Understanding Buy and Bill for Medical Dermatology: A Win-Win

Have you injected Dysport or Botox in your practice? Or perhaps your office sells sunscreens, supplements, or cosmeceutical skin care products? If you answered yes to either of these scenarios, then you or your practice manager are already familiar with the business strategy known as buy and bill.

Aaron Farberg, MD

The buy and bill process allows dermatology offices to provide essential medications to patients during their visits while managing the complexities of purchasing, billing, reimbursement, and regulatory compliance. It requires careful coordination among health care providers, insurers, and pharmaceutical suppliers to ensure patients receive timely and appropriate care.

Although the concept of buy and bill is well known to dermatology practices in the primarily aesthetic-focused areas mentioned above, I have found that relatively few practices use the same management techniques for medical applications. With the rising costs of providing medical services, it behooves all dermatologists and dermatology practice managers to be aware of, and have access to, all the buy and bill systems available to dermatologists. By incorporating buy and bill into both the cosmetic and medical aspects of my own private practice, I have been able to provide an overall higher quality of care for my patients. The differentiated level of service that buy and bill enables is in no small part due to the improvement in patient adherence that I have observed in my practice, which is a major factor for the success of our medical and cosmetic treatments alike. By having immediate access to the treatments that I recommend to my patients in the office, I can provide the tools they need to start treatment before they leave their appointment, and this has clearly improved my patients’ adherence to prescribed therapies.

At the same time, by appropriate incorporation of buy and bill that maintains high standards of compliance, dermatologists can increase office revenue without changing their medical and cosmetic practice patterns. I firmly believe that scaling up the use of buy and bill in dermatology will help enable all practices to continue providing high-quality care to patients with dermatologic diseases. Where in your medical practice can you appropriately advance your buy and bill skills?

Here are some treatments to consider:

Psoriasis Tildrakizumab-asmn (Ilumya) is covered by Medicare Part B, and the manufacturer allows you to use buy and bill with provided support from the company. The injection is administered quarterly, and many patients with moderate to severe psoriasis are appropriate and qualify.

Actinic keratosis (AK) Consider photodynamic therapy (PDT). Aminolevulinic acid (LevulanKerastick, Ameluz) is offered through a buy and bill process. I use a combination of treatments for my patients requiring field AK treatment, but many patients prefer PDT because the treatment takes only 1 visit.

Molluscum Cantharidin (Ycanth) can be offered as buy and bill. It allows consistent treatment and avoids the complications of needing to be washed off at a certain time.

Wounds/surgical defects For refractory or slow-healing wounds, consider a wound-healing graft. Many are available, and most of the companies that offer a product provide either a consignment or a buy and bill process.

These examples are selected from my own practice based on my existing treatment approaches where I have been able to incorporate buy and bill. Of course, each dermatology practice is different, and I encourage practice managers or owners to further explore potential options based on their current practice patterns. My recommendation for dermatologists interested in expanding buy and bill in their office is to contact the device manufacturers or pharmaceutical corporations for the products and medications that your practice and patients already rely on. It is possible that buy and bill programs are available from these manufacturers, and it is worth the time to ask directly for the products you have incorporated into your practice.

For those who are unfamiliar, the process is straightforward. Although specific approaches may differ among practices, what is required are basic accounting and accountability. First, someone is responsible for obtaining patient insurance authorization. For expensive products, such as wound grafts or tildrakizumab, the manufacturing company offers a preapproval portal that ensures and guarantees you will be reimbursed. Now, I am sure many of you are thinking this is a lot of work and that you don’t want to deal with inventory or be in sales. My response to this reasonable concern is simple: As dermatologists we constantly innovate and find new products to incorporate into our practice to improve the care we provide to our patients with skin diseases. Buy and bill can simply be an extension of the work you are already doing, and competent practice managers can incorporate these strategies based on your specific practice patterns and allow you to stay focused on your patients. Start with 1 buy and bill medical product, and give it a try.

Additionally, as in other aspects of practice management, success will require creativity and dynamism. For example, do you prescribe antibiotics for your patients? If so, it might make sense to consider recommending probiotics that can be purchased in office to mitigate gastrointestinal disturbances and dysbiosis. There is no rule that only the local pharmacy can sell such over-the-counter medications, and if it is part of your practice to recommend already, making it available for purchase in your office means saving patients an extra trip or errand and getting a jump on their comprehensive treatment. I will note that this approach is more marketing 101 than rocket science and can truly help our patients stay healthy: Position useful products in the right places at the times when people may need them. I will not propose how to fix our health care system in this brief article, but as the owner of a private practice, I have been required to search for ways to counteract the rising costs of running a successful dermatology practice. One way in which I have accomplished this is buy and bill. Thankfully, this does not take any significant act of brilliance; rather, I have done this by engaging with our practice management team and optimizing what my practice is already doing to provide the highest level of dermatology care for our patients.

Aaron Farberg, MD, is a double board-certified dermatologist, a Mohs surgeon, and chief medical officer at Bare Dermatology in Dallas, Texas. He joined the Dermatology Times Editorial Advisory Board in March 2023 and is currently serving as spring editor in chief.