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Colo., Miss. Require Carve-In Providers to Report on 340B Drugs

New policies in the Colorado and Mississippi Medicaid programs require providers to report on the medications for which they received discounted through the 340B Drug Pricing Program.

Effective Nov. 1, providers’ 340B claims could be denied if they do not include the necessary information.

The new billing policies apply to covered entities in these states that use 340B-purchased drugs for Medicaid beneficiaries, referred to as carve-in providers. Specifically:

  • Colorado’s policy requires carve-in providers to report the 340B acquisition cost of a drug; and
  • Mississippi’s policy mandates that carve-in providers identify 340B-purchased drugs on medical and retail pharmacy claims submitted to the Medicaid program for reimbursement.

The two policies come in response to a Centers for Medicare & Medicaid Services (CMS) requirement that state Medicaid programs define policies and oversight activities related to 340B drugs. The policies are part of a larger effort by states to increase transparency in public programs and lower their share of drug costs in Medicaid.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Kelcie Jimenez is a state policy analyst at America's Essential Hospitals.