Many 340B organizations have no idea that they can actually expand, and expand signficantly their 340B program revenue, by capturing prescriptions written as a result of a referral.
In fact, I have seen programs grow as much as 25% by taking advantage of Referral Prescriptions.
If you ARE NOT currently capturing Referral prescriptions, this is a great place to start your learning.
If you ARE currently capturing some level of Referral prescriptions, you are still in the right place. This will give you some tips on how to maximize that effort.
PS… if you want to bypass the full article and jump right to the “how do I do this”, check out the Conclusion.
What is a Referral Prescription?
A prescription in the context of 340B programs that is a “referral prescription” is one written by a provider that you may have a relationship with because you refer your patients to them.
Simplest example are specialists versus primary care.
You may refer all of your patients to a specific cardiologist clinic for care because they specialize in cardiology.
But you may see the patient in your clinic routinely, and your providers write most of the prescriptions for the patient. And you keep a medical record of this patient and follow them long-term.
Compliance ingredients you need
The key ingredients to ensuring you are complying with 340B when it comes to referral prescriptions are straightforward.
First, you need to clearly articulate your definition of a patient in your policy and procedure. You should articulate that you include prescriptions captured “as a result of a referral” in your policy and procedure.
I personally, like to stick with the basic HRSA definition as written by Apexus, which is to say, the patient is yours if you have a medical record of care, and the provider has a relationship with your organization.
Here is a more detailed description and the actual definition if your ready for nap today.
Secondly, I like to incorporate what specific elements of documentation I expect to be in my medical record to ensure I am complying when capturing referral prescriptions.
There are two, common pieces of documentation you should consider.
First a referral order out. This means if I audit your EHR, I can clearly see that you referred a patient to the specialty which triggered the writing of the prescription.
Next, consult notes back in from the referral specialist. Alternatively, you could consider a request for Consult notes. Reality of documentation between providers is, you can ask for the notes to coordinate care, but you don’t always get them back.
If you are new to Referral Prescriptions, these companies are awesome
There are currently two companies that I would deem to be experts in this particular area of 340B. I’ve had the great fortune of working with both of these companies as a consultant.
The first company is par8o, out of Boston Massachusetts.
par8o specializes in Referral Management and collection of 340B prescriptions compliantly. They are the only strategic partner in the industry currently working alongside of Walgreens. The people there are amazing.
The second company is Rx Solution Partners out of Scottsdale Arizona. Rx Solutions Partners is comprised of long-tenured industry experts in 340B. Their backgrounds are heavily laden in auditing, compliance, and implementations fo 340B programs.
They work with pretty much any 340B third-party software out there.
Referral prescriptions offer a new method for many people participating in 340B, to capture additional revenue for their programs. I’ve written about several others, so you should check out the rest of the articles about building better 340B programs.
This particular area of 340B tends to be confusing for a lot of people and does require certain documentation steps and processes.
There are a couple of companies out there that are experts in this particular area of 340B and you should check them out if you are considering getting started.
Send me a message or a comment and I can put you in touch with some awesome resources.