Problem Statement

The federal 340B Drug Pricing Program lets eligible hospitals buy outpatient drugs at steep discounts, and the resulting savings fund care for underserved patients, making it a meaningful source of margin that hospitals depend on. Keeping that benefit requires staying compliant: only prescriptions tied to qualifying patients, encounters, and authorized providers are 340B-eligible, and hospitals must audit eligibility, report any material breach to HRSA, and recertify annually. For Hospital Qualified and Retail Pharmacy prescriptions, that means reconciling a monthly pharmacy report against the patient's medication history, encounters, and authorizing-provider records to surface any discrepancy. This is a high-volume monthly reconciliation that is slow and error-prone manually, and a missed mismatch is both a compliance exposure and lost program savings.

Automation Solution

This automation audits Hospital Qualified and Retail Pharmacy 340B-eligible prescriptions in Epic using a Macro Helix report and produces a report on patient prescription and authorized-provider discrepancies to maintain HRSA compliance.