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Untangling the Complexity of the 340B Drug Discount and Medicaid Drug Rebate Programs with Dr. Gavin Magaha Kalderos
Manage episode 445531795 series 2949197
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Dr. Gavin Magaha, Senior Director for External Affairs and Policy at Kalderos, describes the 340B drug discount program created in 1992 to help safety net healthcare providers obtain discounted drugs. Over time, this program has grown in complexity, and issues have arisen around duplicate discounts where Medicaid rebates are involved. The current 340B system makes it difficult for stakeholders to share data and lacks transparency. The Kalderos platform incorporates technology and AI and ML tools to address data sharing, validate claims, and prevent duplicate discounts.
Gavin explains, "Our platform primarily helps manufacturers. However, through the activities that we provide service for, we end up helping all stakeholders in a compliant manner or be more compliant with several different drug discount programs, primarily the intersection of the 340B and the Medicaid Drug Rebate programs. We work to help the states, the covered entities in the program, and the manufacturers. All come to a resolution of what's happening out there when you start looking at the data that's going through."
"Top of mind right now that you're hearing in the marketplace around 340B is the concept of who is a patient of a covered entity, what does it mean to be a patient of, whether it's a hospital or a federally qualified health center. The 340B statute is silent on how it defines who a patient is. A lot of the outpatient services that are taking place with hospitals are growing and reaching out into the communities to create more access to healthcare."
"And then you see this footprint of the hospitals growing and taking care of folks in the communities. And then how do you figure out who is a patient of a hospital, and are you a patient for just that one instance of care, or are you a patient of the hospital now in perpetuity? The question becomes, who's eligible for these 340B drugs? The statute, which again came around in the ’90s, doesn't really define who a patient is. It puts a burden and challenge out there for almost all stakeholders to comply with this policy."
#Kalderos #DrugDiscountManagement #340BDiscount #MedicaidDrugRebateProgram #DuplicativeClaims #CoveredEntities #NoncompliantDrugDiscounts #SafetynetProviders #DrugManufacturers
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