340B manufacturer restrictions

January 25, 2023

The 340B Drug Discount Program is a U.S. federal government program created in 1992 that requires drug manufacturers to provide outpatient drugs to eligible health care organizations and covered entities at significantly reduced prices.

Beginning in 2020, some drug manufacturers began restricting 340B discounts when contract pharmacies, such as Walgreens, CVS, or Accredo are used. To regain 340B pricing, most of these manufacturers are requiring covered entities to submit 340B claims data to an organization contracted by pharma that matches this data up with rebate claim data to identify and prevent rebate payments on 340B claims.

Here is an overview document that provides further detail into 340B manufacturer restrictions and how they may impact health plans. Parts of this document were presented at the Jan. 18 Executive Advisory Counsel (EAC) meeting. The EAC includes representatives from all Prime owner Blue plans and provides input on Prime’s business strategy.

Prime is aware of the potential impact of these restrictions on our clients, and we are working diligently to address your concerns. We will continue to communicate as we learn more.

There is no action required from Prime clients at this time.

If you have questions, please reach out to your Prime Client Engagement Representative.