Build a pharmacy network that improves patient access, performs effectively, and remains actively overseen.
Contract pharmacy relationships can increase medication access and provide patients with more convenient dispensing options.
However, adding pharmacies without a clear strategy can also create unnecessary fees, fragmented data, compliance exposure, administrative burden, and underperforming arrangements.
Thrive340B helps covered entities design, implement, evaluate, and manage contract pharmacy networks based on patient access, compliance, operational performance, and sustainable value.
The goal is not the largest pharmacy network. It is the right pharmacy network.
Evaluate Your Pharmacy Network
Covered Entity Responsibility Does Not End With the Contract
HRSA permits a covered entity to enter written arrangements with one or more contract pharmacies, but the covered entity remains responsible for ensuring that those arrangements comply with applicable 340B requirements. (HRSA)
That responsibility includes maintaining auditable records and overseeing controls intended to prevent:
- Diversion
- Duplicate discounts
- Unsupported prescriptions
- Inaccurate claims qualification
- Improper Medicaid billing
- Inadequate replenishment
- Unresolved data discrepancies
Thrive340B helps covered entities establish a structured oversight model rather than relying entirely on pharmacies or third-party administrators.
Pharmacy Needs Assessment
Before adding a pharmacy, we evaluate whether the arrangement addresses a genuine patient or operational need.
The assessment may include:
- Patient geography
- Existing pharmacy use
- Patient preference
- Medication availability
- Specialty medication access
- Hours of operation
- Delivery services
- Mail-order options
- Language access
- Transportation barriers
- Payer acceptance
- Referral patterns
- Existing network gaps
- Clinical service lines
- Manufacturer restrictions
Network Design
Thrive340B helps determine the appropriate combination of:
- Local retail pharmacies
- Regional pharmacy chains
- National pharmacy chains
- Independent pharmacies
- Specialty pharmacies
- Mail-order pharmacies
- Entity-owned pharmacies
- In-house dispensing
- Limited-distribution pharmacies
- Designated pharmacies
The network is designed around patient access, operational feasibility, compliance, and net value.
Pharmacy Selection
We help covered entities evaluate potential pharmacy partners based on:
- Geographic access
- Patient utilization
- Payer participation
- Specialty capabilities
- Delivery options
- Data capabilities
- Technology integration
- Fee structure
- TPA compatibility
- Reporting quality
- Audit cooperation
- Customer service
- Implementation capacity
- Contract flexibility
- Manufacturer access
Third-Party Administrator Selection
The TPA frequently serves as the operational center of the contract pharmacy program.
Thrive340B can help compare TPAs based on:
- Claims qualification logic
- Patient matching
- Provider matching
- Prescription capture
- Referral capture
- Accumulator management
- Replenishment
- Medicaid safeguards
- Data integration
- Exception reporting
- Audit tools
- Financial reporting
- Pharmacy relationships
- Manufacturer restriction management
- Implementation support
- Customer service
- Fees
Contract and Fee Evaluation
Contract pharmacy economics can be difficult to understand because multiple fees may apply to each transaction.
We help evaluate:
- Dispensing fees
- Administrative fees
- TPA fees
- Percentage-of-revenue fees
- Flat transaction fees
- Specialty fees
- Data fees
- Reconciliation fees
- Implementation fees
- Audit costs
- Termination costs
- Minimum-volume requirements
- Performance guarantees
- Reimbursement risk
- Payment timing
Legal counsel should review agreements and advise the covered entity on legal rights, obligations, and enforceability.
Implementation and Onboarding
Once a pharmacy and TPA are selected, Thrive340B can coordinate:
- Contract execution tracking
- OPAIS registration
- Pharmacy identifiers
- Location validation
- TPA configuration
- Provider roster loading
- Patient data feeds
- Encounter data feeds
- Prescription data feeds
- Claims exclusions
- Medicaid settings
- Accumulator setup
- Wholesaler setup
- Replenishment testing
- Financial settlement testing
- Staff education
- Launch timeline
- Go-live validation
OPAIS Registration and Maintenance
Contract pharmacy arrangements must be accurately reflected in 340B OPAIS.
Thrive340B can assist with:
- Initial registration planning
- Pharmacy information validation
- Effective-date tracking
- Termination-date tracking
- Location changes
- Pharmacy ownership changes
- Duplicate-registration review
- Inactive-arrangement removal
- Quarterly review
- Annual recertification support
Claims Capture and Qualification
We evaluate whether contract pharmacy systems identify eligible activity accurately and consistently.
Review may include:
- Patient matching
- Provider matching
- Encounter matching
- Prescription dates
- Refill activity
- Referral prescriptions
- Location eligibility
- Claims exclusions
- Payer exclusions
- Medicaid activity
- Reversals
- Manual overrides
- Exception queues
- Unmatched claims
Optimization recommendations remain subject to patient eligibility and applicable program requirements.
Replenishment Oversight
Contract pharmacy models commonly rely on replenishment processes connecting dispensing activity with covered entity drug purchasing.
Oversight may include:
- Accumulator activity
- Package-size conversion
- Replenishment thresholds
- Purchase orders
- Wholesaler records
- Negative balances
- Reversals
- Returns
- Credits
- Unreplenished claims
- Manufacturer restrictions
- Inventory reconciliation
- Financial settlement
Duplicate-Discount Controls
Contract pharmacy Medicaid activity presents particular compliance complexity.
Thrive340B helps evaluate:
- Medicaid fee-for-service exclusions
- Managed Medicaid exclusions
- Medicaid Exclusion File information
- State-specific requirements
- Pharmacy billing
- Claims identifiers
- Modifiers
- TPA configuration
- Payer tables
- Written procedures
- Exception reports
Manufacturer Restriction Management
Manufacturer policies may limit contract pharmacy replenishment or require covered entities to complete designation and data-submission processes.
Thrive340B can assist with:
- Manufacturer policy tracking
- ESP administration
- Pharmacy designation
- Data-submission monitoring
- Restricted drug identification
- Lost replenishment analysis
- Alternative pharmacy strategies
- State-law monitoring
- Financial impact reporting
- Vendor communication
- Documentation management
Pharmacy Performance Scorecards
Each pharmacy relationship should be evaluated based on measurable performance.
Scorecards may include:
- Prescription volume
- Eligible claim volume
- Gross revenue
- Net revenue
- Fee burden
- Capture rate
- Reversal rate
- Replenishment delays
- Negative balances
- Specialty activity
- Patient access
- Data quality
- Reporting quality
- Compliance findings
- Corrective-action response
- Service quality
Ongoing Network Management
Thrive340B can provide continuing management involving:
- Pharmacy performance meetings
- Vendor escalation
- Data reconciliation
- Claims review
- Financial reconciliation
- Manufacturer restrictions
- OPAIS maintenance
- Provider roster updates
- Internal audits
- Independent audit coordination
- Corrective-action tracking
- Contract renewal evaluation
- Fee renegotiation
- Network expansion
- Network consolidation
Network Expansion
Before expanding, we evaluate whether a proposed pharmacy adds meaningful value.
Questions may include:
- Do patients already use this pharmacy?
- Does it improve geographic access?
- Does it offer specialty capabilities?
- Will it produce sufficient activity to justify oversight costs?
- Can it support required data?
- Are fees commercially reasonable?
- Does the TPA already support it?
- Is it affected by manufacturer restrictions?
- Can the covered entity oversee it effectively?
Network Consolidation
More pharmacies do not always produce better performance.
Thrive340B may recommend consolidation when arrangements:
- Generate minimal patient activity
- Produce little net value
- Create excessive fees
- Have persistent data problems
- Fail to support audits
- Duplicate nearby access
- Create unnecessary oversight burden
- Remain inactive
- No longer align with patient needs
Active Oversight, Not Passive Participation
Contract pharmacy arrangements should be treated as actively managed extensions of the covered entity’s pharmacy program.
Thrive340B helps leadership understand which pharmacies improve access, which arrangements perform effectively, where risks exist, and where changes are warranted.
Better access. Better oversight. Better pharmacy performance.
Strengthen Your Contract Pharmacy Network