How do 340B replenishment logic and Medicaid coordination create duplicate discounts?

Duplicate discounts arise when separate systems classify the same dispense differently across eligibility, claim adjudication, accumulator tagging, replenishment, and Medicaid billing. If payer flags, claim identifiers, or carve-in/carve-out settings do not carry through consistently, a claim can be replenished on the 340B account even though its Medicaid status made that treatment improper.