As we look ahead to 2026, the operational demands on 340B programs are increasing across every dimension. Between the implementation of the 340B Rebate Model pilot and Maximum Fair Price (MFP) covered entities (CEs) are entering a period where manual workflows simply cannot support the level of effort and precision required.
This next year will be pivotal for AI and automation-driven solutions that help teams scale their 340B program and manage complex pharmacy operations with confidence.
Here are the areas where I expect to see the greatest impact from technology innovation across 340B:
1. Compliance Audit Automation Will Become the Standard
Large CEs are grappling with massive 340B claim volumes (often hundreds of thousands per month), while relying on lean teams to maintain program integrity. Manual auditing has become the bottleneck: highly skilled staff spend most of their time reviewing small claim samples, leaving limited bandwidth for strategic work, which limits opportunities for the organization.
One of our health system customers describes the challenge as “looking for a needle in a haystack” when thinking about their approach to identifying compliance issues hidden within millions of annual claims. As programs scale, selectively reviewing 3–5 percent of claims is no longer sufficient to meet evolving expectations from HRSA, manufacturers, and internal compliance committees.
In 2026, 100% automated audit coverage will shift from an aspiration to an operational necessity. CEs adopting compliance audit automation today, like what we’ve built at Plenful, are seeing:
- Comprehensive audit coverage across all 340B claims (contract pharmacy, in-house, mixed use)
- Dramatically improved visibility through structured workflow and dashboards
- Higher audit accuracy and consistency, regardless of staffing fluctuations
- Increased internal confidence heading into HRSA audits
- Faster identification and resolution of diversion
2. Missed Opportunity Identification Will Become a Core Strategy
As 340B margins tighten and oversight intensifies, identifying missed 340B savings has become essential to maximize program impact. Many covered entities recognize they are leaving savings on the table simply because they lack the infrastructure or staffing capacity to audit ineligible claims at scale.
Automation changes this dynamic. By applying consistent, CE-specific business logic across all previously ineligible claims, automation can flag claims that are actually eligible. One large West Coast health system that implemented this approach with Plenful uncovered more than $4.5 million in savings within two months — a level of impact impossible to achieve manually.
In 2026, I expect missed opportunity identification to shift from an occasional effort to a core element of 340B stewardship. Organizations that adopt automated review will enhance their financial performance.
3. AI-powered Referral Capture Will Become a Strategic Lever
Referral capture has historically been one of the most labor-intensive components of 340B program optimization to operationalize. The opportunity is real (especially for high-cost specialty medications), but the manual effort required to surface eligible referrals has kept most teams from pursuing it consistently.
In many covered entities today, referral capture still means a laborious process requiring significant staff and expertise to identify and secure the necessary documentation to qualify an eligible claim. With limited staffing, this exercise is often deprioritized, even though identifying just a handful of high-value claims each month can generate substantial savings.
AI is beginning to change what’s possible. Next-generation referral capture solutions like what we’re building at Plenful can integrate directly with the EHR to analyze clinician notes, scan for referral intent, and flag potential opportunities automatically. Instead of spending their time digging through documentation, teams can focus on reviewing and validating high-value claims surfaced by the platform.
The value potential is meaningful. A West Coast health system partnering with Plenful recently identified 65 high-value opportunities in a single month, including individual claims worth more than $7,000. Another Northeastern health system is targeting referrals worth more than $200 because even modest wins materially move the needle in today’s 340B environment.
4. Rising Complexity from Rebate and MFP Will Demand Scalable Infrastructure
The 340B Rebate Model and Maximum Fair Price (MFP) both represent a fundamental shift in how covered entities must manage data, claim submissions, and reimbursement for select drugs.
For large health systems handling high claim volumes, manual processes simply will not keep pace. The cash float created by higher upfront acquisition costs and complex reconciliation steps make automation a necessity.
Workflow automation platforms can take on the heavy lifting: ingesting claims data across TPAs, normalizing and validating required data elements, preparing daily submission files, and reducing the likelihood of denials or delayed payments through improved accuracy. But one of the most meaningful advantages is the ability to centralize financial and operational oversight. Dashboards like we offer through Plenful’s Rebate Management solution enable reconciliation at the claim level and provide full transparency on pending rebates and denial trends by NDC or manufacturer.
Just as automated compliance audit has become essential for risk mitigation, automated rebate and MFP workflow will become essential for financial stewardship. The organizations that invest in this infrastructure will have greater clarity and confidence in their ability to manage these new and evolving program requirements.
2026: A Turning Point for the 340B Community
Whether through automated compliance auditing, missed opportunity detection, referral capture, rebate management, or preparing for MFP, our message is the same:
Automation isn’t replacing people — it’s supporting and empowering them.
Innovation gives 340B professionals the time, clarity, and precision needed to navigate one of the most complex operating environments in healthcare.
If 2025 was the year of exploration, I predict that 2026 will be the year of adoption and advancement. Now is the time to build the infrastructure that will power your 340B programs to sustainably scale and flourish into the next decade. If you’d like to explore Plenful’s 340B Audit & Optimization suite, I’d be happy to walk you through what’s creating the most value for our covered entity customers. You can request a meeting online here. I’d also love to stay connected with you on LinkedIn.
