Initiating and Navigating the Buy-and-Bill Process

During a Dermatology Times custom video series titled, “Understanding Buy and Bill for Medical Dermatology,” Omar Noor, MD, FAAD, a board-certified dermatologist based in New York City and New Jersey, shared his insights on implementing the buy-and-bill process in his practice, particularly for biologic treatments.

Noor emphasized the importance of establishing an efficient workflow when integrating the buy-and-bill system. He outlined the typical steps: identifying the best treatment option for the patient, issuing necessary blood work slips, and explaining the medication process. Patients then complete a hub form, which is processed by the practice’s biologic coordinator. This individual liaises with insurance companies to confirm coverage and handles any prior authorization requirements. For Medicare patients, prior authorization is not needed, and coverage details are usually confirmed within the same day. Noor said commercial insurance approvals typically take 24 to 48 hours.

Once coverage is confirmed, the medication is ordered and received the next day, ensuring minimal inventory management. Patients return promptly for injection, and billing is submitted immediately. Noor said Medicare reimbursements are typically processed within 2 weeks, offering a streamlined and predictable financial model. According to Noor, this approach can be surprisingly underutilized in dermatology despite its widespread adoption in other areas of medicine. He encourages clinicians to consult colleagues who use buy-and-bill to adopt and customize workflows for their practices.

Noor highlighted that while billing and reimbursement in dermatology are ever-changing, buy-and-bill provides a flexible and efficient model. He noted that manufacturers, such as Sun Pharmaceuticals with their biologic agent tildrakizumab, adapt to shifts in reimbursement rates and medication costs, ensuring the system remains viable for both physicians and patients.

Noor’s experience underscores the potential for buy-and-bill to enhance patient care and practice efficiency, particularly for biologics used to treat conditions like plaque psoriasis. His insights serve as a valuable guide for clinicians seeking to optimize their practice workflows and improve patient outcomes.