Key Impacts on Pharmacies
Cash Flow Disruption:
Pharmacies must pay full Wholesale Acquisition Cost (WAC) for selected drugs upfront, then wait for rebates, creating immediate financial pressure.This differs from the old system where discounts were applied at purchase, freeing up capital.
Increased Administrative Burden:
New processes are needed for submitting rebate claims via platforms like HRSA's Beacon, requiring staff training and system integrations (EMR, TPA).Pharmacies must reconcile these rebates with Part D reimbursements and other program rules.
Financial Challenges for Smaller Pharmacies:
Smaller pharmacies may struggle with the upfront costs, potential credit limit issues, and managing higher non-payment risks.
Altered Profitability & Margins:
While rebates aim to lower costs, the shift changes how profits are calculated (higher revenue/cost of goods, lower margin %) and can impact dispensing spreads, potentially reducing overall 340B profits, notes
the Drug Channels blog.
Potential for Reduced Patient Access:
If pharmacies face significant financial strain or administrative hurdles, they may reduce services, affecting access to medications for vulnerable patients the program aims to serve.
Operational Changes:
Pharmacies need strong partnerships with manufacturers and wholesalers, plus robust automation, to manage the new workflows and data requirements.
The Pilot Program Context
This rebate model is part of a pilot program affecting specific high-cost drugs (like Eliquis, Farxiga, Jardiance) and signifies a potential long-term shift for the entire 340B program, reports
Advisory Board.
Manufacturers must provide support (like data platforms and technical help) to minimize burdens, but the transition remains complex, according to guidance from
the Health Resources and Services Administration.
