CMS move to curb 340B duplicate claims flawed, hospitals in program warn

CMS issued new guidance Jan. 8 intended to help state Medicaid programs avoid submitting duplicate rebate claims for drugs that already get a 340B discount, but a group representing hospitals that participate in the drug-pricing program warns the guidance could undercut the purpose of the program. 

The guidance lays out seven strategies for avoiding duplicate discounts, which HealthPayerIntelligence reports has cost CMS $160.8 million.

The strategies include measures that 340B Health, a group that represents hospitals that participate in the 340B drug pricing program, said are already used by some states to avoid duplicate discounts. The group praised CMS for taking steps to prevent duplicate discounts. 

However, some of the language of the new guidance raised concerns with 340B Health. 

"We are extremely troubled by the inclusion of language that would allow states to limit the ability of some or all 340B hospitals and contract pharmacies to use 340B purchased drugs for Medicaid beneficiaries," 340B Health President and CEO Maureen Testoni said in a news release. "Allowing such an opt-out would undermine the very purpose of 340B and potentially damage safety-net hospitals’ ability to care for patients with low incomes."

To qualify to participate in the 340B drug-pricing program, hospitals have to document the fact that they treat a disproportionately large share of low-income patients enrolled in Medicaid. 

"Preventing hospitals from receiving the statutory discounts 340B provides for outpatient prescription drugs would negate intended purpose of using these savings to provide more care to low-income patients," Ms. Testoni said. 

340B Health asked CMS to reconsider the language in the guidance and to engage with the 340B community to discuss several of the strategies outlined.

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