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340B Audit Technician Practice: Drilling for the Data

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Presentation on theme: "340B Audit Technician Practice: Drilling for the Data"— Presentation transcript:

1 340B Audit Technician Practice: Drilling for the Data
Renee Duffield, CPhT Palmetto Health Columbia, SC

2 OBJECTIVE Describe the technician’s role in providing Quality Assurance for the 340B Drug Pricing Program.

3 Disclosure Statement I have nothing to disclose or conflicts of interest regarding the subject matter of this presentation.

4 Pre-Test What is 340B? A federal program. Discount drug program. A program to help support eligible patients. All of the above. What skills are needed by the technician to provide Quality Assurance for the 340B Drug Pricing Program?

5 Quick Overview of 340B 340B Drug Pricing Program
Section 340B of the Public Health Service Act 1992 Participating manufacturers sign a pharmaceutical pricing agreement with the Secretary of Health and Human Services. Manufacturers agree to limit the price they charge covered entities for covered outpatient drugs.

6 Quick Overview of 340B Health Resources and Services Administration (HRSA) Federal agency which increases access to organizations that help support patients who are underserved, underinsured, isolated, or medically eligible. Center for Medicaid and Medicare (CMS) CMS Audits: Program Integrity Assure no diversion of 340B drugs Eligibility of the Entity/Site Eligibility of the Patient Eligibility of the Prescriber Eligibility of Pharmacy Office of Pharmacy Affairs (OPA) OPA Database Entities, Child Sites, Contract Pharmacies

7 Perform Monthly Audits Export information from different databases
Technicians Role in Providing Quality Assurance for the 340B Drug Pricing Program Perform Monthly Audits Document in Excel spreadsheet Export information from different databases Hospital patient charts Hospital privileged prescribers Contract Pharmacy Vendors

8 Review Criteria to Qualify a Prescription
Technicians Role in Providing Quality Assurance for the 340B Drug Pricing Program Review Criteria to Qualify a Prescription Does the patient have an outpatient visit in a site listed in the OPA Database? Does the patient have a diagnosis related to the medication? Does the prescriber have privileges at the site listed in the OPA Database? Is the prescription documented in the patient’s chart? Is the Contract Pharmacy listed in the OPA Database?

9 Patient’s Chart

10 Self-Audit: Excel Worksheet
Patient Last Name Patient First Name DOB Rx Number Prescriber Verified Physician Name Fill NDC Contract RX Verified Drug Name Date Of Service Date Of Approval RX Child DX Qualify Comments 01/31/1951 Y "0" ADVAIR 01/02/2016 02/01/2016 Found under medication list VENTOLIN 01/04/2016 02/03/2016 10/23/1955 "2" JANUMET 01/05/2016 02/04/2016 Found Documentation/Clinical Summary ED 01/14/1956 PROAIR 01/08/2016 02/07/2016 N Cannot find a prescription 09/30/1955 LANTUS 01/12/2016 02/11/2016 Found Outpt./medications 02/20/1966 BENICAR 01/15/2016 01/19/2016 08/06/1964 SPIRVA 01/22/2016 02/21/2016 Found Outpt/medications/orders/charges Found Outpt./medications/orders/charges 06/04/1947 "3" ELIQUIS 01/23/2016 03/29/2016 Found Inpatient 01/12/1936 "4" SPIRIVA 01/24/2016 02/23/2016 Found Outpt/medications 07/18/1962 "1" DEXILANT 01/25/2016 02/24/2016 Cannot find a prescription 12/06/1936 "6" CRESTOR 01/26/2016 02/25/2016 Docum/Freetext Note/Pt. to see Dr in 2w 01/10/1957 01/30/2016 02/29/2016 Found Inpt/Orders/Medications 10/15/1966 No Physician Privileges

11 Review accuracy of OPA Database
Technician’s Role in Providing Quality Assurance for the 340B Drug Pricing Program Review accuracy of OPA Database Verify names and addresses Entity, Child Sites, Contract Pharmacies BOP Database; Contract Pharmacy Websites; Visits Participate in annual audits by outside auditors Participate in CMS audits

12 Post-Test 1. What is 340B? A federal program. Discount drug program.
A program to help support eligible patients. All of the above.

13 Post-Test 1. What is 340B? A federal program. Discount drug program.
A program to help support eligible patients. All of the above.

14 Post-Test 2. What skills are needed by the technician to provide Quality Assurance for the 340B Drug Pricing Program?

15 Skills Used by Technician in Providing Quality Assurance for the 340B Drug Pricing Program
Work with Different Computer Systems & Databases Hospital system; OPA Database; Third Party Vendors Database sorting and filing; 400 prescriptions or more Microsoft Office: Word, Excel Solve Problems/Work Independently Perseverance, Patience, and Acceptance Organize & Prioritize Tasks/Time Management Deadlines, Other duties (cross-coverage) Communicate Read/Participate in HRSA webinars: interpretations of regulations Prepare reports Discuss audit process with Director & auditors

16 RESOURCES Health Resources and Services Administration (HRSA) Office of Pharmacy Affairs (OPA) Apexus


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