News

Effective February 15, 2022: Payment Policy 340B Drug Payment Reduction

Date: 12/15/21

Ambetter from Superior HealthPlan presents a new payment policy to ensure that providers participating in the 340B Drug Pricing Program are correctly reporting 340B acquired drugs according to guidelines established by the Centers for Medicare and Medicaid Services (CMS). The following policy is scheduled for implementation, and is posted for review on Ambetter’s Clinical, Payment and Pharmacy Policies webpage:

POLICY	EFFECTIVE DATE	APPLICABLE PRODUCTS	NEW POLICY OVERVIEW
340B Drug Payment Reduction CC.PP.070	February 15, 2022	Health Insurance Marketplace (Ambetter from Superior HealthPlan)	For specific drugs acquired through the 340B program, providers are required to report either modifier “JG” or “TB” on these claims. Modifier “TB’ is reported for informational purposes. Modifier “JG” indicates the 340B drug is payable at a reduced rate of Average Sales Price (ASP) minus 22.5 percent.

POLICY

EFFECTIVE DATE

APPLICABLE PRODUCTS

NEW POLICY OVERVIEW

340B Drug Payment Reduction
CC.PP.070

February 15, 2022

Health Insurance Marketplace (Ambetter from Superior HealthPlan)

For specific drugs acquired through the 340B program, providers are required to report either modifier “JG” or “TB” on these claims.

Modifier “TB’ is reported for informational purposes.
Modifier “JG” indicates the 340B drug is payable at a reduced rate of Average Sales Price (ASP) minus 22.5 percent.

To review all payment policies, please visit Ambetter’s Clinical, Payment and Pharmacy Policies webpage. For questions or additional information, please contact Provider Services at 1-877-687-1196.