Buying and Billing Spravato: Is It Worth It?

Deciding whether to order Spravato (esketamine) from a specialty pharmacy or to buy it directly from the manufacturer and bill insurance can be a complex decision for many practices. There are several factors to consider before making this choice:

Key Considerations

1. Capital Investment:

   • Upfront Cost: Spravato is expensive. Ensure you have the necessary capital to cover its cost upfront.
   • Financial Risk: Be prepared to handle potential denied insurance claims for the medication.

2. Staffing and Administration:

   • Eligibility Verification: Adequate staff is needed to verify patient eligibility prior to every visit.
   • Inventory Management: A robust system for tracking inventory, usage, and cost is essential.
   • Revenue Cycle Expertise: Your billing company or staff must be well-versed in the revenue cycle process to navigate billing complexities effectively.

Advantages of Buying and Billing Spravato

1. Streamlined Operations:

   • Bulk Orders: By buying Spravato in bulk and keeping it in-office, you can eliminate the delays associated with ordering from a specialty pharmacy.
   • Availability: Always having the medication on hand ensures there are no shipping or pharmacy delays, allowing for quicker patient treatment initiation.

2. Efficiency and Patient Care:

   • Faster Turnaround: Patients can start treatment faster when you have Spravato in-office. Traditional pharmacy orders involve multiple steps, including authorization, coverage confirmation, and communication between the patient, pharmacy, and office.
   • Immediate Treatment: With approval for buy and bill, you can treat patients the same day their authorization begins, enhancing patient care and satisfaction.

Financial Considerations

1. Profit Potential:

   • Insurance Coverage: Profitability depends on the insurance plan covering the medication and your specific contracting agreement.
   • Fine-Tuned Process: Spravato can be very profitable if the process is optimized, patients are carefully selected, and follow-up is thorough.

2. Administrative Efficiency:

   • Time Management: Ordering from a specialty pharmacy requires significant time to place orders, check them in, send prescriptions, and track patient-specific inventory. In-office medication reduces this administrative burden.

Conclusion

While the upfront risk of providing Spravato in-office is high, the potential benefits are significant. Streamlined operations, faster patient treatment, and the potential for profitability make buying and billing Spravato an attractive option for many practices. Careful consideration of financial capabilities, staff readiness, and administrative efficiency is crucial in making an informed decision.