Why Relying on a Single TPA Could Be Costing You Millions
Third-Party Administrators (TPAs) are valuable partners — but they aren’t perfect. While they manage much of the heavy lifting in 340B programs, relying solely on a TPA can leave covered entities vulnerable to missed claims, lost revenue, and increased audit risk.
The Gaps in TPA Coverage
According to 340B Health, TPAs often operate with limited transparency, making it difficult for covered entities to:
Verify eligibility determinations.
Track claim-level details across multiple contract pharmacies.
Ensure HRSA’s patient definition is applied consistently.
Prepare fully auditable records in case of an audit.
The Government Accountability Office (GAO) has highlighted that incomplete TPA oversight reduces the full benefit of the 340B program, putting millions of dollars at risk.
How Halo340B Bridges the Gap
Halo340B’s Second Check Engine works alongside your existing TPA, not against it. By independently validating claim eligibility, Halo340B helps:
Identify missed claims that TPAs may have overlooked.
Recover up to 20% more eligible claims, based on industry benchmarks from Drug Channels Institute.
Provide real-time dashboards that quantify missed revenue opportunities.
Create HRSA-ready audit documentation with full transparency.
Example: A mid-sized FQHC recently used Halo340B to review six months of claims. The Second Check Engine identified $475,000 in additional eligible savings that had previously gone uncaptured.
Why Now Matters
Rising Drug Costs: Hospitals spend more than $115 billion annually on prescription drugs (American Hospital Association), amplifying the impact of every missed claim.
Manufacturer Restrictions: Continued limits on contract pharmacy discounts make claim capture critical.
HRSA Scrutiny: HRSA Program Integrity Updates show ongoing focus on contract pharmacy compliance and eligibility validation.
