Buy and Bill Specialty Drug Challenges

Prescribers face significant threats and challenges as they manage patients being treated with buy and bill medications. Yet there are specific steps that brand teams can take to protect prescribers as they work together to support patients.

To start at the beginning, accessing, administering, and paying for specialty drugs presents challenges that often extend far beyond those associated with small-molecule medicines. As a result, manufacturers have deployed an array of support systems to assist key stakeholders. Most of these systems are aimed directly at patients, and rightly so; patients are the ultimate consumers and should be the primary beneficiaries.

But patients aren’t the only stakeholders that face serious obstacles as they attempt to navigate the specialty drug marketplace. Prescribers have their own set of hurdles to jump, especially when working with buy and bill medications. Indeed, for marketers of brands in the buy and bill space, proper support of prescribers begins with a solid understanding of the unique threats and challenges faced by prescribers in the specialty-drug arena.

Threats Prescriber Practices Face in Buy and Bill

Independent prescribers face significant threats as they participate in the buy and bill space. Let’s focus on three of the most important:

1. Competition for patients. Independent or physician-owned practices compete for patients against hospitals, hospital-owned clinics, and other provider types. And of late, they’ve been losing the fight. The Drug Channels Institute reported recently that specialty drug distributors’ revenues from independent physician offices has declined significantly, from 73% of sales in 2011 to just 45% in 2016. Conversely, the share from hospitals and hospital-affiliated clinics grew from 22% to 37% in the same time frame.¹
2. Shift to oral and self-administered specialty drugs. The shift to oral and self-administered drugs—especially common for new cancer therapies—can have a profoundly negative effect on a practice’s top and bottom lines as it loses crucial revenue from drug cost markup and administration fees.
3. Declining profit margins. As fee-for-service care (along with its direct revenue from drug cost markup and administration fees) gives way to bundled payments and value-based care, clinics’ profit margins are being squeezed more than ever before.

Together, these threats are conspiring to the point that poor buy and bill medication adherence can take a real financial toll on a practice. Joel Young, a Shreveport, Louisiana-based independent practice consultant with deep expertise in buy and bill management, puts it this way: “The financial strain in many practices has become so acute compared with prior years that even small variations in adherence cause a significant challenge to both contractual obligations resulting in higher acquisition costs and lost economic opportunity by the resulting smaller volume of drug purchases.”

What are the particular prescriber pain points in managing buy and bill brands?

Prescribers face at least four distinct pain points as they manage buy and bill brands:

1. Staff must help patients navigate support systems that are not patient friendly

Patient support systems, while deployed with the best of intentions, are often complex and confusing to patients. Further, few brands provide a “one-stop shop” for all of their patient support programs.

2. Office support is disjointed

Commonly, a brand’s various physician-facing support programs (e.g., benefits verification, benefits investigation, patient assistance programs, and copay support) are provided by different vendors, leaving office staff with the task of learning and managing systems from multiple sources.

3. Gaining patient access to medications is often painfully slow

In many cases, the delay in processing benefits verification, benefits investigation, and prior authorization assistance is so great that treatment selection is impacted.

4. The provider is at financial risk for the cost of the products

Buy and bill medications are expensive products that must be on hand when needed. This puts the practice in the position of being a warehouse and distribution center responsible for product ordering, inventory management, billing, and reconciliation. If not managed flawlessly, or if usage falters or shifts to alternative agents, the costs can be profound.

Young reiterates the threat these pain points represent to a practice: “These challenges can result in a myriad of increased downstream costs to the practice, such as increases in costs of inventorying multiple drugs, time spent with clinical education regarding multiple drugs, and potential for billing errors involving these lower volume drugs.”

What should brand managers do to help protect practice health?

Although brand teams can do little to reverse the three threats described earlier, there are several steps they can take to alleviate the four pain points.

1. Consolidate support services to reduce complexity. Rather than providing a disjointed set of support services that confuses patients and practices alike, bring these disparate programs together under a single integrated provider.
2. Go digital to streamline access. Provide a prescriber-facing hub portal interface from which a prescriber staff member can manage all your brand’s support programs.
3. Provide complete office-staff training. Deploy personnel—either on site or remote—to properly train key prescriber team members on all the facets of the elegant support system you’ve deployed.

With diligent effort, you can provide an integrated support system that will help your prescribers to assist their patients to get on and stay on their specialty medications. And in the end, patients and prescribers will reap the adherence rewards from continuing to have access to your brand. Young sums it up nicely: “Education of the basic business processes of an in-office dispensing program to the providers ordering the drugs and clinical staff fulfilling the orders are crucial to the success of this component of the practice. If providers understand the logic and impact of adherence, and know how to access key support services, they are more likely to manage buy and bill programs successfully.”

References:

1. Fein, A. Drug Channels Institute. “Specialty Distributors’ Customer Mix Changes As Physician Buy-and-Bill Fades.” February 8, 2018.