Each acquisition model presents unique considerations1
Practice
considerations
Buy-and-bill1
Practice responsibilities
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Benefits investigations and prior authorizations (less common), if needed
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Ordering and purchasing the drug, managing drug inventory, and ensuring proper storage
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Assuming financial risk for inventory
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Submitting and tracking reimbursement claims for a drug and related professional services
Additional aspects
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Direct administration of product on hand
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Timely treatments (no delays due to third-party drug shipments)
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Potential to improve patient adherence to treatment
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Opportunity for immediate monitoring for any adverse events
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Ease of managing inventory
Practice
considerations
Specialty pharmacy2
Practice responsibilities
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Staff liaison with specialty pharmacy to ensure separate specialty pharmacy BI and approval in addition to HCP's normal BI process
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PAs, step edits, and other requirements based on pharmacy benefit design
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Letter of medical necessity, letter of appeal, and other remedies to justify treatment
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Potential delays in receiving and administering treatment
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Burden to destroy inventory of white-bagged product for patients who fail to keep appointments
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HCP bills for drug administration to capture drug acquisition via the specialty pharmacy
Additional aspects
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No financial outlay and risk with respect to drug reimbursement
References: 1. Fein AJ. Published October 14, 2016. Accessed June 21, 2020. https://www.drugchannels.net/2016/10/follow-vial-buy-and-bill-system-for.html 2. Fein AJ. Published July 2016. Accessed June 21, 2020. https://www.drugchannels.net/2016/07/how-specialty-pharmacy-is-penetrating.html