The criteria determining who qualifies for discounted medications under the 340B Drug Pricing Program center on the relationship between the patient, the covered entity, and the healthcare services provided. A patient is generally considered eligible if they have an established relationship with the covered entity, receive healthcare services from a healthcare professional employed by or contracted by the covered entity, and the services are consistent with the scope of the entity’s grant or designation. For instance, an individual receiving outpatient care at a hospital clinic that participates in the 340B program, and whose prescription is written by a doctor employed by that hospital, would likely meet the eligibility requirements.
Understanding these requirements is vital to ensuring the program’s integrity and preventing diversion, which involves distributing discounted drugs to ineligible individuals. Proper determination of eligibility helps covered entities maintain compliance and continue providing affordable medications to vulnerable patient populations. The evolution of the 340B program has involved ongoing clarification and refinement of patient eligibility criteria, responding to legal challenges and policy debates concerning program scope and intended beneficiaries.
