Community Health Collective Podcast Host: Jill Steeley Guest: Steve Weinman The 340B rebate pilot is happening, and it isn't a hospital problem. On October 1, HRSA approved 10 drug manufacturers to pay the 340B discount as a rebate instead of an upfront price cut, starting January 1, 2027. In this episode, Jill Steeley sits down with Steve Weinman, principal and CEO of FQHC Associates, to explain what changed since last year's pilot was blocked in court, how the rebate actually works (pay list price, file within 45 days, wait up to 10 more for your money), and why the drug list lands squarely on health centers: diabetes, AFib, COPD, and behavioral health drugs your providers prescribe every day. Steve's bottom line is "hope is not a strategy." There's a lawsuit and there are bills in Congress, but you plan as if this starts on January 1, the same day the Medicaid cliff hits and UDS season starts. Then he walks through seven moves to make now, starting with knowing your float, the dollar amount you'll have to front while you wait on rebates. The flip lands at the end: don't quietly adjust. If health centers make this look tolerable, it'll be 30 more drugs next year. This one is for health center CEOs, CFOs, and pharmacy leaders who need a plan, and a board briefing, before January. **Highlights:** - Where things stand: 10 manufacturers approved October 1, the pilot starts January 1, 2027, and a lawsuit and bills are already in play - What's different from last year's pilot, which a judge in Maine blocked as "hastily assembled" - How a rebate works compared to an upfront discount, explained with a $10 store coupon - Why 45 days to file isn't really 45 days once your contract pharmacy reports and your TPA get involved - The drug list: Jardiance, Farxiga, Januvia, Janumet, Tradjenta, Eliquis, Breo Ellipta, Vraylar, Austedo, and more - The January 1 collision: the rebate pilot, the Medicaid cliff, and the start of UDS season, all on one finance team - The good news: no denials for diversion or duplicate discount disputes, capped data collection, and required denial reporting - Seven moves to make now: know your float, call your wholesaler, pin down your TPA, re-check your sliding fee pricing, brief your board, log every late payment and denial, and keep a story log - Whether to change your formulary, drop contract pharmacies, or bring pharmacy in-house - Why the pilot is a test of how much health centers will tolerate **Quotes from the episode:** > "Hope is not a strategy. So yeah, we hope it'll be delayed, but we better be ready to deal with it." - Steve Weinman > "These are not some high-cost drug that's being used for chemotherapy." - Steve Weinman > "I would not switch TPAs right now because one of them will do it for a nickel cheaper." - Steve Weinman > "This pilot is just that. It's a test to see how much they can subject us to and get away with." - Steve Weinman **Mentioned in this episode:** Steve Weinman, Principal and CEO of FQHC Associates: https://www.fqhc.org, sdweinman@fqhc.org The 340B Rebate Pilot quick guide (how it works, what to do now, and which drugs are included): REBATE GUIDE LINK HRSA's 340B Model Pilot Program page: https://www.hrsa.gov/opa/340b-model-pilot-program Report late payments and denials to HRSA: 340Bpricing@hrsa.com Get in touch with Jill: jill@jillsteeley.com or schedule a call with her (https://calendly.com/jill-v7c/30min). ---