Buy and Bill Use Decreases as 2020 Approaches. Understanding provider-administered drug reimbursement is an ongoing challenge for industry stakeholders. Providers, patients and payers face issues that need to be addressed by companies launching or selling products into this market.
The trend of Buy and Bill has been slowly decreasing due to a number of reasons, including: benefit design, Affordable Care Act (ACA) implementation with risk corridors, contracts among local and regional, rather than national stakeholders, and increasingly risk-sharing arrangements. Risk-based (value-based) or shared-risk contracting has become more important in order to achieve product success.
Historically, the data being reported on Buy and Bill use has lagged and has not accurately reflected the growth of risk-based reimbursement agreements with hospital or individual providers.
Commercial self-insured benefit plans are driving change demanding transparency and vendor contracting. This will have an increasing effect on providers who bill for drugs.
Employers are the major purchasers of care. The effect of the political environment, market fundamentals and employers’ impact on Buy and Bill through various innovative benefit designs will continue to accelerate.
The future of Buy and Bill will be different, as traditional use fades because the products lend themselves to experimentation for high-quality low cost. As the distribution mechanism for Buy and Bill changes it follows that previous incentives of Buy and Bill erode. Payer requirements on specialty drugs and use of options such as white bagging erode many incentives for the traditional Buy and Bill process.
Access Market Intelligence’s ongoing research and client advisory services has monitored the trend of Buy and Bill use and works with clients to minimize the impact it has on specific products in the market. The one certainty is that the percentage of Buy and Bill disruption is not uniform in the marketplace and it depends on a company’s specific product(s).