Data, data everywhere, but not a converted 340B script in sight.

Script conversion starts at intake - Building a compliant and right-sized 340B Program

340B eligible entities and pharmacies alike can be dumbfounded when your specialty program goes live and your converted script numbers don’t look anything like those historical script volume NPI pulls we have been told are the best way to identify contract pharmacy partners. We all know where that usually leaves us both … with broken dreams and a contentious relationship.

Really? Historical NPI Data Pulls Aren’t Where It’s At?

Before I get to my main point of this blog, I want to point out a big issue with historical NPI data pulls when trying to identify a specialty 340B pharmacy partner. If you contract with where the specialty scripts used to be, guess what: they're not there anymore.

Using that outdated strategy to pick a specialty partner will always leave you with broken dreams of program savings growth that can help your organization provide high quality clinical programs and more robust patient assistance. If you are looking where the volume use to be, you will always be chasing your business and over contracting with more pharmacies than you need which in turn leads to elevated audit risk.

A Better Place to Focus

Now to my main point. It’s common knowledge that there are multiple factors for a prescription to end up qualifying and converting for your 340B program. We rely on data after the scripts have been filled to go into those magic algorithms black boxes created by people that neither provider patient care or fill prescriptions in the hopes that something pops out the other side as qualified. Let me let you in on a little secret: A pharmacy’s intake procedures can severally impact the way data is inputted at intake of a script. The PBM will adjudicate the claim whether the provider address is the one written on the script from a qualified site or that of their private practice address.

Did you know, outside of a couple of states, that a majority of specialty prescriptions are still faxed or sent through one off specialty pharmacy portals? What still drives this is the need to transmit the lab values and clinical notes required to complete specialty prior authorizations.

All pharmacies start with physically in-taking a script by entering a provider's NPI. What happens next? A list of addresses associated with that NPI appear and if your staff isn’t properly trained, there is no guarantee whether the address on the script is the actual one that gets selected or if they go with the (perhaps wrong) one at the top of the list and with a single pinkie stroke of that enter or tab key dooming your conversion. This as well as the data entry of all other script data elements are all entered during intake. After intake is completed, the script adjudicates and ships. But if you are only relying on a data feed from a switch or direct data feed established on your behalf by a third party, how would you know?

How Do We Fix This?

The short answer is: together. The longer version is that I believe it starts with the entity working directly with a specialty partner to put in place clear 340B program prescription intake procedures. Only a partner that has actually completed the intake process, actually filled a script, completed the prior authorization understands the process. Relying on third party partners alone who do not provide patient care or fulfill scripts will not fully understand how to identify a solution. It’s important to utilize coordinated messaging with your providers to ensure a top-down, bottom-up clear message to providers and pharmacy staff of what’s important and why it is important. This is key. Working with your specialty pharmacy partner to perform a regular prescribing gap analysis to quality check both the pharmacy’s and your third-party partner’s performance.

And now for a shameless plug. Let me tell you a little about BioPlus. We are a truly independent specialty pharmacy. There is no health plan, PBM, or pharmacy conglomerate pulling the strings in the back ground to carve out scripts based on secretly negotiated rebates or other behind the curtain dealings. BioPlus drives and grows our business through our high-quality customer and provider service. As we built out our 340B program, we took that mindset and applied it to covered entities. We are in the relationship directly with you, no strings attached. We convert or don’t convert, together.

Specialty is so different from retail that it is important to partner with an independent specialty pharmacy that plays the game on your side (the covered entity), keeping your patients, and your providers at the center of their strategy. Choose a specialty pharmacy that is willing to develop intake procedures and be open and honest about their processes and procedures that help you maximize conversion, not one that will hide behind smoke and mirrors. Pick up the phone and talk to whoever your contracted specialty pharmacy is. If they can’t or don’t want to help you, then I suggest you give us a call because we can help.