Specialty Drug Pricing (340B)
Definition
Specialty drugs—including biologics, oncology drugs, HIV medications, and other high-cost therapies—often represent the largest individual savings opportunities in a covered entity’s 340B program. Because specialty drug list prices are very high and the 340B ceiling price is calculated as a deep discount from AMP, the per-unit savings on specialty drugs can be substantial.
Accessing 340B pricing for specialty drugs can be complicated by several factors: many specialty drugs are subject to REMS programs with limited distribution networks, manufacturer restrictions may limit contract pharmacy access, and specialty drugs may require specific dispensing arrangements that are not available through all contract pharmacies.
Covered entities with significant specialty drug volumes—such as cancer centers, HIV clinics, and infusion centers—have the most to gain from optimizing their specialty drug 340B arrangements. Ensuring that specialty drugs are being captured correctly in the 340B program and that all eligible specialty prescriptions are being processed as 340B transactions is a high-value optimization activity.
Frequently Asked Questions
Why Specialty Drug Pricing (340B) Matters
Specialty drugs often represent the highest-value savings opportunities in a 340B program. Covered entities that are not fully capturing specialty drug savings—due to manufacturer restrictions, REMS complications, or data configuration issues—may be leaving significant savings unrealized.
How Virtue 340B Uses It
Virtue 340B evaluates specialty drug capture rates and access arrangements as part of our program optimization and audit services, helping covered entities maximize savings on high-cost specialty medications.