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Many covered entities assume their contract pharmacies are handling everything on the 340B side — and in some cases, the pharmacies believe the same about the covered entity. The result? Missed savings, unflagged claims, duplicate discount risk, and a whole lot of finger-pointing when something breaks.
The truth is: not all contract pharmacies are created equal when it comes to 340B awareness. Some are proactive partners. Others are simply filling prescriptions without fully understanding the requirements, risks, or revenue opportunities tied to your program.
At RxTrail, we’ve seen how a simple check-in with your pharmacies can surface major gaps — and quickly open the door to better alignment and stronger performance.
Here are five questions every covered entity should be asking their contract pharmacy partners to ensure you're both protecting — and maximizing — your 340B program.
If your contract pharmacy is not correctly flagging Medicaid Managed Care (MCO) claims, you could:
What to listen for:
A pharmacy that understands how MCO plan IDs are flagged and can explain the logic they use in their system or TPA configuration.
Red flag:
“I think our TPA takes care of that.”
A common issue we see is pharmacies operating without a current encounter feed — meaning they can’t match prescriptions to 340B-eligible visits.
What to listen for:
A pharmacy that knows what data they need from you (prescriber lists, visit files, etc.) and confirms they get regular, successful feeds.
Red flag:
“We haven’t received a file in a while, but the claims still look fine.”
Every contract pharmacy has a set of rules that determine which prescriptions are eligible for 340B. But logic gets outdated fast — especially when providers change, carve-in decisions shift, or new sites come online.
What to listen for:
“We review logic with your team quarterly,” or “Here’s how we validate that new locations and prescribers are included.”
Red flag:
“We set it up when the contract started and haven’t had to change it.”
You can’t manage what you don’t measure. Your pharmacy should be able to show you:
What to listen for:
Regular reporting, dashboard access, or willingness to walk through performance metrics with your team.
Red flag:
“We don’t typically share that unless there’s an issue.”
Your contract pharmacies are an extension of your 340B program — but only if you treat the relationship as a collaborative partnership, not a plug-and-play arrangement.
By asking the right questions and opening a two-way dialogue, you’ll catch hidden issues, unlock missed revenue, and set the foundation for a stronger 340B strategy.
At RxTrail, we help covered entities bridge the gap between pharmacy partners, TPAs, and internal teams — making sure everyone is aligned on data, logic, and compliance.
Need help reviewing your contract pharmacy logic or building a stronger oversight process?
We’d be happy to walk through your current setup and identify quick wins to improve performance. Schedule a Call
