01 · Intake
Eligibility, missed
340B signals — insurance status, encounter type, income, Medicaid — should be confirmed before the script is written. Most workflows confirm after, or not at all.
The math beneath the mission.
What the 340B Drug Pricing Program is, where most covered entities lose 20–30% of what they're owed, and the seven categories of recovery Velocity stands up — AI-native, on the systems you already have, with no capital, no IT project, and no vendor lock-in.
$81B
2024 program total
HRSA-reported gross spend across the program.
$66B+
Gross-to-net to CEs
Value flowing to covered entities through the program.
25
Methods catalogued
Across seven functional categories of recovery.
20–30%
Typical capture gap
Lost to data quality, eligibility, and shifting restrictions.
Where the dollars hide
Five places most CEs leak — every month, quietly.
Not theft, not fraud — just the natural friction between an unstable regulatory landscape, fragmented data, and a TPA stack that wasn't built to find every dollar.
02 · Data
EHR ↔ TPA mismatch
Patient, prescriber, and encounter records that don't reconcile across systems. Every mismatch is a dropped claim.
03 · Specialty
Referral leakage
Specialty referral scripts carrying $2,000–$20,000+ spreads quietly flow to outside networks. The highest-value scripts move the fastest.
04 · Engagement
Patient drift
Patients who drift out of your system stop being 340B-eligible the moment care fragments. Capture follows the relationship — and the relationship needs work.
05 · Restrictions
ESP & manufacturer rules
Manufacturer restriction policies shift quarterly. CEs that don't keep up lose entire drug classes — and sometimes don't realize it for months.
The Velocity recovery framework
Seven functional categories. One AI-native operating partner.
Twenty-five methods, organized into seven categories of work — all running on Velocity's AI-native infrastructure. We stand up the ones that move your numbers most, on the systems you already have, with no IT project to launch.
01 · Capture
Patient eligibility & intake
Verify 340B signals before the prescription is written — insurance, encounter type, income, Medicaid enrollment — in real time at the point of care.
Real-time intake
02 · Data
Matching infrastructure
EHR ↔ TPA reconciliation logic that catches mismatches before they become dropped claims. Higher capture rates, cleaner audit trails.
Data fabric
03 · Specialty
Specialty pharmacy & referral
Keep specialty referral scripts in-network. Where they have to go outside, capture the spread your CE earned.
Highest-spread scripts
04 · Engagement
Patient education & engagement
Persistent patient communication and education that lifts adherence, keeps 340B-eligible patients in your system, and turns one-time encounters into ongoing relationships the program is funded to support.
Across the lifecycle
05 · Pharmacy
In-house pharmacy
Where the volume and the mission justify it, build the in-house retail and outpatient infrastructure that captures the highest net margin.
For programs at scale
06 · TPA
TPA consolidation & reporting
One unified view across your administrators and contract pharmacies — reporting that actually informs decisions instead of confirming history.
Operational clarity
07 · Compliance
Audit, evidence & HRSA
Audit-ready evidence built into every encounter, not assembled at quarter-end. The documentation HRSA expects, ready when they ask.
Audit by default
+ Always-on
The AI infrastructure beneath
Documentation, clinical AI guidance, compliance, and revenue capture run as the structural layer underneath the seven categories — learning and adapting as rules and data shift.
Continuous evolution
The hardest part of 340B right now
ESP and manufacturer restrictions, plainly.
What's happening
Since 2020 a growing number of manufacturers have unilaterally restricted 340B pricing on certain drugs unless covered entities submit claims data through manufacturer-designated platforms (ESP and its successors). Each manufacturer has its own list, its own rules, and its own changes — quarterly, sometimes monthly.
The legal landscape is moving. The operational landscape isn't waiting. Covered entities that don't track restrictions across every manufacturer they buy from lose entire drug classes from their program, sometimes without noticing for months.
What Velocity does
- Maintains a current map of manufacturer restrictions across every drug your CE dispenses
- Flags claims that fall under newly-restricted policies before they become write-offs
- Where ESP-style submission is the path of least resistance, manages the submission cleanly
- Where it isn't, models the alternative and the trade-offs explicitly so leadership can decide
- Documents your stance and your evidence in case any of this gets audited or litigated later
Compliance, built in
Audit-ready, by default.
Evidence at every encounter — not assembled at quarter-end, not panicked together the week before an HRSA visit. Built into the workflow your clinicians and pharmacists already run.
The posture
Every 340B-eligible encounter generates the documentation the program requires at the moment it happens. Patient eligibility evidence, referral attestations, prescriber relationship records, dispensing details — all stored, all stitched to the source encounter, all queryable.
When HRSA shows up, the answer is already there. When a manufacturer challenges a claim, the chain of evidence is intact.
What that gives you
- Fewer surprises in audit cycles — known issues are flagged in real time, not discovered after
- Faster response to ESP-style data requests; the data is already structured
- A defensible compliance posture that scales with policy change instead of breaking under it
- Peace of mind for the 340B administrator, the CFO, and the board
How we engage
Aligned to your outcomes. No capital. No IT project.
The commercial model is built for non-profit reality. We earn when you earn — and you don't pay to find out whether it works.
Capital
None required
No software purchase, no infrastructure spend, no implementation fee.
Commercials
Gainshare-aligned
Velocity earns a share of the cashflow we recover for you. You keep the majority.
IT project
None to launch
Agents stand up on the systems you already have — EHR, TPA, pharmacy network, claims feeds.
Proof
45-day outcome
Pick the highest-value method first. Live in production by day 30. Outcome measured by day 45.
Want to size this for your CE?
Two routes: run the estimator yourself in two minutes, or have us walk it with you against your real eligibility and payer mix.
Want to check RHTP readiness too? Take the 8-question assessment →