We have our own tribally owned pharmacy today. How would your 340B enhancement service model impact our control—and what are the benefits to us?
Control remains 100% with the Tribe—while operational and financial benefits increase.
Our 340B enhancement service model is designed to support and strengthen tribally owned pharmacies, not replace or take over operations. The Tribe retains full ownership, governance, and decision-making authority across all aspects of its pharmacy and 340B program.
We act as an operator-first partner, providing enhancement services that include people, process, technology, and compliance that complement existing pharmacy teams. Tribes can begin with foundational 340B capabilities, and phase in additional capabilities over time, such as specialty and infusion therapy, based on readiness and priorities.
Benefits to the Tribe include:
- Reduced administrative and operational burden on pharmacy staff
- Faster optimization of 340B purchasing and compliance workflows
- Improved financial performance without sacrificing control
- A flexible model that scales as internal capabilities grow
- Significant ROI that begins within the first month of rollout and scales quickly
The result is a partnership that reinforces tribal self-governance, strengthens pharmacy operations, and expands long-term clinical and financial value—without compromising sovereignty or control.
Can tribes operate an in-house 340B program on their own without relying on outside vendors—and how does that compare to your 340B enhancement services model?
Yes, tribes can operate an in-house 340B program independently. In practice, however, a do-it-yourself approach often means tribes must manage multiple vendors while also handling many operational, compliance, and administrative responsibilities internally.
A fully self-managed model commonly requires tribes to:
- Coordinate multiple vendors for 340B compliance support, audit readiness, and split-billing software
- Rely on manual or semi-manual purchasing processes to determine the better of 340B or Prime Vendor pricing
- Manage reporting, issue resolution, and compliance oversight largely in-house
Absorb significant operational and administrative workload within the pharmacy team
While this approach can successfully deliver foundational 340B value, it often limits the Tribe’s ability to fully optimize the program due to time, staffing, and resource constraints.
Our 340B enhancement services model preserves full tribal ownership and control while helping tribes maximize the full value of the 340B program. Beyond foundational access, we help tribes:
- Build out specialty and infusion services to capture higher-value medications
- Optimize purchasing and inventory strategy through automation
- Assist with payor contracting and alignment to improve reimbursement and sustainability
- Reduce fragmentation through a more integrated operating model
The difference is not control—both approaches preserve it—but the ability to move beyond basic 340B participation and unlock the program’s full clinical and financial potential with less strain on internal teams.
We only have an in-house tribal clinic today. Do you help with full establishment and operation of a 340B pharmacy—and when is it reasonable to expect profitability?
Yes. We support tribes through the full lifecycle of establishing and operating a tribally owned 340B pharmacy—from feasibility and setup through launch, operations, and long-term optimization. The Tribe retains full ownership, governance, and decision-making authority at every stage.
Profitability timing varies, but many tribes experience:
- Initial ramp-up: approximately 6 months
- Break-even profitability often within 12 months, depending on patient volume, payer mix, purchasing optimization, and specialty capture
- For tribes that qualify for startup awards and/or 105(l) lease funding, break-even can often be achieved within a few months of opening, as these funding sources can materially offset startup and early operating costs. Sky works closely with FaceRock to help tribes identify, evaluate, and execute on eligible grants and funding to improve early cash flow and maximize overall project ROI.
Can your 340B solution benefit the Tribe’s W-2 enterprise employees covered under a self-insured health plan?
Yes. When structured appropriately, our 340B solution can create meaningful value for a Tribe’s W-2 enterprise population covered under a self-insured health plan, while remaining compliant with 340B program requirements.
A tribally owned 340B pharmacy may:
- Lower prescription drug costs for the self-insured health plan and protect the plan from future lasers
- Improve access and convenience for W-2 employees filling prescriptions
- Reduce plan leakage by keeping utilization within the tribal system
- Enhance visibility into pharmacy and medical spend to support better plan management
We work closely with tribal leadership, pharmacy teams, legal counsel, and plan administrators to ensure 340B eligibility, patient definition, and compliance requirements are met and that pharmacy operations align appropriately with the Tribe’s health plan structure.
The result is a coordinated approach that can reduce overall plan costs while strengthening the Tribe’s healthcare and economic ecosystem.