The MTF as a Toothless Monstrosity and the Case for 340B Cooperation
Depending on the National Drug Code, 4 of the “year 1” #Medicare “fair prices” are not as low as the #340B price, but 6 MFPs are lower than the 340B price. What that means is that both covered entities and manufacturers have something to lose if they don’t cooperate w/ each other. Because the Medicare Transaction Facilitator is a toothless monstrosity, it can’t provide a way forward.
When the 340B price is HIGHER than the MFP, CEs have a vested interest in getting that lower MFP price. For the CE to get it, w/out inordinate delay, the manu is going to have to know whether it already gave or did not give the 340B price.
The manufacturer needs to know about the 340B price EITHER WAY. If it was given, it matters because the drug maker is only responsible for giving the difference between the initial price and the MFP.
If it wasn’t given, the drug maker needs to know the actual price of the non-340B sale, so that it can get that purchaser all the way down to the MFP, with confidence.
The manufacturer, without additional data, is going to naturally assume that a CE got the 340B price, potentially shortchanging the CE, unless we can break through the data impasse.
When the 340B price is LOWER than the MFP, but the CE bought from its non-340B account, the CE will also want that MFP. But, in that circumstance, the manu will be skeptical it has not already given the lower 340B price, excusing it from any obligation to give the MFP w/out more data. The potential for inordinate delay is clear.
The MTF is going to be useless in addressing these issues; it’s a toothless monstrosity.
W/out an N1 identifier mandate, the MTF won’t have the data to determine the correct price, and manus will argue they have a reasonable basis to dispute the MFP.
Even those few CEs that use the N1 will encounter problems, b/c, w/out a mandate, manus will be uncertain whether the identifier is being used consistently.
It’s a train wreck.
The only way thru this impasse is to cooperate.
I appreciate that will not come easily to either side. Both sides are distrustful. Both sides are angry.
But the only way forward is cooperation.
For me, that’s a direct discount model, in which CEs share the required data with/ the manu in exchange for an expedited payment.
The system has to address CE concerns. It should have short, strict timelines, at least as good as the 14 day MTF standard, and I would hope substantially better. I think 7 days is doable.
It should take TPA feeds so that data submission is as easy as possible.
It should not wait for “accumulations”. CEs should get their $ as soon as possible.
The $ should also go directly to the CE; no middleman should be able to play the float with CE $.
We can make this work. We can…if we cooperate w/ each other.
#lifesciences #biotech #drugpricing #marketaccess Health Resources and Services Administration (HRSAgov), HHS #HRSA #CMS