CHA News Article

Medicare Advantage Plans That Contract With Hospitals Can Negotiate 340B Rates
Non-contract hospitals still subject to 340B cuts

The Centers for Medicare & Medicaid Services (CMS) has updated its frequently asked questions on the billing requirements under the new 340B Drug Pricing Program payment policy. Finalized in the calendar year 2018 outpatient prospective payment system (OPPS) final rule, the policy went into effect Jan. 1.

The update, dated April 2, includes only new information on how Medicare Advantage plans are impacted by the new 340B Drug Pricing Program payment policy. Medicare Advantage plans that contract directly with hospitals can negotiate the rates they pay providers for 340B drugs, and CMS cannot interfere in the payment rates. However, hospitals that do not contract with Medicare Advantage plans are still subject to the rate outlined in the OPPS final rule, which reduced reimbursement from average sales price plus 6 percent to average sales price minus 22.5 percent.