The End of Buy-and-Bill? What BCBS Policy Shifts Mean for Allergy Practices

Over the past few months, a growing concern has been surfacing in conversations with allergy practice owners, and it came up again in a recent client call.

The issue? Major payors, including Blue Cross Blue Shield (BCBS), are increasingly moving away from Buy-and-Bill models and pushing providers toward Specialty Pharmacy (SP) distribution.

For many allergy practices, this shift feels existential.

Let’s unpack what’s happening, why it matters, and what practices should be thinking about before making drastic decisions like selling to a roll-up.

What Is Changing in the Payor Landscape?

Historically, Buy-and-Bill has been a meaningful revenue stream for allergy practices. Providers purchased biologics, administered them in-office, and were reimbursed by payors, often with predictable margins that helped offset thin reimbursement elsewhere.

Now, payors are tightening control.

BCBS and other large insurers are:

• Restricting or eliminating Buy-and-Bill for certain biologics
• Mandating use of Specialty Pharmacies
• Routing medications directly to patients or clinics via SP networks

From a payor perspective, this is about cost containment and utilization control.

From a practice perspective, it’s about lost revenue and operational complexity.

Why This Hits Allergy Practices Especially Hard

Allergy practices already operate in a challenging financial environment:

• Declining reimbursement for office visits
• Rising staff and overhead costs
• Increasing administrative burden

Buy-and-Bill wasn’t just a revenue line; it was often a margin stabilizer.

When that disappears:

• Cash flow becomes less predictable
• Revenue shifts away from the practice entirely
• Administrative work often increases, not decreases

The result? Many independent practices start questioning long-term viability.

Is Selling to a Platform the Only Answer?

It’s not surprising that consolidation is accelerating. Large platforms like Allervie offer:

• Centralized contracting
• Scale leverage with payors
• Short-term financial certainty

For some physicians, that feels like the safest move, especially when the payor environment feels hostile.

But selling isn’t the only option. And it’s not always the best one.

The Bigger Picture: Buy-and-Bill Is Changing, Not Vanishing

Here’s the nuance that often gets missed:

• Not all drugs are moving to Specialty Pharmacy
• Policies vary by state, plan, and indication
• Reimbursement models are shifting, not disappearing

Practices that will remain successful are those that:

• Adapt workflows to SP-driven models
• Tighten operational efficiency
• Diversify revenue beyond drug margins

This is no longer just a clinical challenge; it’s an operational one.

Where Technology and Workflow Matter More Than Ever

As margins compress, efficiency becomes the differentiator.

Practices need to:

• Reduce staff time per visit
• Eliminate documentation bottlenecks
• Improve scheduling, follow-ups, and patient throughput
• Gain real visibility into payer-driven cost and revenue impacts

When you can’t rely on Buy-and-Bill to subsidize inefficiency, every minute and every dollar matters.

A Moment of Decision for Independent Allergy Practices

The payor universe is changing; there’s no denying that. But panic selling isn’t a strategy.

This is a moment for allergy practices to:

• Reevaluate their business model
• Understand true cost drivers
• Invest in tools and workflows that protect independence

The future may look different from what it did five years ago, but independent practices that adapt intelligently still have a path forward.