This model is common for treatments in specialties like oncology, retina care, and rheumatology. Senior Account Consultant, Retina - Hartford, CT

: Reimbursement is generally based on the Average Sales Price (ASP) plus a fixed percentage (typically ASP + 6%).

: Providers take on the financial risk of buying the drug upfront and must manage "reimbursement challenges," such as ensuring they are paid more than the acquisition cost.

: These drugs are typically covered under the Medicare Part B medical benefit rather than the pharmacy benefit because they require professional administration (e.g., injections or infusions).

In the context of Medicare Part B, "" is a reimbursement model where a healthcare provider—such as a doctor or clinic—purchases a drug or biologic from a distributor, administers it to a patient in an outpatient setting, and then bills Medicare (or another payer) for the cost of the drug and its administration. Key Features of Buy and Bill

: Clinics must handle complex logistics including specialty pharmacy operations, medical coding, and managing "procedure-based" therapy adoption.

: Unlike the pharmacy benefit (Part D) where a pharmacy manages the drug, the provider is responsible for ordering and maintaining the inventory.