Episode 15: 340B Neutral Clearinghouse Pioneers: A Conversation with Executive Leaders at RxParadigm
In this episode of our business-focused podcast 340B Leaders Upfront, host Anna Mangum sits down with RxParadigm senior leaders Tim Neylan, Chief Operating Officer and Lauren Reiss, Chief Strategy Officer. RxParadigm is a pharmacy technology solutions provider developing what the firm describes as the first ever neutral 340B claims clearinghouse. Tungsten+PLUS™ is a new system to resolve duplicate discounts and other pricing discrepancy challenges.
A neutral infrastructure, RxParadigm argues, is particularly important because it provides a shared operational framework that is not exclusively controlled by manufacturers, covered entities (CEs), or other single stakeholders. This can support greater trust, transparency, standardization, and operational consistency.
Key Topics Covered:
Pathway to 340B
Tim and Lauren outline their backgrounds in managed IT services and business process and operations, respectively. Lauren shares how working in 340B is a "family" business for her, her brother and their children, who are following in Lauren's father's footsteps in 340B service companies.
340B Skillset
Lauren discusses some of the key skills and aptitudes that are increasingly valuable for 340B professionals: coordinating across multiple, often disconnected systems, understanding how to interpret and apply data across business functions, and adaptability.
Mitigating Medicare Maximum Fair Price Workflow Impacts
Tim provides an overview of RxParadigm's portfolio and how it continues to support clients in navigating the increasing pace of policy changes in the 340B landscape. Lauren emphasizes the need for providers to have ready access and visibility into their own data, and for standardized processes and policies to respond to the disparate types and patterns of data requests from drug manufacturers and other stakeholders.
Lauren discusses RxParadigm's recent analysis showing that 40% of Medicare Maximum Fair Price (MFP) claims missed the mark in January, the first month of the new program's effectuation, and how the firm supports clients in improving their performance given operationally complex and heavy MFP workflows. She describes how Tungsten+PLUS™ takes care of disputes when MFP reimbursements and 340B rebate payments are not made accurately, on time, or at all.
Oregon and National 340B Claims Clearinghouse Solutions
Tim outlines how RxParadigm is serving as a clearinghouse for data from CEs and pharmacies in Oregon, in response to a new state policy requiring CEs and their pharmacies to include a 340B indicator. Tim also touches upon the Rx Paradigm's first of its kind national neutral clearinghouse. Unlike the current vendors that are retained by the drug industry to collect claims data from CEs, Rx Paradigm's service is an impartial solution to the industry-wide challenge of 340B de-duplication, enabling trusted coordination, compliance, and accuracy across stakeholders without the need to share sensitive information.
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