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- Buy-and-Bill
News
Article
When and How to Employ the Buy and Bill Model
Key Takeaways
- The buy-and-bill process enables direct in-office medication administration, bypassing Specialty Pharmacies, and facilitating faster patient access to biologics.
- Insurance claims processing takes about six weeks, with Medicare being faster, while clinicians manage upfront costs using extended payment cycles.
Noor emphasizes that patient access is the primary consideration when deciding to use the buy-and-bill model.
During a Dermatology Times custom video series titled, “Understanding Buy and Bill for Medical Dermatology,”Omar Noor, MD, FAAD, a board-certified dermatologist on staff at Penn Medicine, shares his expertise on the buy-and-bill process. As a clinician utilizing the technique, Noor provided valuable insights into this evolving aspect of patient care.
"The buy-and-bill process allows dermatologists to purchase medications, administer them directly in-office, and seek insurance reimbursement," Noor explains. This approach bypasses the Specialty Pharmacy route, enabling faster access to biologics for patients who might otherwise face barriers. While limited to select medications, buy-and-bill can open doors to innovative treatment options for patients in need.
Noor highlighted the intricacies of billing and reimbursement, noting that insurance companies typically take about 6 weeks to process claims, with Medicare reimbursing faster. To manage upfront costs, Noor said clinicians often have a 90-day window to pay for the biologic, which can be extended to approximately 120 days by utilizing credit card payment cycles. This timeline helps practices avoid financial strain while ensuring continuous patient care.
A key success factor, according to Noor, is implementing a robust, safety-first model. "The main concern with buy-and-bill is the risk of insurance non-payment, given the high cost of biologics," he said. To mitigate this, Noor’s practice relies on a biologic coordinator to verify insurance coverage and collaborates with pharmaceutical field reimbursement managers. These experts confirm coverage details, including patient responsibilities, ensuring financial viability.
Noor emphasizes that the buy-and-bill model has been particularly successful in his practice for nearly 2 years, especially with tildrakizumab. "Financially, it’s been fantastic," he shares. By combining meticulous planning with strong partnerships, Noor demonstrates how the buy-and-bill process can be a practical and effective strategy for clinicians.
