More Resources | Manufacturer Actions | Pharmacy Benefit Manager Notices | Express Scripts

Effective March 1st, 2021, Express Scripts will require N1 transaction data to indicate the prescription was 340B. 

Express Scripts: New 340B claims identification and submission requirements communication

FAQs:

• How do we comply with this request?
  • Should you choose to comply, you’ll need to work with your respective pharmacy software services to determine how to send N1 type transactions to Express Scripts.
  • The decision to provide or not provide the information is truly at the discretion of the covered entity and contract pharmacy. Remember to review your Pharmacy Services Agreement (PSA) that governs each relationship.
    • Considerations to review:
      • Potential impacts to network access
      • Potential impacts to reimbursement
      • Time and labor expenses for the pharmacy to reverse and re-adjudicate transactions
        • This could also include any additional work if a prior authorization (PA) was included on the initial submission and needs to be re-adjudicated.
      • These transactions are not captured within 340B Architect
      • Express Scripts has posted an FAQ as well and can be located at https://www.express-scripts.com/art/prc/340B_Drug_Discount_Program_N1_Transaction_FAQ.pdf.

• What do we need to do in 340B Architect?
  • No action within the software is required because we do not capture this information in 340B Architect.

• Do we have to re-adjudicate claims after we see them qualify in Architect?
  • We recommend contacting your pharmacy software vendor to determine how N1 transactions are to be processed.

• How do we submit an N1 transaction?
  • We recommend contacting your pharmacy software vendor to determine how N1 transactions are to be processed.

• How can we identify claims we need to submit an N1 transaction for?
  • Report 29 will identify claims by payor if provided.
  • This report can be filtered down as needed by affected BINs.
  • Utilization Manager can also be filtered by BINs
  • We do not have a comprehensive list of ESI BINs and recommend contacting ESI to obtain any necessary information.

Macro Helix assumes no responsibility or liability for any errors or omissions in the content of this [list/report]. The information contained herein is provided on an "as is" basis with no guarantees of completeness, accuracy, usefulness or timeliness.

• How could this be scaled for the industry?
  • Industry compliance would require change to all switch providers and TPAs to successfully implement changes.
  • Simply put, this is bigger than any one entity.