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September 18, 2018 | Blog

The “Buy-and-Bill” Model vs. the Pharmacy Benefit: How Do They Compare?

“Buy and bill” can represent a significant revenue stream for your customers.

But how well does your sales team understand this distribution and reimbursement model? Without the proper training on this topic, sales professionals may fail to adequately demonstrate their knowledge and credibility with specialists.

Understanding the Basics of Buy and Bill

How a specialty drug ultimately reaches the patient—and how it is paid for by that patient’s insurance—varies considerably depending on how it is reimbursed.

Currently, there are two main ways that a specialty drug can be reimbursed as it flows through the supply chain:

  • As a medical benefit through the “buy-and-bill” model
  • Or as a pharmacy benefit

But there’s a lot more to know about these models.

Going Beyond the Basics

To help sales professionals understand the different models—and their implications for their valued specialist customers—CMR Institute has developed a new training course on buy and bill.

This engaging training course was developed to complement your sales team’s knowledge and proficiency in the specialty drug market. Specifically, the buy-and-bill training course can help your sales team answer questions such as:

  • What are the differences between the medical benefit (buy and bill) and the pharmacy benefit?
  • What is the role of providers, distributors, and specialty pharmacies in each type of reimbursement and distribution model?
  • What is “white bagging” and “brown bagging”? How do these workarounds allow payers to reimburse specialty drugs under the pharmacy benefit rather than through the buy-and-bill model?
  • Which providers are most likely to find success with buy and bill?
  • Under which type of model are payers more likely to use prior authorization and other strategies to manage the cost of specialty drugs?

Contact us at solutions@cmrinstitute.org to learn about this course and our other Specialty Drugs training courses covering:

  • An Introduction to Specialty Drugs
  • Specialty Drugs: Stakeholders and Market Trends
  • Specialty Drugs: Distribution and Reimbursement
  • The Dynamics of the Specialty Supply Chain
  • The Cost of Specialty Drugs

Click here to discover how these specialty drug training courses can help your new and experienced specialty sales professionals better understand the business of specialty drugs.

 

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