The proposal
From ASP plus 6% to ASP minus 33.4%.
Beginning January 1, 2027, CMS has proposed a significant reduction in Medicare reimbursement for certain outpatient drugs purchased through the 340B Drug Pricing Program.
Under the proposal, reimbursement for applicable 340B-acquired drugs would decrease from ASP plus 6% to ASP minus 33.4%. This represents a 39.4-percentage-point reduction relative to ASP and could significantly affect hospital pharmacy margins.
Identifying the exposure is the easy part.
Rather than simply identifying reimbursement reductions, our approach evaluates opportunities to address those reductions through drug purchasing strategies, clinically appropriate therapeutic alternatives, and ongoing financial optimization.
The process
Five steps from exposure to action.
EngineRx works alongside pharmacy teams to analyze drug acquisition costs, utilization patterns, and reimbursement structures - helping uncover financial exposure and prioritize opportunities for improvement.
01 · COLLECT
Data collection & integration
Drug acquisition costs, utilization, reimbursement information, and purchasing arrangements - organized into one view of the hospital's pharmacy economics.
02 · ANALYZE
ASP reimbursement impact
Existing reimbursement compared against proposed or implemented ASP methodologies - identifying the drugs and categories facing the deepest margin compression.
03 · IDENTIFY
Therapeutic alternatives
Hospital pharmacists evaluate drugs under reimbursement pressure for clinically appropriate alternatives - weighing acquisition cost, reimbursement, utilization, and clinical considerations.
04 · MODEL
Financial modeling & prioritization
Pharmacists and data engineers model potential substitutions and purchasing strategies - quantifying savings and ranking opportunities by financial impact and clinical feasibility.
05 · IMPLEMENT
Support & ongoing optimization
Review of identified opportunities with pharmacy leadership, plus ongoing monitoring as costs, utilization, and reimbursement policies evolve.
All potential changes remain subject to the hospital's clinical review and formulary approval processes.
The result is a targeted set of recommendations designed to help hospitals make informed decisions.
The Vitalyze difference
Pharmacists first. Engineers alongside.
Vitalyze brings together the clinical experience of hospital pharmacists and the technical capabilities of expert data engineers to deliver sophisticated, pharmacy-driven financial analytics. Our approach is built around three core principles:
01
Designed by hospital pharmacists
Our analytical methodology is developed by hospital pharmacists who understand the clinical, operational, and financial complexities of hospital pharmacy management.
02
Supported by expert data engineers
Our data engineers work alongside hospital pharmacists to develop advanced analytical tools that evaluate drug acquisition costs, utilization patterns, reimbursement structures, and potential financial opportunities.
03
Focused on actionable results
We go beyond identifying reimbursement exposure. Our analysis identifies practical opportunities to optimize drug selection, reduce acquisition costs, and protect hospital pharmacy margins while maintaining clinical priorities.
Prepare for the future of drug reimbursement.
As Medicare reimbursement methodologies continue to evolve, hospitals and health systems need the analytical capabilities and pharmacy expertise necessary to anticipate financial challenges and respond effectively. Vitalyze's ASP Reimbursement Optimization service provides the insight needed to evaluate reimbursement exposure, identify clinically appropriate alternatives, and develop strategies to protect hospital pharmacy financial performance.