Driving Transparency to 340B Rebate Exclusions

A health plan was losing rebate dollars from improperly categorized claims. PSG’s rebate monitoring solution helped confirm rebate eligibility and recoup millions for the client.

The Challenge

The 340B Program is a federal initiative enabling certain hospitals and clinics to purchase medications at a discount. Pharmaceutical manufacturers have limited visibility into what claims were purchased at the 340B discounted price and in response have dramatically increased the quantity of claims excluded from rebates to payers. Payers are often in the dark about the appropriateness and accuracy of these exclusions, which can result in a meaningful impact on the plan’s financial performance.

A health plan was challenged with a high percentage of claims flagged as 340B by the PBM and excluded from rebates. The plan had limited leverage with no clear way to validate or dispute those decisions and needed a reliable, data-driven approach to confirm which exclusions were appropriate and recover lost rebate value.

PSG’s Supporting Services

Artemetrx: An integrated platform that transforms data into intelligence, driving improved management of drug spend and trend across both the pharmacy and medical benefits.

Artemetrx Rebate Monitor: Designed to protect your financial interests by accelerating the identification of variances between expected and received rebates.

Learn More

Rebate value can be lost when claims are excluded without transparency or validation. Download the case study to learn how you can leverage analytics and expert support to identify errors, challenge exclusions, and protect rebate performance.