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August 6, 2013  
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Murer Consultants, Inc. 

Principals

 

Cherilyn G. Murer, JD, CRA 

President/CEO 

cmurer@murer.com

 

Michael A. Murer, JD 

Executive Vice President 

mmurer@murer.com

 

Lyndean L. Brick, JD

Senior Vice President 

lbrick@murer.com

  

58 North Chicago Street

7th Floor

Joliet, Illinois 60432

(815) 727-3355

Fax:  (815) 727-3360  

  340B Deadline Looming -  

Are you Compliant with the  

GPO Prohibition?  


Please be advised that a critical 340B-related deadline is rapidly approaching on August 7, 2013.  If you are unsure if your facility is currently in compliance, we urge you to call us to discuss before the August 7, 2013 deadline passes.

 

As noted in Murer's recent 340B client advisory, the Office of Pharmacy Affairs ("OPA") clarified its position and policy relative to the Group Purchasing Organization ("GPO") Prohibition.  OPA's February 2013 clarification stated that 340B-enrolled disproportionate share, children's, and freestanding cancer hospitals cannot purchase "covered outpatient drugs" from a GPO account, and all original 340B drug purchases in a virtual inventory environment should be made off of a non-GPO account, such as a wholesale acquisition account ("WAC").  OPA granted providers until August 7, 2013 to make any necessary adjustments to internal policies and practices to ensure compliance with the GPO Policy Statement.  No extensions will be granted.  Failure to comply may result in removal from the 340B program.
WAC Account Drug Purchases

The following are examples of drugs that must be purchased from a WAC account:

  1. Medicaid drugs if the hospital does not provide 340B drugs to Medicaid patients (i.e. carve-out facility);
  2. Drugs that are provided to patients that do not meet OPA's patient definition (e.g. patient seen in a private physician office);
  3. Drugs that are not available at 340B pricing.

Below is a tool that Murer developed to assist providers with their GPO Prohibition compliance assessments.  We urge you to assess and re-assess compliance since running afoul of the GPO Policy Statement can result in termination. 

.

Drug Purchasing and Billing Matrix by Payor / Patient Status

© Murer Consultants, Inc. 2013  

 

 

Payor/

Setting

 

Inpatient

 

Mixed Use Setting

(e.g. ED)

340B Eligible Outpatient

340B  

Rate Unavailable

 

In-House Retail Pharmacy

Medicare

 

 

 

 

 

Billed At:

Group Purchasing

Organization 

(GPO)

 

 

Usual and Customary

("U + C")

Inpatient: GPO

340B Eligible Outpatient:  340B

Non-340B Outpatient:  WAC

 

U + C

 340B

 

 

 

 

 

 U + C

Wholesale

Acquisition

Account 

(WAC)

 

 

  U + C

  340B OR WAC for drugs unavailable at 340B rates

  

 

U + C

  Medicaid

(Carve In)

  

 

 

 

Billed At:

  GPO

 

 

 

 

 

U + C

Inpatient: GPO

340B Eligible Outpatient:  340B

Non-340B Outpatient:  WAC

 

U + C (Inpatient);

Actual Acquisition Cost (AAC) (Outpatient); OR

U + C if state does  

not require AAC billing

   340B

 

 

 

 

 

  AAC; OR

U + C if state does not require AAC billing

   WAC

 

 

 

 

 

AAC; OR

U + C if state does not require AAC billing

  340B OR WAC for drugs unavailable at 340B rates

 

 

AAC; OR

U + C if state does not require AAC billing

  Medicaid

(Carve Out, if state permits)

Billed At:

  GPO

 

 

U + C

Inpatient: GPO

Outpatient:  WAC

 

U + C

  WAC

 

 

U + C

   WAC

 

 

U + C

   WAC

 

 

U + C

  Private Payer

 

 

 

 

 

Billed At:

  GPO

 

 

 

 

 

U + C

Inpatient: GPO

340B Eligible Outpatient:  340B

Non-340B Outpatient:  WAC

 

U + C

  340B

 

 

 

 

 

U + C

WAC

 

 

 

 

 

U + C

340B OR WAC for drugs unavailable at 340B rates

 

 

 

U + C

Self-Pay

 

 

 

 

 

Billed At:

GPO

 

 

 

 

 

U + C

Inpatient: GPO

340B Eligible Outpatient:  340B

Non-340B Outpatient:  WAC

 

Provider discretion

  340B

 

 

 

 

 

Provider discretion

WAC

 

 

 

 

 

Provider discretion

340B OR WAC for drugs unavailable at 340B rates

 

 

 

Provider discretion

   Charity

 

 

 

 

 

Billed At:

GPO

 

 

 

 

 

U + C

Inpatient: GPO

340B Eligible Outpatient:  340B

Non-340B Outpatient:  WAC

 

Provider discretion

340B

 

 

 

 

 

Provider discretion

WAC

 

 

 

 

 

Provider discretion

340B OR WAC for drugs unavailable at 340B rates

 

 

 

Provider discretion

 

 

The professionals at Murer Consultants have extensive experience in all facets of the 340B program. Murer is available to assess your facility's compliance with the GPO Policy Statement and recommend changes to ensure compliance. If you would like more information, please contact Murer by phone at (815) 727-3355 or by email at mmurer.com

 

We would be happy to assist you with any of our broad consulting services or whenever you have any questions, comments or concerns.

  

Murer Consultants