By: Riley Protz
Client Background
- Large non-profit hospital Disproportionate Share Hospital (DSH) with eligible child sites in Primary Care, Neurology, and
- An expansive contract pharmacy network of over 95 contracts
Problem
In line with the experiences of many covered entities around the nation, this hospital has experienced a drastic decline in its 340B program savings, particularly in the contract pharmacy arena. Hospital Leadership became increasingly concerned with the reduction in savings, subsequent decline in the viability of clinical services supported by these savings, and overall financial stability of the hospital. The hospital engaged SpendMend Pharmacy to identify an opportunity to mitigate its contract pharmacy losses in an efficient and compliant manner.
Solution
Leveraging the organization’s primary care child sites and contract pharmacy network, SpendMend Pharmacy was able to identify an untapped opportunity for capturing prescriptions written by referred Specialist Providers. By providing SpendMend Pharmacy experts with access to their contract pharmacy TPAs and EMR system, the hospital’s operational workload remained minimal. A SpendMend 340B Specialist reviewed non-qualified contract pharmacy claims each month to identify prescriptions written by referred Specialists for which the covered entity maintained responsibility of care. These prescriptions were then manually qualified as 340B-eligible within the TPA and auditable records supporting this classification were retained for the hospital.
Result
Within the first 6 months of implementation of a referral capture program with SpendMend Pharmacy, the hospital achieved a net savings increase of over $240,000. This takes into account all SpendMend and TPA fees as well as 340B drug cost for inventory replenished. With the confidence that SpendMend Pharmacy prioritizes compliance, hospital leadership remains engaged and satisfied with the program.
+$240K Net Savings in First 6 Months