Express Scripts has implemented a new policy for reporting 340B claims, and the American Hospital Association is urging the pharmacy benefit manager to withdraw it, arguing it will create "substantial burden and cost" for the U.S. healthcare system.
The policy requires 340B hospitals that use contract pharmacies to apply a new code for all 340B claims. Express Scripts, one of the largest PBMs in the country, justified the requirement by saying it will increase transparency into the 340B program.
But the hospital association said in a June 15 letter addressed to Amy Bricker, president of Express Scripts, that the action is a "major overreach for a pharmacy benefit manager that has no defined legislative or regulatory role in the 340B program."
"Given the existing robust federal oversight of the 340B program, it raises significant questions about Express Scripts' true motivations," the association wrote.
The association said complying with the policy isn't as simple as adding a new code to a claim. It will require "significant" investments in information system upgrades, additional staffing and other resources, "at a time when such resources are limited due to the ongoing COVID-19 pandemic."
The association is requesting Express Scripts withdraw the policy immediately.
"We question why a PBM has appointed itself to police a federal program to which it is not a party and which will bring no benefit to either the 340B program or the millions of patients who rely on the program's benefits," the association said.
Express Scripts declined to comment to Becker's Hospital Review, but pointed to a Frequently Asked Questions document, which states the policy is not new and doesn't change pharmacies' reimbursements.
Read the full letter here.