340B Drug Discount Program
The 340B Drug Discount Program is a federal program requiring drug manufacturers participating in the Medicaid Drug Rebate Program to provide outpatient drugs to eligible health care organizations/covered entities at discounted prices. To receive these discounts, organizations must register with the Health Resources and Services Administration (HRSA) and meet & maintain certain requirements outlined by HRSA and the 340B Office of Pharmacy Affairs Information System (OPAIS).
Carving-in
When an eligible organization enrolls in the 340B program they must decide whether they will “carve-in” and use 340B purchased drugs for Medicaid members. Providers seeking to carve-in for Oklahoma Medicaid will be required to follow all federal and state requirements and should reach out to our offices at DrugRebateUnit@okhca.org.
Visit https://www.hrsa.gov/opa/program-requirements/index.html (HRSA Website) for all federal requirements.
State requirements
Covered entities must notify OHCA in writing within 30 days of any changes in 340B participation, as well as any changes in name, address, MPN (Medicaid provider number), etc.
The covered entity must maintain their status on the HRSA Medicaid exclusion file and report any changes to OHCA within 30 days.
Carved-in providers will participate in a shared savings with OHCA for 340B purchased drugs dispensed to members in our Traditional SoonerCare population, as well as those in our SoonerSelect population. Savings will be applied by MPN & Service Locations.
To prevent duplicate discounts in regards to the Medicaid Drug Rebate Program, all prescription drugs billed to Traditional Soonercare, or SoonerSelect plans, by 340B pharmacies will be considered 340B drugs whether purchased through the 340B program or otherwise.
Beginning 9/12/2022, SoonerCare will require carved-in, covered entities to differentiate between 340B purchased drugs and non 340B purchased drugs by using procedure code modifiers with physician administered drugs billed on outpatient/hospital claims. This requirement applies to claims submitted for Traditional SoonerCare services as well as SoonerSelect.
340B purchased drugs
- Medicare Part B crossover claims - modifiers JG or TB are to be used on 340B purchased drugs as indicated by Medicare.
- SoonerCare outpatient/hospital claims – modifiers JG or TB are to be used on all 340B purchased drugs.
Non 340B purchased drugs
- All outpatient/hospital claims – Modifier UD is to be used on all non 340B purchased drugs.
Outpatient/hospital claims billed to SoonerCare by carved-in 340B covered entities will have claim lines for CODs denied if one of these three modifiers is not present. This requirement will apply to claim lines with a date of service on or after 9/12/2022. All physician administered drug lines on medical claims identified as non 340B purchased drugs will be submitted to the manufacturer for Federal rebates.
To avoid disruptions in reimbursement, it is important that providers notify OHCA of carve-in and carve-out dates as soon as possible.
Contract pharmacies for covered entities may be permitted to bill drug products purchased under the 340B Drug Discount Program to the Oklahoma Medicaid Program when certain conditions are met and an agreement is in place between OHCA, the contract pharmacy and the covered entity. These pharmacies will be subject to the recovery process stated above.
Please reach out to DrugRebateUnit@okhca.org with any questions regarding the program.
