Full-service TPA for covered entities: eligibility, implementation, contract pharmacy setup, claims capture, HRSA audit readiness, and manufacturer-restriction tracking — with performance-aligned pricing and zero base fees.
A 340B program is only worth what survives review. RxLeverage runs the administration end to end — registration through reinvestment reporting — so savings are captured aggressively and documented conservatively.
We confirm covered entity status, grant or designation documentation, and outpatient site eligibility before anything else — including child sites that need to appear on a filed cost report.
HRSA OPAIS registration inside the quarterly window, wholesaler and 340B account setup, policies and procedures written to match how your clinic actually operates.
Sourcing and contracting retail and specialty partners, negotiating dispensing terms, and registering each arrangement so it is on the public record before a single claim is captured.
Prescriber and patient-relationship rules applied to every claim, with duplicate-discount and diversion checks running before qualification — not after an auditor finds them.
Self-audits on a schedule, a complete claim-level audit trail, and documentation assembled in the format HRSA asks for — so a notice is an inconvenience rather than an emergency.
Contract pharmacy restrictions change constantly and quietly. We track them by manufacturer and by pharmacy, model the revenue impact, and adjust your network before the loss shows up.
Plenty of administrators sell you software and call it a program. These four things are the actual job — ask any TPA you are evaluating to walk you through all four.
Verify covered entity status, eligible sites, and prescriber relationships before promising savings. A TPA that projects revenue before confirming eligibility is selling you an audit finding.
Register with HRSA in the correct quarterly window, stand up wholesaler accounts, contract retail and specialty pharmacies, and write policies and procedures that match real operations.
Apply patient-definition and prescriber rules on the way in, screen for duplicate discounts and diversion continuously, and keep a claim-level trail that can be reproduced on demand.
Run scheduled self-audits, track manufacturer restrictions as they change, and report savings and reinvestment in terms your board, your grant officer and HRSA all recognize.
The usual TPA contract charges a monthly platform fee whether or not the program performs, which quietly transfers all the risk to the covered entity. We do not do that. There is no base fee — our compensation is a share of the savings the program generates, so a slow quarter costs us before it costs you.
340B is a federal drug pricing program, created under section 340B of the Public Health Service Act and administered by HRSA. Participating drug manufacturers must offer covered outpatient drugs to eligible safety-net providers at discounted prices. The savings stay with the provider, and the statute expects them to stretch scarce resources further — more patients served, more comprehensive services.
Eligibility is defined by federal grant status or hospital designation — not by need. It includes federally qualified health centers and FQHC look-alikes, Ryan White HIV/AIDS program grantees, STD and tuberculosis clinics, family planning and hemophilia treatment centers, and certain hospital classes such as disproportionate share, critical access, sole community and children's hospitals. If you hold a qualifying grant or designation, the first step is confirming which of your outpatient sites are covered.
No implementation fee, no monthly platform fee, no per-claim charge. Our compensation is a share of the savings your program actually captures. If a quarter produces nothing, we are paid nothing for it. It is the same arrangement we would want if we were sitting on your side of the table.
The gating factor is HRSA's registration calendar, not our build time. Registration happens in quarterly windows with participation starting the following quarter, so realistic timelines run about 60 to 120 days from kickoff to first captured claim, depending on where you land in the window and how quickly contract pharmacy agreements are executed. We do eligibility and documentation work in parallel so nothing waits on the window.
Restrictions have become routine and they change without much notice. We track them by manufacturer and by pharmacy, quantify what each one costs your program, and rework the network — which usually means shifting volume, adding a partner, or pursuing an in-house or specialty route — before the shortfall shows up in a quarterly report.
Bring your entity type, your sites, and your current contract pharmacy arrangement. In thirty minutes we will tell you what is capturable, what is exposed, and whether switching administrators is worth your time.