What process verifies a patient's eligibility for the 340B program?

The process that verifies a patient's eligibility for the 340B program is commonly referred to as eligibility verification. This step is crucial for ensuring that the patient meets the necessary criteria laid out by the program to qualify for discounted medications. During this process, healthcare providers typically check several key factors, such as the patient's enrollment in a specific Medicaid program or their status as a low-income or uninsured individual, aligning with the requirements established by the Health Resources and Services Administration (HRSA).

Eligibility verification helps to ensure compliance and maintain the integrity of the program by confirming that patients indeed qualify for 340B pricing on their medications. This process often involves a thorough review of patient records and may include coordination with state Medicaid programs or other payer systems to affirm the patient’s eligibility status.

The other terms—eligibility assessment, eligibility review, and eligibility audit—while related to the verification process, do not specifically describe the direct act of confirming patient status for 340B participation. For instance, assessment and review might involve analyzing broader aspects of eligibility criteria, while an audit usually pertains to evaluating compliance or performance against set standards, rather than verifying individual patient eligibility.