As we approach 2025, the 340B Program and the broader healthcare landscape are poised for significant shifts, especially with the planned rollout of changes to the Medicare Prescription Payment Plan.
What do these changes mean for current 340B providers, TPAs, and specialty pharmacies? And if you’re a healthcare provider interested in developing or expanding your 340B program, what can you expect?
At Remy Healthcare, we believe in being proactive, not reactive, so over the next 3 weeks, we’re bringing you our team’s top predictions for 2025 in the 340B / TPA space. Make sure to tune in every week for the next 3 weeks to get an exclusive peek into our crystal ball!
Medicare Changes in 2025 – An Overview
While change is constant, and no one really knows what the future will bring, impending changes to the Medicare Prescription Payment Plan have key players in the 340B and specialty pharmacy space paying attention.
With upcoming changes to Medicare’s Prescription Payment Plan, potential reclassification of key drug categories, and the growing importance of patient touch points in care models, healthcare providers must stay agile. These developments could impact everything from specialty pharmacies to FQHCs (Federally Qualified Health Centers), and understanding how to navigate them will be essential for maintaining patient care and financial sustainability.
Prediction 1: Certain Drug Classes May No Longer Be Classified as Specialty Drugs
An intriguing prediction for the future is that certain drug classes, such as antiretrovirals, CGRP antagonists, GLP-1s, pancreatic enzymes, and PCSK9 inhibitors, may not remain categorized as specialty drugs. If this happens, it could have significant implications for healthcare providers participating in the 340B Program.
Specialty drugs often come with higher costs and require more complex handling, but a reclassification could lower costs and broaden access for patients, especially within FQHCs and community health centers.
For healthcare centers, particularly those serving underserved populations, this reclassification might result in expanded access to critical medications that were previously restricted. Drugs like PCSK9 inhibitors (used to lower cholesterol) and GLP-1s (often prescribed for diabetes management) could become more affordable, giving providers the opportunity to offer these treatments to a broader patient base.
However, this shift also raises potential challenges. FQHCs and healthcare providers will need to stay informed about changes in drug classification and ensure they are optimizing their 340B purchasing strategies.
Without a clear understanding of which drugs qualify as “specialty,” there’s a risk of financial inefficiency or, worse, failing to meet patients’ medication needs.
What’s Next?
With the Medicare landscape changing rapidly, healthcare providers must remain adaptable to stay compliant and optimize patient care. Whether partnering with specialty pharmacies, navigating drug reclassifications, or enhancing patient engagement through telephonic touch points, the key to success is preparation.
To ensure your healthcare center is ready for whatever comes next, contact Remy Health today. Our team of experts will help you stay program-ready and position your organization for success in the evolving healthcare environment – no matter what the future brings!