CMS Proposes Rule: 340B onus now on Medicaid MCOs

On May 26, 2015 the Centers for Medicare & Medicaid Services (CMS) proposed to make Medicaid managed care organizations (MCOs) responsible for establishing procedures to prevent 340B duplicate discounts in the managed Medicaid setting. In the proposed rule, CMS has clarified that the onus will fall solely on the MCO to create models to prevent duplicate discounts. While we laude CMS’s attempt to clarify the gray area around managing Medicaid and 340B that resulted from the passage of the ACA, it is our opinion that this proposed change will be problematic. We believe that the proposed rule increases potential risk of duplicate discounts, as MCOs have limited intelligence as to the 340B status of adjudicated claims. Furthermore, the significant majority of contract pharmacy platforms operate on a post-adjudication model – meaning the 340B status of the claim is not known until some weeks after the dispensing and adjudication of the claim.

The CMS website is accepting comments about this proposed rule until July 27.

For more information, please contact Jason Hardaway, Managing Partner, CiiTA, LLC.