The Janssen Buy-and-Bill program is a streamlined approach for healthcare providers to acquire and administer SPRAVATO® (esketamine), a groundbreaking treatment for treatment-resistant depression.
Janssen’s Buy-and-Bill Program model allows healthcare providers to purchase SPRAVATO® directly from an authorized specialty distributor (SD), administer it to patients, and then bill insurance payers for both the medication and associated services.
This program is ideal for practices that want flexibility in managing their inventory and providing timely treatment to patients without waiting for shipments tied to individual prescriptions.
Key Features of the Janssen Buy-and-Bill Program
The Buy-and-Bill Program provides greater control over inventory and ensures patients receive timely treatment. Below are the detailed features of the program:
- Direct Purchase: Healthcare providers purchase SPRAVATO® directly in bulk from a specialty distributor. This allows practices to secure a consistent supply of the medication, ensuring they have access to it whenever needed for their patients.
- On-Demand Inventory Management: With the Buy-and-Bill model, providers maintain complete control over their inventory. This flexibility enables practices to treat patients as their needs arise, avoiding unnecessary delays and enhancing patient care delivery.
- Medical Benefits Coverage: The cost of SPRAVATO® is typically covered under the patient’s medical insurance benefit. This ensures that practices can offer treatment with minimal financial burden on the patient while reducing out-of-pocket costs for them.
- Comprehensive Billing Services: The program enables providers to bill for both the medication and the administration services associated with SPRAVATO®. This simplifies the reimbursement process, making it more seamless and efficient for healthcare practices.
How Does the Janssen Buy-and-Bill Program Work?
To successfully implement the Buy-and-Bill program, healthcare providers must follow a series of steps:
Step 1: Become a REMS-Certified Treatment Center
SPRAVATO® is a controlled substance that requires Risk Evaluation and Mitigation Strategy (REMS) certification. To participate in the Buy-and-Bill program:
- Complete the SPRAVATO® REMS certification process.
- Ensure your practice meets all state and federal regulations for handling controlled substances.
Step 2: Establish a Contract with an Authorized Specialty Distributor
Once certified, you need to partner with an authorized SPRAVATO® distributor. This involves:
- Selecting a distributor from Janssen’s approved list.
- Completing the “Know Your Customer Questionnaire” required by Janssen.
- Setting up an account with your chosen distributor.
Step 3: Conduct Benefits Investigation
Before administering SPRAVATO®, verify the patient’s insurance coverage:
- Determine if SPRAVATO® is covered under their medical benefit.
- Obtain prior authorization from the payer if required.
- Identify any out-of-pocket costs or co-payments that may apply.
Step 4: Purchase and Store Inventory
After approval:
- Order SPRAVATO® in bulk from your specialty distributor.
- Store it according to state and federal guidelines to ensure safety and compliance.
Step 5: Administer Treatment
On treatment day:
- Use your on-hand inventory to administer SPRAVATO® under direct supervision, as required by REMS.
- Document all necessary details, including dosage and patient response.
Step 6: Submit Claims for Reimbursement
After administering SPRAVATO®:
- Submit claims to the patient’s insurance payer for both the medication cost and related services (e.g., monitoring during administration).
- Use appropriate billing codes specific to esketamine treatment (e.g., S codes, J Codes, or G codes).
Step 7: Receive Payment
Once approved by the payer:
- Receive reimbursement based on your contract terms.
- Pay your distributor for the purchased inventory, factoring in any discounts or rebates offered by Janssen.
Advantages of the Janssen Buy-and-Bill Program
The Buy-and-Bill pathway offers several advantages for healthcare providers:
- Flexibility in Treatment Scheduling: With SPRAVATO® readily available in your inventory, you can accommodate patient appointments without delays caused by waiting for pharmacy shipments.
- Streamlined Reimbursement Process: The program simplifies billing by allowing providers to submit claims for both the drug and related services under one process.
- Enhanced Control Over Inventory: Practices can manage their stock efficiently, ensuring they have enough supply to meet patient demand.
- Eligibility for Discounts and Rebates: Janssen offers potential discounts or rebates for eligible providers, further reducing costs.
- Improved Patient Access: By maintaining an on-site inventory, you can help patients start treatment sooner, which is particularly important for those dealing with severe depression.
Challenges of Buy-and-Bill & How to Overcome Them
While the Buy-and-Bill model offers many benefits, it also comes with challenges:
1. Upfront Costs
- Practices must invest in purchasing inventory upfront before receiving reimbursement.
- Solution: Take advantage of Janssen’s discount programs or savings plans to reduce initial costs.
2. Complex Billing Process
- Submitting claims for both medication and administration services can be complicated.
- Solution: Use specialized billing software or partner with a medical billing service experienced in SPRAVATO® claims.
3. Storage Requirements
- As a controlled substance, SPRAVATO® requires secure storage facilities that comply with DEA regulations.
- Solution: Implement robust storage protocols and train staff on compliance requirements.
Billing Considerations for Spravato
Proper billing is crucial to ensure timely reimbursement and avoid claim denials. Here are some tips:
- Use Accurate Billing Codes: Ensure you use codes specific to esketamine treatment, not generic ketamine codes.
- Negotiate Payer Contracts: Work with payers to secure favorable reimbursement rates for SPRAVATO®. Highlight its clinical benefits and cost-effectiveness compared to other treatments.
- Monitor Reimbursement Trends: Stay updated on changes in payer policies or coding requirements that could impact reimbursement rates.
- Track Patient Eligibility: Regularly verify patient benefits and pre-authorizations before each treatment session.
2026 Billing Updates for SPRAVATO® Buy-and-Bill Claims
In 2026, healthcare providers must be extremely vigilant with Spravato coding and billing practices to avoid substantial financial losses. Many practices make common errors that reduce reimbursement.
Common Coding Mistakes
- Using standard evaluation and management (E/M) codes such as 99215, 99417, or other add-on E/M codes instead of the correct SPRAVATO® codes.
- Bundling medication and administration improperly, which leads to missed reimbursement.
Potential Financial Impact
- 56 mg SPRAVATO® dose: Incorrect coding can result in losing $600–$900 per claim.
- 84 mg SPRAVATO® dose: Incorrect coding can result in losing $850–$1,100 per claim.
This emphasizes the critical importance of accurate coding. Even small errors can accumulate into significant financial losses for a practice.
Correct Coding Practices
For Medicare or Medicare-following insurance plans:
- G2082: Use for 56 mg dose
- G2083: Use for 84 mg dose
For non-Medicare insurance plans:
- S0013: Use for both 56 mg and 84 mg doses
- Input the unit field as either 56 or 84, depending on the dosage administered
If your practice is doing Buy-and-Bill, separate CPT codes for physician work are not required, as the codes are bundled to include both medication and professional services.
Janssen Support Programs
Janssen provides additional support to help practices navigate the Buy-and-Bill pathway:
- Janssen CarePath: Offers resources like benefits verification, prior authorization support, and co-pay assistance programs for eligible patients.
- Savings Programs: Patients may qualify for savings cards that reduce out-of-pocket costs associated with SPRAVATO® treatments.
- Educational Resources: Access training materials on proper billing practices, REMS compliance, and inventory management through Janssen’s website or support team.
Conclusion
The Janssen Buy-and-Bill program simplifies access to SPRAVATO®, enabling healthcare providers to offer this life-changing treatment efficiently while managing costs and maximizing reimbursement potential.
By following the outlined steps, including becoming REMS-certified, partnering with an authorized distributor, conducting thorough benefits investigations, and adhering to proper billing practices, your practice can successfully integrate this pathway into its operations.
To further streamline the process and reduce administrative burden, FC Billing provides full-cycle Spravato billing services, whether your practice utilizes Buy-and-Bill, AOB, or both, delivering end-to-end support with a 100 percent claim payment guarantee.
