ACE Contract Pharmacy & Third Party Administration Flashcards
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Read the first 6 ACE Contract Pharmacy & Third Party Administration flashcards as text
What does TPA stand for in the context of the 340B program?
Answer: Third Party Administrator
TPA stands for Third Party Administrator, a vendor that manages 340B data and operations — such as split billing or claims adjudication — on behalf of a covered entity.
What is a key service that a Third Party Administrator (TPA) typically provides to 340B covered entities?
Answer: Managing split-billing software to identify 340B-eligible claims
TPAs commonly manage split-billing software systems that identify which pharmacy claims qualify for 340B pricing, separating them from non-340B claims.
When a TPA commits an error that results in a 340B violation, who is held responsible by HRSA?
Answer: The covered entity, which retains compliance responsibility
HRSA holds the covered entity responsible for all 340B compliance, regardless of TPA errors, because the entity cannot transfer its statutory obligations to a vendor.
Which of the following should be included in a contract between a covered entity and its TPA?
Answer: Data ownership, audit rights, breach notification procedures, and performance standards
A sound TPA contract should address data ownership, the covered entity's right to audit, breach notification timelines, and service level performance standards.
How should a covered entity evaluate ongoing TPA performance?
Answer: Through periodic audits, performance reviews, and reconciliation of 340B savings data
Covered entities should periodically audit TPA data, review performance against contract benchmarks, and reconcile reported savings to ensure accuracy and compliance.
What is a replenishment model as used by TPAs in 340B contract pharmacy arrangements?
Answer: A model where eligible prescriptions are identified and the covered entity orders replacement inventory at 340B prices
In a replenishment model, the contract pharmacy dispenses drugs from its own inventory, and after eligible claims are identified, the covered entity replenishes that inventory at 340B ceiling prices.