Buy and Bill Trend: Are there Contradictions to Vendor or Pharma’s Reported Data

ObamaCare Problems

Buy and Bill Trend:  Are there Contradictions to Vendor or Pharma’s Reported Data

Distribution based sales of specialty pharmaceuticals raises critical issues for manufacturers and providers as plan year 2016 decisions have been made and 2017 preparations begin by purchasers.

  • For pharmaceutical manufacturers, the dilemma arises when (1) reimbursement is limited or eliminated under benefit coverage or (2) historical relationships with retail pharmacies for traditional or other products change as they develop a strategy to use a limited specialty pharmacy instead of the established channel(s).
  • For providers, the dilemma arises through the inability to bill for the drug to achieve the billing revenue desired—as an independent or health system.
  • Catching insurer/purchaser attention, the National Institute of Health reported healthcare spending about $120 billion on cancer treatment alone each year. If these costs are not properly managed, annual spending could soar to as much as $207 billion by 2020.

Buy and Bill has been dwindling down slowly recently due to benefit design changes (decreasing) as well as consolidation (increasing) impacting its use by providers. This has gained the attention and concern by employers. ACA implementation with risk corridors has had the effect to further delay the elimination of Buy and Bill when many thought it would be dead. But that has not eliminated the gradual decline.