Program Management & Optimization Flashcards
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Read the first 7 Program Management & Optimization flashcards as text
Under the 340B program, which entity is primarily responsible for ensuring that duplicate discounts do not occur when a covered entity uses contract pharmacies?
Answer: The covered entity
The covered entity bears primary responsibility for preventing duplicate discounts, including implementing systems to separate 340B and non-340B claims at contract pharmacy locations.
A 340B covered entity wants to maximize savings on specialty drugs. Which strategy best aligns with 340B program compliance requirements?
Answer: Use 340B pricing only for patients who meet the definition of a 340B patient
340B savings may only be used on drugs dispensed to patients who meet the program's definition, ensuring the benefit is tied to eligible patient encounters.
Which of the following metrics is most useful for evaluating the financial performance of a 340B program?
Answer: 340B savings as a percentage of total drug spend
Measuring 340B savings as a percentage of total drug spend provides a direct indicator of the program's financial impact and efficiency.
What is the primary purpose of a 340B third-party administrator (TPA)?
Answer: To manage claims data and ensure proper 340B accumulation at contract pharmacies
TPAs manage the data flow between covered entities and contract pharmacies to accurately identify, accumulate, and replenish 340B-eligible claims.
A federally qualified health center (FQHC) discovers it has been charging Medicaid fee-for-service patients full price while purchasing those drugs at 340B pricing. What must occur?
Answer: The FQHC must refund the overcharge to Medicaid and implement corrective measures
Charging Medicaid at full price while using 340B pricing constitutes a duplicate discount, and the covered entity must refund improperly received amounts and correct its systems.
Which approach is considered a best practice for a 340B program coordinator managing multiple contract pharmacy agreements?
Answer: Implementing real-time data analytics to monitor eligibility and accumulation
Real-time data analytics enables proactive identification of eligibility issues and ensures accurate 340B accumulation across all contract pharmacy locations.
When a 340B covered entity transitions from an in-house pharmacy to a contract pharmacy model, which compliance step is most critical immediately after the transition?
Answer: Registering the contract pharmacy with HRSA before dispensing 340B drugs
Contract pharmacy locations must be registered with HRSA prior to dispensing 340B drugs to ensure the arrangement is authorized under the program.