B’s complexities for our clients while optimizing compliance and the financial benefit of the program.”
In addition to helping employers adhere to regulations, Prism Health Group's 340B program also offers a range of benefits for health system partners and entities that receive federal subsidies, including access to expensive medications, compliance support, and financial sustainability. By freeing up resources for healthcare organizations, the program indirectly benefits employers by enabling them to invest in other areas of their organization, such as employee benefits, which can help attract and retain top talent. Having witnessed the benefits that employers sustain following Prism Health Group's consulting, Hytken notes:
“Our clients do a really good job of redistributing savings yielded from the 340B program by developing generous subsidy programs for the uninsured population. More recently our partners have been extremely concerned about rising costs of certain specialty medications and have been deploying patient specific and therapeutic class solutions directly benefiting a broader range of people. In several instances however our entity partners have verbalized that they would not be able to keep their doors open if it was not for savings generated through the federal government's 340B program.”
Controversial or not, 340B enables covered entities to stretch federal resources as far as possible, at the same time reaching more eligible patients. By offering a comprehensive approach to effectively utilizing the 340B Drug Pricing Program, Prism Health Group is poised to improve employer balance sheets and healthcare systems across the country by helping bring this program to fruition.
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