Buy and Bill Process Will Continue to Diminish in 2018!

Buy and Bill Process Will Continue to Diminish in 2018!

Buy and Bill refers to a provider purchasing the medication and then supplying the medication along with the service. Buy and Bill has been the primary method of distribution of specialty drugs, primarily IV oncology drugs, whereby oncology practices typically purchase these drugs from specialty distributors/group purchasing organizations (GPOs), which are then billed to payers under the medical benefit.

Payers make reimbursement decisions during traditional buy and bill that go to the physician’s office. In the traditional buy and bill process, relationships with the pharmaceutical manufacturer, drug wholesaler and GPO impact the price the product purchase at the amount that the product is billed.

Specialty pharmacies are making strong inroads into the buy and bill model via ‘white bagging’. White bagging is the method of delivery by which physician-administered drugs are dispensed by a specialty pharmacy (SP) for a specific patient, shipped to the physician for administration, and generally paid under the pharmacy benefit rather than the medical benefit. The payer for the drug reimburses the specialty pharmacy; the physician is only paid a drug administration fee.

Buy and Bill use is constantly changing and will continue to diminish due to benefit design changes, ACA implementation with risk corridors, contracts among local and regional, rather than national stakeholders, and the increase in risk-sharing arrangements.

AMI’s report “Buy and Bill Process Will Continue to Diminish in 2018” identifies the critical issues facing pharmaceutical manufacturers and providers and offers strategies to work with Employers for success in the evolving market.

AMI works with clients on a customized basis to help determine the impact on specific products and develop a strategy to take advantage of the change in reimbursement.

AMI’s new report answers the following: 

• What are the current and future cancer trends in the U.S.?
• What role does the oncologist play in the use of drugs in treatment ?
• What is Medicare Part B reimbursement?
• What is Buy and Bill and what are the trends in purchasing and distribution of specialty drugs?
• What is White and Brown Bagging?
• What role do Employers play and what is their impact on the use of Buy and Bill?

The report’s Table of Contents includes:

Cancer in the U.S – pgs. 5-7

Oncology – pgs. 8-12

• Oncologists
• Treatment
• Drugs

Medicare Part B – pg. 13

Buy and Bill – pgs. 14-22

• Background/Trends
• White/Brown Bagging
• Distribution
• Purchasing

Employers Role/Impact in Buy and Bill – pgs. 23-25

Conclusion – pgs. 26-27

References – pgs. 28-29

The report’s Tables and Figures includes:

• Estimated Number of New Cancer Cases in U.S. in 2018
• Percentage of Personalized Medicines Approved by the FDA
• Percent of Chemotherapy Drug Administration Claims in the Hospital Outpatient Setting
• Oral Drug Distribution Channels
• Percentage of Oncology Drugs Distributed Through Various Channels
• Components and Relationships with “Traditional” Distribution and Reimbursement Buy and Bill Mechanisms
• Basis for Physician Reimbursement Under Buy and Bill for Cancer Type Drugs
• Share of In-Practice Administered Drugs Purchased in 2015 by Source
• Oncology Practices Sourcing Some or All Drugs Through Specialty Pharmacies
• Components and Relationships with “Updated” Distribution and Reimbursement Buy and Bill Mechanisms
• Ratings by Employers of their Understanding About How Cancer Care Affects the Workforce
• Top 10 Health Conditions Costing Employers the Most

AMI published a new report in September 2018, Specialty Pharmacy Oncology Increasing at Expense of Buy and Bill Usage, which builds upon this report and focuses on the increasingly important role that specialty pharmacies are playing in the dispensing of oncology drugs, at the expense of Buy and Bill usage.