Deborah Dempsey, Pharm.D., MBA, on appealing 340B claims | PBMI 2026

It is very difficult for a plan sponsor to appeal a claim it believes was neither discounted under the 340B Drug Pricing Program nor rebated, according to Deborah Dempsey, Pharm.D., MBA, RPh, chief operating officer of ProAct, a mid-size pharmacy benefit manager headquartered in Syracuse, New York.

The clearest appeal opportunities come from healthcare entities that operate their own in-house pharmacy and therefore know their actual drug acquisition costs, Dempsey said in an interview with Managed Healthcare Executive last week at the 2026 Pharmacy Benefit Management Institute Annual National Conference in Orlando, Florida.

“They understand what the acquisition costs of their drugs are, and so when they know they're not getting it at that lower acquisition cost, they're then able to evaluate if they got a rebate on it, and when those two things don’t match up, that's where there's an appeal opportunity,” Dempsey explained.

Even then, the appeal process is difficult because of how long it takes to get the data needed to make that comparison, Dempsey said. Up to 12 months can pass between when a claim is submitted back to the manufacturer and when a rebate is returned, making it hard “to go back and follow the breadcrumbs to try to resolve disputes.”

340B discounts typically exceed the rebates drugmakers pay to pharmacy benefit managers, according to Dempsey. That difference means manufacturers are likely making less margin on a drug paid for through the 340B program than on a non-340B claim to which a rebate is applied, Dempsey said. Drugmakers might, therefore, have an incentive to steer drug claims away from the 340B program if they could, she noted. But the 340B program has grown. According to the Health Resources and Services Administration, the part of HHS that runs the 340B program, 340B covered entities purchased $100 billion in outpatient drugs covered by the program in 2025.

Dempsey spoke with MHE after participating in a panel at the PBMI conference titled “340B and the Employer: Rebate Erosion, Transparency and What Comes Next.” She was joined on the panel by Mary Bellanti, RPh, vice president of clinical strategy and sales at MedImpact; Karen van Caulil, Ph.D., president and CEO of the Florida Alliance for Healthcare Value; and Jeff Dunn, Pharm.D., MBA, president and CEO of NeosRx.