Current through Vol. 42, No. 1, September 16, 2024
(a) The
340B Drug Discount Program is a drug-pricing program established under section
256b of Title 42 of the United States Code (U.S.C) under which a manufacturer
of covered outpatient drugs agrees that it will not charge a 340B covered
entity more than the 340B price for a 340B covered outpatient drug.
(b) Covered entities participating in the
340B Drug Discount Program will adhere to the following provisions outlined in
this Section and as defined in
42 U.S.C. §
256b. Covered entities must:
(1) Notify the OHCA Pharmacy Department in
writing within thirty (30) days of any changes in 340B Program participation,
as well as any changes in name, address, National Provider Identification
(NPI), SoonerCare Provider Number, etc.
(2) Maintain their status on the Health
Resources amp; Services Administration (HRSA) Medicaid Exclusion File (MEF) and
report any changes to the OHCA within thirty (30) days.
(3) Execute a contract addendum with the OHCA
in addition to their provider contract.
(c) To prevent a duplicate discount,
quarterly adjustments will be made to all pharmacy or medical claims for drugs
submitted by covered entities when billed using the registered SoonerCare
Provider Number on the MEF.
(1) All pharmacy
claims submitted by covered entities shall be adjusted by the 340B ceiling
price whether purchased through the 340B Program or otherwise.
(2) Medical claims submitted by covered
entities with procedure code modifiers indicating the use of the 340B purchased
drugs shall be adjusted by the 340B ceiling price. OHCA will adjust each claim
by subtracting the 340B ceiling price from the amount reimbursed and
multiplying the difference by the quantity submitted. OHCA will use the 340B
ceiling price applicable to the quarter in which the claim is paid. Medical
claims submitted by covered entities with a procedure code modifier indicating
the use of non 340B purchased drugs will not be adjusted by the 340B ceiling
price and will be submitted for federal rebates as required by CMS. Covered
entities are required to use an appropriate procedure code modifier on all
physician administered drug lines when submitting medical claims.
(3) If a 340B covered entity fails to pay
quarterly adjustments invoiced by OHCA within forty-five (45) days of receipt,
it may result in a debt to the State of Oklahoma subject to applicable interest
pursuant to prompt payment methodology at OAC
260:10-3-3.
(4) The quarterly adjustments invoiced,
including applicable interest, must be paid regardless of any disputes made by
the covered entity. If a covered entity fails to pay OHCA the adjustments
invoiced within forty-five (45) days of receipt, the adjustments invoiced and
applicable interest will be deducted from the facility's payment.
(d) 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 the OHCA, the contract
pharmacy, and the covered entity. These pharmacies will be subject to the
recovery process stated in this Section.
