March 1, 2024
3 min read

Leveraging AI in 340B Auditing & Optimization

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Healthcare is undergoing a revolutionary transformation, thanks to the advancements in artificial intelligence (AI) and cloud computing. This combination is significantly enhancing efficiency and compliance, reaching unprecedented heights.

For providers and pharmacy operators, manual tasks and daily operations have been significantly impacted by AI, as it automates and improves the efficiency of these processes. This includes managing the 340B Drug Pricing Program, a critical federal initiative that improves patient care by offering covered entities who serve vulnerable populations the opportunity to purchase outpatient drugs at significantly reduced prices.

Innovative technology, like Plenful, is accelerating and simplifying the labor-intensive work associated with 340B program management, auditing, and savings identification and qualification.

With ongoing changes to 340B policies and procedures, it can be challenging to manage a compliant 340B program. In order to maintain eligibility and avoid financial penalties, providers must adhere to strict rules and requirements and pass regular audits from HRSA, the federal agency tasked with running the 340B program.

Alongside additional requirements, covered entities must:

  • Prevent diversion of 340B drugs to ineligible patients
  • Prevent duplicate discounts between the 340B program and Medicaid drug rebates
  • Be prepared for and respond to audits by the federal government or drug manufacturers

If a program is found to be out of compliance, covered entities will be subject to significant financial penalties, loss of eligibility, or suspension from the program. These negative outcomes harm both the covered entities and the patients that desperately rely on services funded by 340B discounts.

Managing a compliant 340B program often means working with one or more Third Party Administrators (TPAs). While TPAs enhance the value of a compliant program, it also introduces a challenge of disparate data, leading to increased complexity and manual workload for covered entities. Plenful's cloud-based solution, powered by AI, expedites and streamlines the management of the 340B program for healthcare providers.

First, Plenful ingests various real-time and static files from a variety of formats, including:

  • Excel documents
  • CSV files
  • PDF documentation
  • JSON data from API endpoints
  • HL7v2 messages

Plenful automatically converts this disparate data into an organized and standardized format, allowing for a 360° view of data feeds across multiple contract pharmacies, TPAs, and 340B eligible locations. Then, by leveraging machine learning and highly configurable rule-based logic, Plenful identifies potential savings opportunities and highlights the most valuable items for review.

Plenful also fulfills a critical aspect of 340B compliance - automating the manual work associated with auditing. Plenful’s platform is used by covered entities for both ongoing internal audits / opportunity analyses and in support of external audits by HRSA and other stakeholders.

By leveraging Plenful, covered entities can proactively identify errors, exceptions, and potential findings before an external audit takes place. Plenful’s platform also provides comprehensive data analytics and reporting capabilities. Covered entities can leverage these capabilities to assess program performance, identify opportunities, and make real-time, data-driven decisions.

By incorporating Plenful into a 340B program, covered entities gain a valuable tool for enhancing efficiency, driving compliance, and optimizing savings. Embracing the potential of artificial intelligence is critical to fully realizing the benefits of the 340B program and sustaining access to critical patient care programs. Plenful is dedicated to alleviating manual work in 340B operations, empowering teams to practice at the top of their license, and driving efficiency and enhanced patient care.

If you would like to explore how Plenful's innovative solutions can transform your experience with the 340B program, please reach out to our team!
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