If you’ve been tasked with helping to manage your in-house pharmacy’s 340B Drug Pricing Program, then encouraging provider colleagues to use your pharmacy for the majority of their 340B-eligible patients is an effective way to increase 340B revenue, experts noted at APhA2025, in Nashville, Tenn.
“I am a big believer in tracking where our prescriptions are going,” said Andrew Lewandowski, PharmD, the director of pharmacy for Canyonlands Healthcare in Arizona and Nevada. “[Providers have] freedom of choice,” so be ready to make the case for why your in-house pharmacy is their best option, he stressed.
If your tracking data show that a provider rarely uses the in-house pharmacy, then Dr. Lewandowski will meet with them to understand why. Sometimes it is a matter of education; the provider does not know that the in-house pharmacy works with numerous insurance plans, and so had been sending patients to other pharmacies mainly for that reason.
“It’s a matter of reassuring that we can work with their patients, and then they start sending more prescriptions our way,” Dr. Lewandowski said. The in-house fill rate will never be 100%; sometimes an insurer will require mail-order fulfillment or prescriptions through a specialty pharmacy. His target is that every Canyonlands provider routes 50% or more of prescriptions in-house. If a provider goes elsewhere because the preferred medication is not in-house, then Dr. Lewandowski will use this information to boost his formulary as much as possible.
Canyonlands is a federally qualified health center that treats people regardless of their ability to pay, using insurance benefits if they have them but not as a requirement. Savings from 340B drug purchases help fund this mission. The more that its providers route prescriptions in-house, Dr. Lewandowski said, the greater the 340B revenue that Canyonlands is likely to receive.
One point Dr. Lewandowski makes with providers, in addition to the variety of insurance plans covered, is convenience. If someone can fill prescriptions at the same time they see their physician, that’s simpler than traveling elsewhere to get a medication. There are also patient care benefits to filling prescriptions in-house, Dr. Lewandowski noted.
“Now these patients are being taken care of in a collaborative model. As pharmacists, we have more access to patient records,” including lab results that are not usually included in prescription records, Dr. Lewandowski said. The pharmacist can analyze lab results to, for instance, suggest dosing changes or potentially a new medication altogether.
“The line of communication is now direct. The pharmacy is often attached to the clinic, or the provider is a phone call away,” he said.
However, the 340B program faces headwinds, Dr. Lewandowski noted. “Manufacturers are changing the eligibility rules,” he said, such as reducing the number of contract pharmacies that can fill a 340B prescription. The same drugs are in the 340B program as before, he added, but with tighter access controls designed to reduce 340B discounts that manufacturers pay. Manufacturers note that some 340B entities do not funnel these discounts back into patient care, requiring stricter rules.
Some manufacturers’ actions have sought to rein in the 340B program by putting limits on contract pharmacies’ participation. Fortunately, the program has its champions in Congress, including Sen. John Thune (R-S.D.), who is a sponsor of the SUSTAIN 340B Act, which among other changes would ensure hospital access to discounted drugs through community and specialty contract pharmacies (bit.ly/3GS2Wge-PPN). (The draft bill was expected to be introduced in early 2025, but the timing has been delayed.)
In the meantime, Dr. Lewandowski said in-house pharmacies, such as Canyonlands, are operating as they always have. This stability allows pursuing greater 340B revenue in the ways that he proposed at the APhA meeting.
Even though he is not directly affected by what happens at contract pharmacies, Dr. Lewandowski worries that the ultimate effect will be reduced patient access to 340B medications. He called for pharmacist advocacy to protect current 340B arrangements in their states.
Growth Despite Uncertainty
“We work with a lot of health systems on implementing ways to keep more of their care in-house because that’s one of the best defensive moves health systems can make right now,” regardless of how 340B evolves, said Dave Hager, PharmD, FASHP, a managing director at Visante, who is on the editorial advisory board for Pharmacy Practice News.
“Keeping care local is the right thing to do from a patient perspective. It makes providers happy because usually they get better service for their patients from their own health system, it’s more transparent and it’s better financially,” Dr. Hager said, adding that this strategy also gives health systems new revenue to expand services.
There’s little operational downside from bringing more pharmacy business in-house, Dr. Hager noted, even if at first blush this seems to require significantly more staff or overhead. “The margin from new ambulatory pharmacy services, particularly specialty pharmacy and infusion services, is more than sufficient to cover any additional operating expense to expand services. The return on investment is so strong,” he said.
The advice for safety net health systems to fill more 340B prescriptions in-house is time-honored; this necessarily generates more revenue than if patients fulfill prescriptions elsewhere. But the possibility of drug manufacturers switching to providing 340B medications to facilities via a “rebate model” looms in the background. Under this approach, health systems would pay the full price for 340B medications first, and then receive a rebate later as their discount. Right now, 340B covered entities obtain discounts on an ongoing basis, and do not pay full cost for medications covered by the program.
“Some federally qualified health centers see this as an existential threat, arguing they do not have enough cash on hand to pay full price first,” Dr. Hager said. As of now, the federal Health Resources and Services Administration does not permit 340B program rebates, he noted.
The sources reported no relevant financial disclosures beyond their stated employment.
This article is from the June 2025 print issue.