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SAN DIEGO, SEPT. 21, 2023 — Today, SUNRx, a leading healthcare technology company and 340B administrator, announced that it has acquired AuthorityRx. The acquisition complements SUNRx’s current 340B offerings with the addition of auditing and enhanced compliance services as well as two cloud-based applications.

The automated Advanced Claims Capture (ACC) product supports clients by improving savings through the capture of outside referral providers, and the manufacturer support application restores and protects savings associated with recent manufacturer-imposed restrictions requiring claims uploads.

“Identifying referral claims and other missed claims due to manufacturer restrictions has in the past been a complex, often manual process, but missing these savings can hinder 340B entities’ ability to fulfill their mission,” said Mary Van Hoozer, General Manager at SUNRx. “The acquisition of AuthorityRx will allow SUNRx to offer an enhanced, proprietary, and compliant way to capture additional claims and provide the associated financial benefits for covered entities.”

As the industry’s leading compliance and auditing service, ACC offers an ease-of-use referral claims capture solution that can significantly increase 340B savings by uncovering and resolving fallout claims. In fact, current users of ACC have, on average, nearly doubled capture rates and revenue. ACC is Third-Party Administrator (TPA)-agnostic and can be seamlessly integrated for any covered entity, regardless of the TPA they use.

ACC’s innovative automation streamlines processes while compliantly extending eligibility to outside providers using an approach that has been validated in multiple HRSA audits. This SOC-2 certified solution also delivers a level of visibility and transparency that other programs cannot.

“For many covered entities, the 340B program is a lifeline that allows them to keep their doors open,” said Aaron Lott, PharmD, founder and president of AuthorityRx. “By combining the technology and expertise of our companies, we will give entities greater resources to serve patients and communities.”

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Media Contact

Lee Harris, Managing Principal, Sales & Strategic Relations, SUNRx
lharris@sunrx.com
858.208.8785

 

About SUNRx

SUNRx is a healthcare technology company that assists healthcare facilities with 340B administration. Our technology helps covered entities optimize their supply chain and pharmacy operations. We provide comprehensive, auditable technology-enabled solutions, including contract pharmacy, referral capture, specialty pharmacy, advanced claims capture, and the market-leading uninsured 340B prescription discount card, with a hands-on approach to program implementation and support of compliant 340B program management. Based in San Diego, SUNRx has been managing 340B programs since 2006 and provides clients industry-leading expertise and hands-on customer support. SUNRX is a subsidiary of MedImpact the nation's largest independent pharmacy benefit manager (PBM) and health solutions company. Learn more at SUNRx.

 

About AuthorityRx

AuthorityRx is a technology and pharmacy consulting firm. The company is made up of diverse and licensed healthcare professionals who are uniquely qualified to identify the cause of complex healthcare challenges and provide innovative solutions to resolve those challenges. Based just outside of Kansas City, AuthorityRx has brought millions of new dollars to healthcare organizations and their underserved communities across the country with our intense focus on pharmacy marketplace dynamics to include 340B auditing and compliance services, assisting with licensing retail pharmacies, accrediting specialty pharmacies, and designing custom health plan solutions for healthcare providers.

 

The contents of this page are confidential and proprietary to 340B Holdings, LLC (SUNRx) and may contain material SUNRx considers Trade Secrets. This document may not be reproduced, transmitted, published or disclosed to others without prior written authorization from SUNRx.

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The 340B program serves as a lifeline for many communities, allowing them to provide critical services to vulnerable, underserved patients. But unfortunately, the industry faces a spectrum of challenges, from mounting drug manufacturer restrictions to incomplete referral claims capture, which hinder a covered entity’s ability to optimize their 340B program.

To help covered entities broaden the reach of their 340B program, SUNRx, a leading 340B technology solutions company, recently acquired AuthorityRx, including the automated Advanced Claims Capture (ACC) solution. By combining the technology and expertise of the companies, SUNRx is able to provide entities greater resources to serve patients and communities.

Today, when a patient of a 340B entity visits a referral provider, the entity often loses the potential savings associated with their 340B program. In the past, identifying referral claims and other missed claims with traditional referral capture models has been a complex, often manual process that results in missing savings.

By uncovering and resolving fallout claims, ACC offers a user-friendly referral claims capture solution that can help significantly increase 340B savings. In fact, in some cases, it can nearly double capture rates and revenue.

One Solution Can Have a Big Impact

In an industry subject to ever-evolving, complex regulations and restrictions, compliance remains a constant challenge. Some covered entities even limit themselves by forgoing referral capture, leaving 340B dollars behind because of compliance concerns.

The risk of HRSA audits is ever-present and ensuring that your claims capture process is audit-ready is critical. ACC streamlines the audit processes while extending eligibility to outside providers with a proven approach that ensures a high level of visibility and transparency.

Security, Transparency, and Control
A claims capture solution should be SOC 2-certified, offer a high level of visibility and transparency, and track the progress of claims throughout the process.

Streamlined Data Integration
Many entities want to capture additional savings but do not have the resources to go through a lengthy integration. Combining data and analytics from multiple provider databases and diverse platforms can be complex, but it’s critical that systems are compatible and can efficiently share data.

ACC eliminates the need for extensive data integration. We do not need EHR access and can work directly with TPAs to streamline the process. Entities also gain useful drug spend metrics and data that can identify and attract new patients and providers.

 

How We Can Help

We know 340B savings and community programs go hand-in-hand. For many covered entities, the 340B program is a lifeline that allows them to keep their doors open. We created ACC to help covered entities unlock significant savings and give them greater resources to serve patients and their communities.

About SUNRx
As a leading healthcare technology company, SUNRx assists healthcare facilities with 340B administration. Our technology helps covered entities optimize their supply chain and pharmacy operations with comprehensive, auditable technology-enabled solutions. To learn more about how SUNRx helps covered entities optimize their 340B program, visit www.sunrx.com.

About Aaron Lott
Aaron Lott, PharmD, is the founder and president of AuthorityRx. He built AuthorityRx and designed the ACC solution with his wife, Kim. AuthorityRx has brought millions of new dollars to healthcare organizations and their underserved communities across the country with their intense focus on pharmacy marketplace dynamics.

By Aaron Lott

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Since 2020, select drug manufacturers have begun deploying restrictions or limitations on the sale of their products through the 340B program. This has proven to be a marketplace disruptor that has shifted the landscape of the 340B contract pharmacy program, as covered entities have experienced a loss of savings and have had to increasingly rely on entity-owned retail and/or specialty pharmacy operations to help in their mission. The issue of manufacturer restrictions has endured several legal challenges as well with some states, such as Arkansas, Louisiana, and West Virginia, having measurable success with combating the manufacturer restrictions.

Regardless, manufacturers continue to impose restrictions with the assistance of 340B ESP, a drug industry vendor that facilitates 340B claim management and oversees implementation of drug maker policies. In many cases, the restrictions made by the manufacturers will be applied to the covered entity for all contract pharmacies unless the covered entity has created an account, made designations, and/or submitted claims within 340B ESP. Depending on the manufacturer and the type of restrictions they impose, this will restore access to either some or all of their products for one or some contract pharmacies. Each manufacturer has a policy document outlining the specific restriction(s) they are imposing and the obligations of the covered entity, as well as any exceptions, say for non-hospital covered entities. Nevertheless, covered entities will want to ensure they understand the restriction methodology and choose the most appropriate pharmacy(ies) based upon geography, drugs available to dispense at the pharmacy, and if their providers utilize the pharmacy.

For covered entities that have a 340B ESP account and have made designations while submitting claims, there are a variety of quality assurance exercises to complete that will ensure 340B ESP is facilitating the manufacturer restrictions appropriately.

On a monthly basis, covered entities should log into ESP and review all designations that have been made with each manufacturer to ensure they are still designated and are aligned with the covered entity’s designation strategy. The covered entity should download the eligibility file and ensure it matches each manufacturer that the covered entity clicks into. Any discrepancies identified should be addressed immediately with 340B ESP. Upon completion, send the eligibility file to your Third-Party Administrator and Wholesaler partners for additional review.

Third Party Administrator and Wholesaler Review

Upon completion of the designation review and ensuring the 340B ESP system is demonstrating the correct information, the covered entity will want to communicate with their third-party administrator(s) and wholesaler(s) to ensure they understand the pharmacies that have been designated for use. These partners will need to make sure any pharmacy or drug “blocks” are appropriately implemented or removed to facilitate 340B pricing. On a monthly basis, these partners will want to share what their current blocks are pertaining to 340B ESP and the manufacturer restrictions to ensure alignment.

Manufacturer Policy Changes and 340B ESP Updates

Any time a manufacturer releases a policy update, or a new manufacturer decides to impose restrictions, the covered entity will want to immediately log into 340B ESP and complete the Designation Review. A new designation may be required, or a designation may warrant an adjustment to ensure optimal savings occur. In rare instances, 340B ESP may make enhancements or communicate downtimes within their system. If the covered entity receives a communication from 340B ESP about this, the covered entity will want to log into 340B ESP and complete the Designation Review to ensure no designations were adjusted as a result.

Regular monitoring of the 340B ESP system is critical to minimizing losses of savings with the 340B contract pharmacy program. For any additional assistance with ensuring optimal savings, which includes assessing the correct contract pharmacy opportunities and troubleshooting 340B ESP designating, please contact AuthorityRx.

About AuthorityRx
AuthorityRx is a technology and pharmacy consulting firm. The company is made up of diverse and licensed healthcare professionals who are uniquely qualified to identify the cause of complex healthcare challenges and provide innovative solutions to resolve those challenges. Based just outside of Kansas City, AuthorityRx has brought millions of new dollars to healthcare organizations and their underserved communities across the country with our intense focus on pharmacy marketplace dynamics to include 340B auditing and compliance services, assisting with licensing retail pharmacies, accrediting specialty pharmacies, and designing custom health plan solutions for healthcare providers.

About Justin Ott
Justin Ott, MHA, is the Principal, Account Management of AuthorityRx. He has 12 years of experience with the 340B program serving at the covered entity, pharmacy, consulting, and technology levels. AuthorityRx has brought millions of new dollars to healthcare organizations and their underserved communities across the country with their intense focus on pharmacy marketplace dynamics. Reach out to Justin at jott@authorityrx.com

By Justin Ott