Specialty Pharmacy Oncology Revenue Increasing at Expense of Buy and Bill Usage. The term “Buy and Bill” refers to the process of physician management of certain medicines, primarily specialty medicines or drugs that require injection or infusion. AMI reported in early 2018 that the Buy and Bill Process Will Continue to Diminish.
AMI’s new report, Specialty Pharmacy Oncology Revenue Increasing at Expense of Buy and Bill Usage, builds upon our February 2018 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.
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.
Recently, however, specialty pharmacies have been 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.
Specialty pharmacy focuses on high-cost, high-touch medication therapy for patients with complex disease states—cancer, multiple sclerosis, and many others. Every year, the number of oral oncolytics approval by the FDA has steadily increased. Recent industry research has shown that sales of specialty drugs, led by oncology, through distributors has decreased while sales through specialty pharmacies increasing. This increase will continue as more independent pharmacies focus on specialty drugs and hospitals and health systems, and food retailer launch specialty pharmacies.
Buy and Bill use is still an option but all signs and trends indicate that its use will continue to diminish due to the specialty pharmacy growth trend, and 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 new report “Specialty Pharmacy Oncology Revenue Increasing at Expense of Buy and Bill Usage” identifies the critical issues facing pharmaceutical manufacturers and providers and offers strategies to work with Employers for success in the evolving market.
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 Buy and Bill and what are the trends in purchasing and distribution of specialty drugs?
- What is Medicare Part B reimbursement for drugs?
- What is Site of Care and how does it impact Buy and Bill?
- What specialty pharmacies focus on oncology drug dispensing?
- What role do Employers play and what is their impact on the use of Buy and Bill?
The report’s Table of Contents includes:
Spending on Cancer Drugs – pg. 5
Cancer in the U.S – pgs. 6-7
Alternate Sites of Care – pgs. 8-9
Oncology – pgs. 10-13
Specialty Pharmaceuticals Distribution – pg. 14
Medicare Part B – pgs. 15-16
Buy and Bill – pgs. 17-25
- White/Brown Bagging
Specialty Pharmacy Oncology Dispensing – pgs. 26-28
Employers Role/Impact in Buy and Bill – pgs. 29-30
Conclusion – pgs. 31-32
References – pgs. 33-34
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
- 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
- Specialty Pharmacy Percent of Total Revenues that came from Cancer Drugs in 2016
- Year-to-Year Growth (2017-2016) in Specialty Pharmacy Revenue from Dispensing Cancer Drugs
- Ratings by Employers of their Understanding About How Cancer Care Affects the Workforce