Express Scripts Requires 340B Claim Identification

Express Scripts made a specific requirement for 340B contract pharmacies to identify 340B claims in the January 2021 Provider Manual.  Prior to 2021, pharmacies were requested to voluntarily identify 340B claims.  An additional method for pharmacy 340B claims reporting started on March 1, 2021 but is not clearly or completely described in the Frequently Asked Questions document on the Express Scripts website.  This requires using the NCPDP “N1” Information Reporting transaction, which is typically for Medicare Part D supplemental coverage information.  Pharmacy systems must be able to submit “N1” transactions, which are part of the version D.0 standard, to comply with Express Scripts’ requirement.

This requirement includes all members, regardless of prescription coverage plan, and is not limited to claims for Medicaid members.  Covered entities and pharmacies involved in the 340B program understand that manufacturers are not responsible for both Medicaid drug rebates and 340B discounts on a single dispensed drug.

According to the Frequently Asked Questions document, “This change was made in the spirit of greater transparency. It is not intended to lead to a change in reimbursement rates, network participation, or a pharmacy’s ability to service as a Contract Pharmacy for 340B Covered Entities.”

Express Scripts also notes that if the pharmacy identifies the 340B claim after submission, the pharmacy should update Express Scripts using the “N1” transaction within 10 business day of the identification.


Posted: April 2021

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