Challenge
A large 14-hospital East Coast health system has a successful 340B program but was concerned about missing drug discount opportunities. The health system felt internal process gaps were preventing drugs from being replenished at 340B pricing when they qualified for the 340B discount.
Solution
R1 340B Recovery increases eligible prescription capture by reviewing ineligible claims to find allowed referral prescriptions and identify EHR data issues. R1 audited ineligible prescriptions from six owned pharmacies to determine the validity of the initial assessment. R1’s proprietary technology and auditing process created data analytics for the identification and quantification of missed 340B savings. Enhanced reporting allowed the health system to easily make decisions to strengthen future 340B performance and savings.
Results
At audit completion, the health system identified and saved over $5.3 million due to missing or incorrect information. Previously non-eligible prescriptions were identified, and all necessary information to qualify the prescriptions as 340B eligible was provided. Additionally, the identification of areas of 340B expansion resulted in potential revenue and cost savings.
Financial
$5.3M
to-date expense reduction
Operational
0.8%
reversal rate on ineligible prescriptions