| Maintenance | Exclusions

This topic describes how 340B Architect processes purchases and why purchases go to your WAC account rather than your 340B or GPO account.  

WAC Accounts and 340B Architect

340B Architect evaluates each drug dose administered to a hospital patient. The system maintains three separate accumulations: 340B, GPO, and WAC and splits the purchases three ways.

Step 1 - 340B

Eligible purchases are deducted from 340B accumulations. If the quantity of NDC purchases exceeds the current 340B accumulation, the remaining purchase quantity is evaluated against GPO accumulations.  

Step 2 - GPO

Purchased quantities of each NDC are evaluated against GPO accumulations.

Step 3 - WAC

All remaining purchases that do not split to 340B or GPO are ordered on the WAC account.

The following purchases are sent to the WAC account:

• Doses dispensed to Medicaid outpatients if the entity carves out Medicaid
• Purchase volumes that exceed the quantities utilized by the hospital for inpatients and outpatients
• Undocumented 340B or GPO eligible NDCs
  Undocumented eligible NDCs can result from not separately charging for items. Items absent from the Crosswalk (such as NDCs/CDMs in Architect), undocumented wastage, etc.

Macro Helix does not populate the GPO Exclusion Exemption list without specific instructions from your pharmacy. When determining candidates for inclusion on this list, consider items purchased for your pharmacy that are not considered Covered Outpatient Drugs subject to the GPO Exclusion. You should independently confirm that all items included on the GPO Exclusion Exemption List are appropriate. If you have any questions about these elections, you are advised to seek legal counsel.

WAC Purchase Scenarios

Certain situations can cause a 340B or GPO eligible item be assigned to your WAC account.

The following examples depict why that occurs.

New Drug on the Market

A new drug is available on the market and is purchased by the hospital for the first time. The drug is not mapped in the 340B Architect Crosswalk, and it is sent to the hospital’s WAC account.

Item does not have a 340B Price in Drug Catalog

A hospital purchases an item that, while used for outpatients, does not have a 340B price in the drug catalog. This charge automatically goes to WAC.

Combined Charges

A patient receives a drug for an outpatient procedure. The drug is included in the procedure cost and is not identified separately in the hospital’s patient charge data or the data feed sent to Macro Helix.

Product Waste

A drug order is prepared for a patient, but it is then determined that the patient cannot receive the dose or they no longer require the drug. The pharmacy discards the medication and reorders inventory to restock the pharmacy’s supply. If waste is not charged to the patient and Macro Helix does not receive waste data, it will not contribute to accumulations and may result in excessive WAC purchases.

Unmarked Inpatient Filters

A hospital adds a new Inpatient type, but does not update it in 340B Architect. This causes all charges for this Inpatient type to go to the hospital’s WAC account.

Medicaid Outpatients in a Carve-Out Hospital

Outpatient Medicaid drugs cannot be purchased on 340B when the hospital is carving out Medicaid. At the same time, these outpatient doses are subject to the GPO Exclusion therefore preventing GPO replenishment. As a result, all outpatient Medicaid doses are replenished on WAC.

Insufficient Data Feed

A hospital is missing utilization data that should have been sent to Macro Helix, resulting in inaccurate accumulations.