DIR Fees, DIR Fees 2024, Independent Pharmacy Accounting, Pharmacy Growth

The Bottom Line Pharmacy Podcast: Overcoming Challenges with 340B Contracts Featuring Amanda Gaddy

Data from the NCPA shows that there are over 17,000 health care facilities that are eligible to participate in 340B programs, with many of these facilities being located in rural America.

This can give your pharmacy a competitive advantage and make your pharmacy the healthcare hub of your community by providing care to an underserved patient population.

But how do you know if this is an area worth exploring? In this episode of The Bottom Line Pharmacy Podcast, Scotty Sykes, CPA, CFP and Bonnie Bond, CPA sit down with Amanda Gaddy, R. Ph. Co-Founder and COO of Secure340B to dive deep into 340B contracts, legislative updates, how DIR fees are affecting contracts, and the impact it can have on your bottom line!

Join the discussion with us!

The Bottom Line Pharmacy Podcast is your regular dose of pharmacy CPA advice to fuel your bottom line, featuring pharmacists, key vendors, and other innovators.

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More resources about this topic:  

Resource – Explore 340B Opportunities

Podcast – Understanding 340B Contracts

Webinar – How to Thrive in the 340B Space

If you prefer to read this content, the video transcript is below:

Bonnie Bond: It’s been a day. I got a flat tire this morning, Amanda, of which I changed myself. 

Amanda Gaddy: Oh no, and it’s only 9:45 Yay, girl power. That’s awesome. 

Scotty Sykes: On the side of the road. 

Bonnie Bond: On the side of the road, not at my house on the cement. Yeah, on the side of the road. 

Amanda Gaddy: Oh wow. 

Scotty Sykes: What was the biggest challenge of changing that tire? 

Bonnie Bond: Getting the lug nuts loosened. My husband, I called him, he was an hour away and he’s like, I can’t. He’s like, you’re just gonna have to call somebody or whatever. He’s like, I don’t think you can do it. And then I was like, mm. 

Amanda Gaddy: Oh, don’t say I can’t do it. 

Bonnie Bond: I was like, why, why, why don’t you think I can do it? He’s like, I just don’t, I just don’t think you’ll be able to do it. So I was like, I gotta go. So I sent him a picture of it changed. Then he told me it looked a little crooked, but I made it here, so.  

Amanda Gaddy: It got through there. You made it. 

Scotty Sykes: It worked. 

Scotty Sykes: All right, everybody, welcome to another episode of The Bottom Line Pharmacy Podcast. Today we have Amanda Gaddy, Co-founder of Secure340B, been a regular on our podcast and webinars over the years. So welcome back, Amanda, and we’re glad to have you. 

Bonnie Bond: Always love having Amanda. 

Amanda Gaddy: I’m glad to be here. 

Scotty Sykes: Always an exciting and interesting topic, 340B. We have a lot of clients. We see a lot of pharmacies out there with 340B. And… 

Bonnie Bond: We see a lot of clients that ask us, Scotty, about 340B they don’t understand it at all. 

Scotty Sykes: Well, it’s hard to understand. And yeah. 

Bonnie Bond: Well, you know, they’re like what’s that? 

Scotty Sykes: And so, Amanda, why don’t you kind of just give us a background on 340B, you know, what it is, what opportunities are there for pharmacies in this space and, you know, where you see this going into the future. And we’ll just start it off there. 

Amanda Gaddy: Sure, so with 340B, it’s a program that was established in 1992. And basically, it allows certain entities like not – for – profit hospitals and clinics at QHCs to partner with local pharmacies, specialty pharmacies, to provide medications at a discount to patients who don’t have insurance, but it also will provide a revenue stream to help, especially some of these rural hospitals. And the way that works is for the patients who have insurance, the pharmacy bills the claim just like normal. They’re reimbursed just like normal from their contracted rate with that PBM. The patient pays the exact same thing, but the pharmacy keeps a portion of that as their fee, their dispensing fee, and basically pays the covered entity for the remaining amount. They write a check, do transfer. So, the hospital or the clinic, they’re getting revenue in that they didn’t have otherwise, and they’re paying for the cost of the drug to be sent back to the pharmacy. But the cost of the drugs are way less than what the pharmacy’s paying for it. So, if you think about like an insulin, the pharmacy may be paying $500 for it, reimbursed based on that amount, but then the covered entity may be able to keep that revenue and then pay 10 cents for it. And so that’s where the revenue comes from. So that the covered entities can use that revenue to maybe offer more services they couldn’t provide otherwise and just increase access to medications for those patients in the community. For the pharmacy, and this is why it’s so important to understand your business, the dispensing fee is the margin for a claim. And so, when it’s structured correctly, a pharmacy will never lose money on a prescription. Let’s say it’s a brand prescription and they have negotiated a fee of 25 % of the total paid amount. That means they’re making 25% every time they fill a brand product. So, you can see, especially in the world today, when they’re adjudicating a claim and it’s going through and they’re showing a $10, $50 loss, but if they know it’s 340B, it could be like a $250. So we say, “hey, look we’re gonna get all your dispensing data and we’re gonna roll it up and say, okay, you’re dispensing, your true margin for this claim is your dispensing fee.” And so, we’re basically giving the pharmacy actual records so that they know exactly how much they’re making. It’s not fake because it’s showing a loss in their system and it’s really a gain. We’re able to roll it up by household to say, “okay, this household is either overall a winner or a loser.” We’re doing it by NDC to show Ozempic, for example. You know, they fill 10 prescriptions, 6 are 340B, 4 are not. Overall, they’re making money on Ozempic. And so, it’s like, it’s sort of like we don’t want them to throw the baby out with the bathwater, but they can’t do it if they don’t have the analytics and overlay that information to see. 

Bonnie Bond: And looking at all this information as a whole has gotten really big. It’s mind blowing to me, you know, to be a pharmacist and have to actually start pulling this information. You know, we just, I just had was on a call this morning with someone who was struggling with that. She’s a startup. And so, she’s like, I don’t want to turn people away already because I’m trying to, that’s what she’s trying to do is drive business in. So, she’s trying to do that. She’s trying to look at not just the one drug yes, I am losing money on this, but I’m trying to look at the family unit as a whole to make sure at least I’m positive on that so I can keep them. It’s just for me in my mind, it’s just a lot to try to pull all that. 

Amanda Gaddy: It is a lot and these community pharmacies, they care about their patients. They’ve been seeing Mrs. Smith for however many years, and they don’t want to turn them away.  

Bonnie Bond: Right. 

Amanda Gaddy: And so, I mean, it becomes a huge business decision. And like with 340B, it’s a little bit more complicated because again, you keep just running a report out of your pharmacy management system and have that data available that really shows you the true picture. 

Scotty Sykes: And with this, if you’re looking to get into 340B right, you can’t just sign up for 340B. I mean, you have to, the contracts are different. You have to understand the contract, how it’s structured, what that dispensing fee is. It’s not just a standard cookie cutter, right? Everything’s different.  

Amanda Gaddy: Yeah, they’re all different 

Scotty Sykes: All of them are different. Yep.  

Amanda Gaddy: And you have to take into consideration other things like wholesaler rebates on all of your purchases. You know, what’s this going to do to your percentages that you, your targets that you have to meet. And that’s one reason we don’t like to do generics in the program, because if you pull a bunch of generics out of the retail purchases and put them on a 340B account, it can skew your rebates for everything. So, there’s so much to it, but I can, I mean, overall, it’s not for everybody. But if there’s an opportunity and it’s structured correctly and monitored, y’all it can be a game changer. It really can. 

Bonnie Bond: Yeah, we see it for sure. 

Scotty Sykes: We do have some 340B pharmacies who are doing very well. How do you know, how does a pharmacy owner know if there is an opportunity? Is it just going and knocking on doors in the covered entity space? How do they do that? 

Amanda Gaddy: So they’ll go to, it’s 340BOPAIS.HRSA.gov There’s a website and you go on there and you can simply go on and search. You can search by zip code, city and then you can click on if there are any 340B opportunities and actually see if they already have contract pharmacies, but it has the contact information for the current entity. So, what I like to say is, you know, especially in rural America, this should be a partnership. Same patients go into the clinic and the hospital that’s coming to the pharmacy and have a conversation. I mean, these pharmacies are doing so much more than a chain is doing as far as like, you know, med sync, packaging, delivery, all those things.  

Scotty Sykes: Actually…caring for the patient. 

Amanda Gaddy: Yeah, right. But all those things help the covered entity as well. So, I like to say go in at first and just talk about how the services that you’re providing and then say, you know, would it make sense for us to explore the opportunity of being a 340B contract pharmacy? And that’s really where we come in. We can do analytics. We get the dispensing data from the pharmacy. We take the MPLS from the covered entity and we show, okay, if you would have been a 340B contract pharmacy last quarter, this is what it would mean to you. This is what it would mean to the covered entity. And we also are able to apply those manufacturer restrictions. So I think there are like 31 manufacturers who now restrict contract pharmacies to just one. 

Scotty Sykes: Yeah. So, talk about that, that manufacturer restrictions. I know that’s kind of grown the past year or two, you know, what are the challenges with that now and 340B? 

Amanda Gaddy: Yeah, I mean, it’s had a lot of challenges, especially for the uninsured programs, the patients who don’t have insurance. And now if they can’t get to that one pharmacy, they’re not able to get their medication. But it’s cut down on what has been, what can qualify significantly. I mean, for hospitals, I think it’s 31 manufacturers. There has been some positive legislation that has passed in Arkansas, Louisiana and West Virginia. It was obviously appealed. In Arkansas, it went to the Eighth Circuit, which covers a region, and they upheld the state law. And so, we’re seeing manufacturers restore pricing to multiple contract pharmacies in those areas. So that’s a positive. Now, if the other states in that Eighth Circuit, if they pass legislation as well at a state level, then they probably would be able to, you know, use that ruling and get those manufacturers to be required to ship back to multiple contract pharmacies. 

Bonnie Bond: Yeah. 

Scotty Sykes: That’s quite a precedent set there at the eighth circuit there. 

Amanda Gaddy: It really is. 

Scotty Sykes: Bonnie, I’m switched back to coffee, by the way. 

Bonnie Bond: No more tea. 

Scotty Sykes: Kind of switched off the tea. You know, we have a lot of clients who are on 340B, they do very well with it. Some of them kind of dip their toe into it and it doesn’t make quite, it’s not what it could be. Other clients… 

Bonnie Bond: Or Scotty, we have people that get into it and they don’t have anyone look over their contract. And so we have seen contracts that are not… great. 

Scotty Sykes: Well, that, we do see that quite a bit. 

Amanda Gaddy: Well, and I wanted to bring up too, sometimes they think that if they’re in a contract, they can’t renegotiate it within a certain time period. And I always say, let’s go back to this is a partnership. And we’ve had a lot of success going back and showing the data to the covered entity and having contracts changed outside of those contract terms. Because if you can show that the pharmacy is losing money, like, come on, like… 

Bonnie Bond: Right. 

Amanda Gaddy: Hospital clinic, they don’t want them. A lot of times people set up these contracts, they don’t even know the impact. You know, they’ll just sign it thinking, I’m just going to be a partner with this clinic and have no idea. Now, it’s not as bad now that DIR fees are at point of sale. But if you were on a flat fee before and you were keeping like $40 and then you had a 10 % DIR fee later, they were really seeing some financial cash flow issues. And so… 

Scotty Sykes: So, I was going to ask you about that, that DIR fee change and how that’s impacting that 340B because a lot of contracts didn’t consider that DIR fee previously. 

Amanda Gaddy: Well, it’s interesting because the way that it’s the language of some of the agreements would say like it would be like a percent of total amount collected, but some of the PSAOs would withhold that money. So adjudicated claim, it comes back and says pharmacy is going to be paid $100. They would actually only receive, let’s say $90 because they’re holding that money. So they’re not really collecting it. And so, that’s been a challenge to how do you interpret collected. But it’s actually, if pharmacies are on a percent based dispensing fee, it’s actually helping them now. Because before, let’s say they were getting 20%, then they were paying 10 % after that DIR fees, right? Now they’re getting maybe getting paid a lower amount at point of sale, but they’re keeping that whole 20%. Does that make sense?  

Bonnie Bond: Yeah, that makes sense. Mm -hmm. 

Scotty Sykes: Yeah. Yeah. 

Amanda Gaddy: So, from an accounting standpoint, it’s a little bit cleaner to understand. 

Bonnie Bond: Yeah, that makes a lot of sense. What’s new with Secure 340B with you guys? Anything new going on? 

Amanda Gaddy: Yep, so we still have our Navigator program and that is where on a quarterly basis we take all the dispensing data, I mean all of their 340B data, all their purchases, and we want to compare what they’re making with 340B to what they would make without 340B. We’re also tracking inventory, how many packages are they being invoiced for, how many are they receiving, and what is still due to them. 

Bonnie Bond: Interesting. 

Amanda Gaddy: And then we, during this account management, so we find an issue, then we work with the TPA and we help resolve it. We’re also tracking manufacturer restrictions, like by month and by quarter to say, okay, which products are still qualifying, which ones are you still getting? Because that’s another thing, if they’re invoiced when it qualifies, and not only after replenished, we need to make sure they’re getting the products. And so, we are tracking that as well. And so that’s our Navigator Account Management. Our new tool is what I was referring to before, we’re calling it counter fill. And that’s where we take all their dispensing data, overlay the 340B dispensing fee, and then we’re able to roll it up by payer, which are your best and worst payers, household, NDCs, and then also prescriptions, like which prescriptions are, and then we’re also, this is really cool, is we’ve got a predictive tool, because a lot of times they’ll say, well, we need to know if you think it’s gonna qualify.  

Bonnie Bond: That’s awesome. 

Amanda Gaddy: And so, we’ve got a way that they can type in the prescription number, yes or no, it’s qualified previously. If it’s a new prescription, they can type in the NDC, the NPI, and it will show them how often that NPI qualifies or that NDC qualifies, and if it was replenished. So, for example, if they put in Ozempic and the NPI was, let’s say, 70 % of the time it qualifies. It’s not going to qualify if they’re Medicaid so that could be, but they can look at the history and say okay if I fill this and it’s not 340B I may lose $10 but if it is 340B I’ll make $250 and so it may be worth the risk to go ahead and fill it. So, it’s just a tool that they can use to make some decisions for things that haven’t qualified previously and so we’re really excited about that. 

Bonnie Bond: Mm -hmm. Yeah, that’s good data. There we go. 

Scotty Sykes: For sure. And that you mentioned that inventory piece, which is a key area for sure, because we see a lot of pharmacies that do the Rx Assessment and they don’t have any idea how their inventory is maybe replenished or how it should be replenished or how it impacts the accounting records. And that can kind of open a can of worms in some instances for sure. So, you have that inventory piece kind of built in?  

Amanda Gaddy: Yes, it’s built in. So, we’re tracking, we’re saying definite number, how many invoices, I mean, packages are you getting invoiced for? How many have been replenished? What is the difference and what is in the accumulator? Because the accumulator is valued if they’re on a pay on dispense program, meaning their invoice from the claim qualifies, regardless if they receive it or not. If they’re invoiced only after it’s been replenished, they can have an accumulator, but it’s not really financially impacting them until they get that product and are invoiced for it. So that’s, I would say the big takeaway, if you’re doing 340B today and you are on a program that you’re invoiced when the claim qualifies, log in and check your accumulator because that is just cash, money sitting there. 

Scotty Sykes: Yes, for sure. And we actually love it because our clients that use Secure 340B send us, you guys send us the accumulator every month. So we get that right into the system. So, it’s awesome. 

Bonnie Bond: Mm -hmm. We love data and those reports. They definitely help us do our job better. Yeah. It’s not an estimate. Yeah. 

Amanda Gaddy: And it’s real numbers, right? It’s not whatever’s just coming out of the pharmacy management system, which is not accurate. I mean, that’s the big takeaway too is the dispensing fee is the margin for that claim. But you got to make sure you’re getting the inventory back as well. 

Scotty Sykes: What else Amanda, what else is hot and heavy in there 340B? 

Amanda Gaddy: That to me is the biggest thing is helping pharmacies make that decision about do I fill this brand or do I not fill this brand? And having that information because again, I’ve heard pharmacies that are just like, we’re just not gonna fill GLP -1s anymore.  

Bonnie Bond: We hear that all the time, all the time. 

Amanda Gaddy: And I’m like, wait, wait. And that is exactly why we created this program is because that was conversation I had and I said, before you make that decision, let me just dig a little bit deeper. Let me get all your claims and we went through this process and it became a valuable tool. And so it came at a sheer need of that clarity of what is 340B, what’s not, and what does that look like when you roll it up. 

Bonnie Bond: I’m going to ask a dumb question and we can edit this out if it you guys can tell me if it’s dumb. Is there a way to use this program if you’re not a 340B pharmacy to just look at the data? 

Amanda Gaddy: Yeah, that’s actually a really good question that I would like to ask a pharmacy because it’s intended for 340B to overlay. And I don’t know how much their pharmacy management systems provide this information. Do they roll it up at the household level? Do they roll it up? I would think that that would be part of their dispensing data, but that’s a great question. 

Bonnie Bond: Maybe, yeah. I just know that that is something that we hear constantly. Again, that was on the call this morning. It’s on every call in the last three months is, I’m just gonna stop filling X, Y, and Z. Or I’m gonna use a different, there’s programs out there where you can have kind of a mail order situation for those things so they don’t have to carry the cost. I’ve even had a pharmacist tell me that they have a Walgreens across the street they have them fill it and they go pick it up for them and have it there for them. Yeah, so. 

Amanda Gaddy: Yep, that is something as well. And the one about the mail order, that was also, we’ve talked to them because we want to make sure that pharmacy, if they are 340B, they’re not carving those out, you know. And so that has been a solution that we’ve discussed. But I also heard that some of the chains had stopped filling just GLP-1s or whatever. So, they’re kind of pushing back as well. 

Bonnie Bond: Right. Yeah. I figured they’d catch up on that too at some point, yeah. Yeah. 

Amanda Gaddy: Right. But it’s just a, it’s a sad day that we even have to have this conversation.  

Bonnie Bond: It is, it is. 

Scotty Sykes: It’s terrible. 

Amanda Gaddy: I mean, we, we were talking about how do we keep our patients at the local level without losing, losing a lot of money. 

Scotty Sykes: It’s terrible. You cannot, it’s, it’s, it blows my mind that you have to turn patients away in instances. Like what, what, what are we, what is going on out there? That is absolutely. 

Bonnie Bond: Yeah. Why would you ever lose money on filling a script? Like I just, that’s what I can’t understand. 

Scotty Sykes: It’s healthcare. We’re trying to help people. I mean, it’s health care. 

Bonnie Bond: Especially huge amounts of money for some, you know, I’ve had clients show me different things and you’re talking about a lot of money for some. But like you, like I said earlier, it’s just, it’s mind blowing that you even have to, as a pharmacist, have to sit down and you’ve worked all day and you’re doing all this stuff. And then you have to sit down then and analyze household groups and… 

Bonnie Bond: What makes sense and should I still keep this client I mean this patient because oh I do make some money on these and trying to balance all that I mean and then you’re dealing with insurance all the time and it’s a lot. 

Amanda Gaddy: And then we had the whole MD on change healthcare fiasco. And that actually has been another deal that we had to deal with with 340B because the TPAs weren’t getting the claims. So now we’re trying to get historical data, but some of these patients were uninsured, okay? So they’re leaving the pharmacy with three months of Jardiance and it’s not hitting the system. And so it’s a lot of money.  

Scotty Sykes: Yeah, that Change Healthcare fiasco is just unbelievable. I mean, you got new reimbursements, DIR fee hangover and boom, here comes this change healthcare mess screwing up all kinds of receivables. Nobody knows what they’re owed anymore. I mean, it’s just a mess… 

Amanda Gaddy: Another thing I wanted to bring up is some of these company, I mean, the TPAs are going back, let’s say they’re restoring the pricing and they’re going back and qualifying claims from 2023. Big problem. If you’re listening to this and this happens to you, you need a detailed list of exactly what is going to be sent because we have that huge WAC reduction, you know, from 2023 to 2024 for insulin and inhalers. So, if a pharmacy would bill in 2023, there’d be an invoice on the higher cost, right? They’re getting a product that’s worth way less in 2024. So, when they go to bill that same product, now instead of it being worth $500, it’s worth $100. So, and those are the kind of, that’s an analysis that we do. You know, we get the list, and we say, okay, what was the price in 2023 versus 2024? And we calculate the difference. So that you can make a decision. Now, there’s one pharmacy this happened to and it actually, because they were losing on some of the insulins, it was okay because the WAC went up on a lot of the other claims. And so it balanced out. But you don’t know what you don’t know until you’re looking at the data. 

Scotty Sykes: So you guys, Secure 340B, you guys have that portal and those features. So you guys just give a little overview of the services and service level, I guess you guys do. 

Amanda Gaddy: Sure, so we are working on a portal right now. Everything is report generated and I think it’s like a pretty little summary page. But so the services that we provide is we do contract review, renegotiations, it’s all data driven. Like none of this is like, hey, let’s just throw out a number and see what happens. We wanna show the impact on the pharmacy as well as the covered entity. And then once, you know, they get an agreement, we work through implementation, making sure everything’s set up correctly, the right wholesaler is set up, that they understand. I mean, training and education is huge because you can have a great contract, but if you don’t know how to manage the inventory, then it can be a disaster. And I’ll give you an example of that. One pharmacy, when they received their 340 orders, they thought it was free because it was being billed to the hospital and shipped to them. And so, they were like, well, we can use it at some point, not knowing that’s just replacing what you’ve already purchased from your wholesaler. So, if you only need three Lantus, you only, it’s not going to help you to have 10, you know, because you get over inventory over swell. And so that education piece is so important. Like, no, this is not free. It’s just replacing what you’ve already purchased. And we need to keep your inventory exactly where it is today. You may have a little bit of a bump, but don’t have a whole bunch of extra. So that’s one of the services that we provide. And then the ongoing maintenance, especially with all these manufacturer restrictions, tracking all of that, you know, showing the pharmacy what they’re making with their 340B versus what they would make if the claims were not 340B, tracking that inventory and the manufacturer restrictions, and then really troubleshooting. I mean, every time we do quarterly reports, we go through the data. I mean, probably four people touch the data as far as like looking at it. QA’n, making sure everything is exactly the way it’s supposed to be, and then coming up with what are our action steps here. And sometimes it can be as simple as finding a couple of claims that they’ve been invoiced for that’s unavailable, like the NDC’s changed, that happened with Ozempic last year, and we find it, we’re like, okay, we can’t wait three months to true these up, we need it on the next invoice. So, it happened this quarter with Simply. or it could be one pharmacy where we found about $700 ,000 between several other stores of inventory that has been invoiced but not replenished. 

Bonnie Bond: Ugh. Whoa… 

Scotty Sykes: Golly. 

Amanda Gaddy: And just to make it even more complicated, and that nobody was trying to do anything wrong, but they went and tried to make an adjustment and they thought they were reversing the claims, but it just decremented the accumulator. And so the way we found it is because I was like, wait, we ran a report last quarter and it showed this many packages. We have no purchases. So something has gone awry here. And we found it. And so that’s the eyes looking at the report saying something’s off here. 

Bonnie Bond: Whoa…$700 ,000. 

Amanda Gaddy: There was some specialty stuff in there. 

Bonnie Bond: So, Amanda, what trade shows are you hitting up first? 

Amanda Gaddy: I’ll definitely be at NCPA. And I think that may be it. I don’t know if I’m doing any of the other ones this time. 

Bonnie Bond: Yay. Sounds nice. 

Scotty Sykes: Columbus. 

Amanda Gaddy: Yeah, I’m excited. 

Scotty Sykes: Columbus, right? Never been to Ohio. 

Amanda Gaddy: I don’t think I have either. 

Scotty Sykes: I don’t know too much about Ohio, to be honest. 

Bonnie Bond: Have I? I think I have been to Ohio. Is Cleveland in Ohio? 

Scotty Sykes: Cleveland, Ohio, yep. 

Bonnie Bond: Yeah, so I’ve been to Cleveland. 

Scotty Sykes: Well, Amanda, great update. We, well, Bonnie, you got to do your segment. 

Bonnie Bond: What’s that? Oh, the bottom line. Okay, at the end of each podcast, we kind of have our bottom line from what we discussed. So I’ll go first. I like to go first that way nobody takes mine, even though I mean, they’re really beating on the… It’s really loud in here. I guess my takeaway, I love the information, the new, I think you called it, the what, counterfill? All of these different programs. I mean, we talk about it all the time. These independents, we have to, you know, they have to get out there and do all this extra work unfortunately to stay on top of things and this is just another example if you’ve got a 340B program to definitely take advantage of something like that to make sure that you are covered and that you are getting the most out of your contract as you can. 

Scotty Sykes: Amanda. 

Amanda Gaddy: Oh, okay. My bottom line is if you’re in 340B, know your numbers. If you don’t have time to do it, use somebody, get somebody to help you because it can, especially if you’re high volume, because it can be, like I said, a game changer in a very good way and in a negative way as well. And, you know, if anybody wants to schedule a strategy call with me to see if this would be a good partnership, I mean, we’re not for everybody because if you’re a small little 340B program, you may not need us. But if it’s a large program, and you want somebody extra eyes to monitor it, then please feel free to reach out. 

Scotty Sykes: And my bottom line is look in your community and see if there’s opportunities here because branching out and finding new areas of revenue, profitable revenue is as important as ever. And 340B may be it for you. So, look for those opportunities and that’s my bottom line. 

Amanda Gaddy: Can I have another bottom line?  

Bonnie Bond: No, you can only have one. 

Scotty Sykes: Go for it. 

Amanda Gaddy: And this really is true. If the contract is structured correctly, the pharmacy will never lose money on a 340B. 

Bonnie Bond: Yes. Yes. And Amanda, you guys will… 

Scotty Sykes: So, once you find the opportunity, the contract and then the data. 

Amanda Gaddy: Right. Yes. 

Bonnie Bond: And Amanda, you guys do that, right? Strictly, I mean, you can just look, be engaged to review contracts.  

Amanda Gaddy: That’s exactly…  

Bonnie Bond: Yeah. 

Amanda Gaddy: We are not attorneys and I’d say that like the legally stuff, but I can look for like payment terms, dispensing fee, winners only, the things that are gonna impact that pharmacy operationally. 

Bonnie Bond: I have another bottom line too. Sorry. But I learned this the last time we spoke and you said it again today and it is so big because we, I hear it so much. People say I have this 340, I already have a contract, I already signed it. But if you find out that it is not beneficial or maybe there’s some things that need to be changed or updated, it can still be negotiated. It is not set in stone. 

Amanda Gaddy: 100%. And we do that as well. We’ll do like an analysis, an overall analysis, just to show a pharmacy like where they are today. And then they don’t have to sign a long contract with us. It’s just like, let us like do like a health check of your 340B program. 

Bonnie Bond: Perfect, yes. 

Scotty Sykes: You know what? I was going to, I got another bottom line. What about, I was going to ask this question. I forgot. What about the intermediary?  What role do they play? How important is that in this conversation with 340B?  

Amanda Gaddy: Who like the third party administers? 

Scotty Sykes: Like, the macro helix or the whoever. 

Amanda Gaddy: They’re very important because they’re taking all the data from the pharmacy and the hospital or clinic and they’re putting rules in place to decide what qualifies and what doesn’t qualify. Now they will lean towards the covered entity to make some of those decisions on those rules, but they’re responsible for ordering, invoicing, and so it’s important to know the platform. 

Scotty Sykes: Does the pharmacy have a lot of control over that intermediary in terms of who that is and so on? 

Amanda Gaddy: Yeah, typically they don’t because at this point most entities have their own TPA that they can’t accept. But I will say that if there’s an issue with it or we’ve seen it where claims aren’t qualifying or something’s happening and we’re like, these claims should qualify and we’re showing them, oh, I forgot to mention that too. We’ve got another tool that we can show which claims we think should have qualified that didn’t, which is huge based on the provider, the drug replenishment. That just got added last week, so I’m excited about that. 

Bonnie Bond: That’s great. 

Scotty Sykes: Technology is your best friend in this space. I’ll tell you.  

Amanda Gaddy: But it is important to know and there are ways to change if it’s needed.  

Scotty Sykes: Yeah. 

Amanda Gaddy: But we work with all the different TPAs. 

Bonnie Bond: A .I. coming I’m sure will help. 

Scotty Sykes: All right. Well… 

Bonnie Bond: I got one more… 

Scotty Sykes: How to change a tire, step one. 

Bonnie Bond: Just because you’re a woman doesn’t mean you can’t change a tire.  

Amanda Gaddy: That’s right. That’s right. 

Bonnie Bond: Bottom line. Bottom line.  

Scotty Sykes: Hey, I gave you some props on that. 

Bonnie Bond: Girl power. I’ve had a couple people that are like, that’s pretty awesome. I even had a guy that stopped at the end and he was like, very good. Good job.  

Scotty Sykes: And you don’t have any, you don’t have any like dirt on you. So like, I changed tires, I’m covered. 

Bonnie Bond: I do. I just, I put water like on my pants and was like, it was, I was dirty. Yes. 

Scotty Sykes: Well, thank you again, Amanda. Appreciate you coming on. Always welcome to jump on and I’m sure we’ll be seeing you around sometime soon. Yeah. 

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