The 340B discount can be challenging to navigate if one doesn’t understand how it works and whether or not they are eligible to claim the rebate. Both the state and the covered entity are eligible for the discount, however only one can receive the reimbursement.
CMS released some guidance to assist states with the 340B duplicate discount.
A common question has recently caused waves in the 340B community; what happens when “a Medicaid [patient] is prescribed a drug that is going to be dispensed from a 340B covered entity (or an affiliated pharmacy)? Does the State Medicaid plan get the rebate or does the covered entity get the opportunity to acquire the drug at the 340B discount?” According to “the statue, the manufacturer doesn’t have to pay twice: either the State gets the rebate or the covered entity gets the discount. Unless a State asserts [its] right to claim the rebate, the State and covered entity work it out between themselves.”
Do you have a clear process in place for declaring to Medicaid which 340B drugs were dispensed to acquire the rebate?
