How One FQHC Generated $151,000 in Revenue From Just 60 Prescriptions

In today's challenging healthcare landscape, Federally Qualified Health Centers (FQHCs) are constantly seeking sustainable revenue sources that align with their mission to provide comprehensive care to underserved communities. While many health centers operate 340B pharmacy programs, few maximize the program's full potential.

During a recent CEO Bootcamp expert session, Michelle Marten, Pharmacy Director and COO at PureView Health Center, shared innovative strategies that have dramatically increased their pharmacy program's bottom line. These approaches not only generate significant revenue but also improve patient access to medications - particularly specialty drugs that might otherwise be financially out of reach.

The Specialty Prescription Strategy

Perhaps the most eye-opening revelation from Michelle's presentation was PureView's approach to working with self-funded employer groups. By establishing strategic relationships with these groups and leveraging their 340B inventory, they achieved remarkable results:

"In 8 months we filled 60 prescriptions and we have a net profit of $151,000," Michelle shared with our bootcamp participants.

This approach creates multiple winners:

• Health centers generate significant revenue to support their mission
• Employer groups substantially reduce their pharmacy benefit costs
• Patients gain access to expensive specialty medications with reduced or eliminated copays

Michelle emphasized the importance of working with a compliance consultant to ensure these arrangements meet all regulatory requirements. With proper guidance, this strategy can be implemented while maintaining full compliance with 340B program rules.

Capturing Revenue from Outside Referrals

Another powerful strategy Michelle detailed was PureView's "referrals" approach - capturing 340B revenue from prescriptions written by outside providers.

Since the landmark Genesis vs. Becerra court case, health centers have gained additional flexibility in how they can utilize the 340B program. Health centers can now fill prescriptions from outside providers with 340B inventory as long as certain conditions are met:

1. The patient has been seen by your PCP within the last 2 years
2. The medication is recorded in your EMR
3. Notes from the outside provider are added to the patient's chart
4. Your provider is alerted about the outside care

 

"It does require some extra work from your pharmacy staff," Michelle acknowledged, "but there is a lot of revenue to be made there."

 

This approach is particularly valuable for patients who see both your primary care providers and specialists elsewhere. Rather than losing that prescription revenue to retail pharmacies, you can capture it while often providing medications at a lower cost to patients.

Safe Harbor Act Implementation

Michelle also shared how PureView is implementing the Safe Harbor Act to waive Medicare Part D copays for patients on sliding fee scales while still processing prescriptions through insurance.

Traditionally, many health centers face a difficult choice when Medicare Part D patients have high copays:

• Process through insurance and risk patients not picking up prescriptions due to cost
• Bypass insurance and offer medications at a discounted cash price (forfeiting the insurance revenue)

The Safe Harbor Act provides a better alternative: waive copays for eligible sliding fee scale patients while still billing insurance. This approach:

• Ensures patients receive needed medications
• Maintains insurance revenue for the health center
• Creates a foundation for potentially expanding copay assistance to other patient populations

Implementation Considerations

While these strategies offer significant revenue potential, successful implementation requires:

1. Clear policies and procedures that document your approach and ensure compliance
2. Staff training to properly manage these more complex pharmacy operations
3. Relationships with employer groups in your service area
4. EMR integration to properly document outside provider information
5. Regular compliance reviews to ensure ongoing adherence to 340B requirements

Looking Ahead

As pharmaceutical costs continue to rise and specialty medications represent an increasing portion of healthcare spending, health centers with robust 340B programs will be better positioned to serve their communities while maintaining financial sustainability.

The strategies shared by Michelle demonstrate how innovative approaches to 340B program management can create significant value for health centers, patients, and community partners alike.

Want to learn more revenue-generating strategies for your health center? Our CEO Bootcamp brings together health center leaders with industry experts to share practical, actionable approaches to improving financial performance while advancing mission. This month, we'll be exploring strategic growth opportunities through branding, marketing, and community partnerships. Our guest experts will share how one health center increased patient volume by 23% through targeted marketing strategies and partnerships with local organizations. Contact us to learn more about joining our next cohort.