Lead Product Designer
Full time, remote
Feb 2018 – Present
Lead Product Designer
Automating transactions in healthcare with blockchain.
Mediledger was established in 2019 by leading companies in the life sciences and healthcare industry and is powered by Chronicled. We combined blockchain technology and advanced cryptography to be the ultimate privacy-first platform for healthcare trading partner transactions
Annual spend under the 340B program has grown by 700% in the last 10 years to $35 Billion, and the number of Contract Pharmacies participating in the 340B program has grown from 1,200 to 28,000 in the same time frame. This has led to an escalating issue of manufacturers paying out Medicaid rebate claims on drugs where a 340B discount was already applied, also known as a duplicate discount. Multiple pharmaceutical manufacturers have now put in place Medicaid claim requirements and/or 340B discount restrictions in an effort to solve the duplicate discounts problem. Healthcare providers are now facing a growing list of unique requirements from different drug manufacturers that seems unsustainable, and could increase administrative burden and decrease drug access to eligible patients.
- Pharmaceutical Manufacturers
- Covered Entities under the section 340B(a)(4) of the Public Services Act
- State & Federal Agencies administering 340B/Medicaid Programs
340B Eligibility Summary
Currently, there is uncertainty on how to manage 340B-based eligibility with the recent shifts in the approach to Contract Pharmacies. Even without Contract Pharmacies, there are significant gaps in communicating 340B Contracts as it requires significant manual work to maintain 340B Covered Entities. This can drive misalignment on eligible customers, leading to chargeback disputes and increased reconciliation time.
Future State Summary
The MediLedger 340B Eligibility Solution will help Manufacturers manage and communicate exhaustive 340B Eligibility, including Contract Pharmacies, providing the Wholesaler with complete confidence in the eligible customers and chargeback submissions. MediLedger Claims & Credits will also enforce 340B specific adjudication rules to ensure chargeback claims are adjudicated accurately and efficiently.
The solution will be broken down into several primary features detailed below. An existing integration empowers each feature to the HRSA database which includes both Covered Entities and Contract Pharmacies.
Contract Pharmacy Exception Management
MediLedger will provide a UI to help identify Contract Pharmacy exceptions from the entire list of Contract Pharmacies provided by HRSA. These exceptions can be managed at a global or contract level. This will allow a Manufacturer user to denote specific Contract Pharmacies as exceptions, which are then placed into specific contracts and then communicated using MediLedger Contract Communication.
This will help to significantly reduce the manual work and coordination required to maintain and communicate exception Contract Pharmacies by utilizing a centralized streamlined location.
Contract Pharmacy External Integrations
Several Manufacturers utilize specific avenues to determine if a Contract Pharmacy should be identified as an exception. These can be applications or documents submitted by the pharmacy itself or an external source such as 340B ESP.
MediLedger can help automatically consume these documents that signify a Contract Pharmacy as an exception and display this in the UI, impacting eligible contracts downstream.
Contract Eligibility Determination
MediLedger will facilitate a Manufacturer user to configure eligibility rules for 340B contracts in the node. For example, these rules can be based on COT or Market Segment.
Once Contract Pharmacy exceptions have been identified, MediLedger will automatically run the configured Contract Eligibility rules against the entire HRSA database and the Contract Pharmacy exception list. This will construct an exhaustive contract eligibility list for each 340B contract and communicate said contract to all applicable wholesalers. MediLedger will consistently maintain the eligibility list as changes occur in the HRSA database.
340B contract eligibility will no longer have room for misalignment between trading partners; Wholesalers will know precisely which Covered Entities and Contract Pharmacies are eligible for chargebacks. This removes the need for Manufacturers to maintain the HRSA database records in their current RM/ERP system.
340B Chargeback Adjudication
Once 340B contracts have been communicated accurately, MediLedger will enforce 340B specific adjudication rules at the ZKP layer to ensure 340B chargeback claims are adjudicated accurately in real-time. For example, MediLedger can enforce that 340B IDs are provided for Contract Pharmacies and that there are exact address matches for a claim to be approved.
This will allow Manufacturers and Wholesalers to focus on legitimate disputes and managing the membership processes.