Specialty drug acquisition models

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Distribution

Administration

Reimbursement

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Buy-and-bill

HCP purchases the drug from a specialty distributor, allowing the product to be available on hand vs acquiring from a specialty pharmacy

HCP's office or alternate site of administration
(depending on payer requirements)

HCP submits reimbursement claim to payer for:

• Drug reimbursement

• Drug administration

NOTE: Medicare Part B requires that HCP-administered drugs must be acquired under the buy-and-bill method.

Distribution

Administration

Reimbursement

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Specialty Pharmacy

Brown bagging

• HCP sends a prescription (may be subject to PA)

• Patient pays applicable OOP and picks up the drug at a retail pharmacy, or specialty pharmacy ships it to the patient

• Patient brings the drug to HCP's office

White bagging

• HCP sends a prescription (may be subject to PA)

• Patient pays applicable OOP costs

• Specialty pharmacy ships the drug to HCP

• Self-administered drugs are administered by patients or caregivers at home

• HCP-administered drugs are administered in the HCP's office or an alternate site of administration

• Specialty pharmacy submits drug reimbursement claims to payer

• HCP submits reimbursement claims to payer only for professional services associated with drug administration, not the cost of the drug

• The drug may be billed under the patient's medical benefit

Click to learn about the alternative ways to administer specialty drugs.

Note: An HCP can be a physician's office, a hospital outpatient facility, a clinic, or an alternate site of administration.

OOP, out-of-pocket; PA, prior authorization.

Reference: Fein AJ. Published July 26, 2016. Accessed June 21, 2020. https://www.drugchannels.net/2016/07/how-specialty-pharmacy-is-penetrating.html

Reference: Fein AJ. Published July 26, 2016. Accessed June 21, 2020. https://www.drugchannels.net/2016/07/how-specialty-pharmacy-is-penetrating.html