August 29, 2011—The National Council for Prescription Drug Programs (NCPDP) has formally notified 340B health care providers that it will not change its forthcoming telecommunication standard to prevent pharmacy benefits managers (PBMs) and private payers from using it to lower reimbursement for 340B retail drugs.
During an Aug. 11 meeting in Atlanta, representatives of hospitals, hemophilia treatment centers, and community health centers enrolled in the drug discount program asked NCPDP to remove point-of-sale and retrospective identification of 340B claims from the standard pending implementation of safeguards to protect covered entities from decreased reimbursement.
NCPDP, which develops information-exchange standards for the pharmacy services industry, recently revised the standard to make 340B transactions in the area of third-party adjudication more transparent. The 340B providers say that although they support greater transparency, they fear that NCPDP’s efforts will lead to reduced reimbursement to safety-net providers and thereby undermine the 340B program.
During the Atlanta meeting, two NCPDP work groups voted to implement the new 340B identification method over the 340B providers’ objections. A provider participant in both meetings described the discussions as heated. A third work group then considered and endorsed the votes of the other two, reportedly once again amid heated discussion. In general, PBMs and representatives of the payer community were said to have voted to preserve the standard while pharmacies and providers voted in support of the proposed changes.
The NCPDP work groups did, however, approve a separate request by the 340B providers to limit the use of values requiring submission of 340B prices to Medicaid fee-for-service programs only. The providers said that without the changes, they would have been required to disclose 340B prices to private payers in violation of federal law and guidance from the Health Resources and Services Administration.
Safety Net Hospitals for Pharmaceutical Access (SNHPA), one of the groups that called for changes, said it is reviewing its options on how to respond to NCPDP’s decision.
“While SNHPA is disappointed that NCPDP did not remove the ability to identify 340B claims from its telecommunication standard, we were pleased that it recognized the confidentiality of 340B prices by restricting disclosure of 340B acquisition cost to Medicaid fee-for-service programs only,” the 340B hospital association said. “SNHPA remains concerned that PBMs will use NCPDP’s 340B identification standards to target 340B claims for lower reimbursement. We plan to continue pursuing other strategies, including legislative remedies, to address the growing problem of discriminatory 340B reimbursement.”