Glossary Category: Drug Pricing & Pharmacy Operations
These terms explain how 340B pricing works in practice and where operational complexity creates risk, especially in contract pharmacy and TPA workflows. Use these definitions to interpret pricing discussions, purchasing ratios, and compliance controls.
A contracted price negotiated by the Prime Vendor Program that is below the wholesale acquisition cost (WAC), available to covered entities subject to the GPO Prohibition as an alternative to GPO pricing for non-covered outpatient drugs.
Contracts negotiated by the Prime Vendor Program for non-covered outpatient drug products and services needed in the pharmacy environment, including vaccines, blood glucose monitoring supplies, and pharmacy automation hardware and software.
The traditional Medicaid payment model in which providers are paid for each individual service rendered, as opposed to Medicaid managed care arrangements where providers receive capitated payments.
A drug that is only available through a restricted distribution network designated by the manufacturer, often due to safety requirements or specialty distribution needs, which can limit a covered entity’s ability to access 340B pricing through standard channels.
A voluntary program managed by Apexus under a HRSA agreement that negotiates sub-340B pricing and other value-added contracts on behalf of 340B covered entities, providing access to discounts below the statutory ceiling price.
The company that manages the 340B Prime Vendor Program under a contract with HRSA, providing sub-340B pricing, distribution solutions, and educational resources to 340B covered entities.
A contracted price negotiated by the Prime Vendor Program (Apexus) with drug manufacturers that is below the statutory 340B ceiling price, providing additional savings to participating covered entities.
A physical address registered in OPAIS where a covered entity may have 340B drugs delivered, including in-house pharmacies, entity-owned warehouses, and central fill facilities—but not contract pharmacies.
A pharmacy that is owned by and is a legal part of the 340B covered entity, typically listed as a shipping address in OPAIS and used to directly dispense 340B drugs to the entity’s eligible patients.
A covered entity’s election in OPAIS regarding whether it will (carve-in) or will not (carve-out) bill Medicaid fee-for-service for drugs purchased at 340B prices, which determines duplicate discount prevention obligations.