Caresource of oh buy and bill medications

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Having stock on hand allows for limited delays to administer medication. Patients can initiate therapy at their first visit. Additionally, physicians can make any necessary dosing adjustments without delays and interruptions from administrative duties. Although the promise of profitability is appealing, there are some risks and challenges that should be considered.

Implementing buy and bill does involve risk for the provider because they will be purchasing the drugs and processing claims in the office. Therefore, the provider must stock, manage, and bill these medications properly to be paid in an timely manner. In addition to the high risk, there is increasing competition. Specialty drugs are highly profitable and many players in the healthcare system are looking to get involved.

Many independent or physician-owned practices must compete for patients against hospitals, hospital-owned clinics, and other provider types. Recently, there is a shift from oral medications to specialty drugs and value-based care. This can lead to loss of revenue for prescribers. Consequently the drug cost is much higher for specialty drugs.

Administrative fees are more prevalent. Bundled payments limit the markup with value-based care. Buy and bill also comes with a higher need for inventory management, minimizing waste and liability for administration. This is also burdensome. Health systems with a small specialty population may face bigger issues in buy and bill. In cases where patients may discontinue the medication, do not show up for appointments, or are changed to an alternative drug, the health system may lose hundreds and thousands of dollars.

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