AHA urges Express Scripts to rescind 340B claims reporting policy

Drug prices
The American Hospital Association wants Express Scripts to pull a 340B claims reporting policy. (Getty/Tero Vesalainen)

The American Hospital Association (AHA) wants Express Scripts to rescind a policy that would require contract pharmacies to apply a unique code for claims under the 340B drug discount program.

Express Scripts said in an FAQ for providers that it has requested such reporting from its network pharmacies for several years, and it issued a notification in August 2020 that it was mandatory. The pharmacy benefit manager giant further updated the policy in January, notifying in-network pharmacies of additional ways to report 340B claims that would come into effect on March 1.

"This change was made in the spirit of greater transparency," Express Scripts wrote in the document (PDF). "It is not intended to lead to a change in reimbursements rates, network participation, or a pharmacy’s ability to service as a Contract Pharmacy for 340B Covered Entities."

Express Scripts said the reporting requirement would be applicable to all claims unless prohibited by law.

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In a letter to the PBM sent Tuesday, the AHA argues that because the 340B program has stringent government oversight, the policy "raises significant questions about Express Scripts' true motivations."

The organization added that compliance with the policy could add to the burden on providers already struggling as a result of COVID-19. Complying with the requirement requires significant investment in system upgrades and staff, the AHA said.

"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 AHA wrote.

We've reached out to Express Scripts and will update this story when we hear back.