340B Drug Program Reimbursement Calculator - Test

Published 01/23/2023


340B Drug Program Reimbursement Calculator

Average Sales Price

The 340B Drug Pricing Program allows certain hospitals and other healthcare providers to purchase drugs and biologicals (other than vaccines) that are administered in a hospital outpatient department from drug manufacturers at discounted prices.

Our interactive 340B Drug Program Reimbursement Calculation Tool will assist you in determining the expected reimbursement amount.

All items below must be true:
  • Facility is reimbursed under Outpatient Prospective Payment System (OPPS)
  • Drug has a status indicator K
  • Drug being subject to Average Sales Price (ASP) + 6 percent reimbursement methodology
  • Line-item billed with HCPCS modifier JG
Calculator Use
  • Select appropriate drug pricing year and quarter file for dates of service billed
  • Enter amount into ASP field
  • Calculator will return single unit reimbursement amount
Calculator Exceptions
Items below are not considered when calculating reimbursement:
  • Patient responsibility
  • Sequestration
  • Other primary payer
  • If drug is reimbursed under other methodology besides ASP + 6 percent
Calculator Explanation
  • (X/1.06) * 0.775 = reimbursement
    • X is ASP dollar amount, which includes a 6 percent markup
    • 1.06 is markup value
    • 0.775 leaves amount of reimbursement left (as opposed to calculating reduction, which would have used 0.225)
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