To make sure that the program is working as effectively as it could, the Prime Vendor Program was enabled to help participants facilitate their administrative work. Apexus was awarded the contract from HRSA to be the sole vendor for all participants. The prime vendor helps negotiate sub 340(b) pricing with drug manufacturers, increase distribution networks, and provides added-value services as well.
Although this program has shown to be very effective, it has also been plagued by fraud. A type of fraud that has been recurrent since 340(b) has been enacted is called “double dipping”. This occurs when the safety net provider dispenses the 340(b) medication to a qualifying patient but neglects to inform Medicaid. Therefore, Medicaid will reimburse the patient the standard AWP-17%+7.25. This amounts to a much greater reimbursement than it would be if it were claimed as a 340(b) patient, thus increasing the profit margin for the safety net hospital. There are currently some reforms taking place to help reduce this type of abuse.
It is very important for pharmacist to understand the different types of government programs available to the public in regards to healthcare. These programs can serve as opportunities for pharmacists to help implement our skill set.
Posted by Peyman Mahdavian, PharmD Candidate 2015