Profile: BioScrip Inc (BIOS.OQ)
24 Jul 2014
BioScrip, Inc. (BioScrip), incorporated in 1996, is a provider of pharmacy and home health services, which partners with patients, physicians, hospitals, healthcare payors and pharmaceutical manufacturers to provide clinical management solutions and the delivery of prescription medications and home health services. Its platform provides service capabilities and the ability to deliver clinical management services, which offers patients a community-based and home-based care environment. Its core services are provided in coordination with, and under the direction of the patient’s physician. Its home health professionals, including pharmacists, nurses, respiratory therapists and physical therapists, work with the physician to develop a plan of care suited to its patients’ specific needs. Whether in the home, physician office, ambulatory infusion center or other alternate site of care, it provides products, services and condition-specific clinical management programs, to improve the care of individuals with complex health conditions such as gastrointestinal abnormalities, human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome (AIDS), cancer, iron overload, multiple sclerosis, organ transplants, bleeding disorders, rheumatoid arthritis, immune deficiencies and congestive heart failure. In April 2014, LHC Group Inc purchased two of its operating subsidiaries, doing business as Deaconess HomeCare and Elk Valley Health Services.
The Company’s Infusion/Home Health Services segment provides services consisting of home infusion therapy, respiratory therapy and the provision of durable medical equipment products and services. Infusion services include the dispensing and administering of infusion-based drugs, which require additional nursing and clinical management services, equipment to administer the correct dosage and patient training designed to improve patient outcomes. Home infusion services also include the dispensing of self-injectible therapies. Home health services include the provision of nursing services and therapy visits, private duty nursing services, hospice services, rehabilitation services and medical social services to patients primarily in their home. Its Pharmacy Services segment consists of its traditional and specialty pharmacy mail operations, community pharmacies and integrated pharmacy benefit management (PBM) services, which includes discount cash card programs. These segment operations are designed to offer customers and patients delivery of traditional and specialty pharmacy products and services. The services also include care management programs customized to each patient's care plan in coordination with the patient's physician.
Infusion / Home Health Services
The Company is a provider of home infusion services in the United States. Home infusion involves the preparation, delivery, administration and clinical monitoring of pharmaceutical treatments, which are administered to a patient through intravenous (into the vein), subcutaneous (into the fatty layer under the skin), intramuscular (into the muscle) and intra-spinal (into the membranes around the spinal cord) methods. Its home infusion services involve the intravenous administration of medications treating a range of acute and chronic conditions, such as infections, nutritional deficiencies, various immunologic and neurologic conditions, cancer, pain and palliative care. Its services are provided in the patient's home but may also be provided at outpatient clinics, the physician's office or at one of its ambulatory infusion centers. It receives payment for its home health services and medications pursuant to provider agreements with government sources, such as Medicare and Medicaid programs, Managed Care Organizations (MCOs) and other commercial insurance (together with PBMs, Plan Sponsors). The therapies provided are Parenteral Nutrition (PN), Enteral Nutrition (EN), Antimicrobial Therapy, Chemotherapy, Immune Globulin (IVIG) Therapy, Pain Management, Hemophilia and Respiratory Therapy / Home Medical Equipment. PN provides intravenous nutrition customized to the nutritional needs of the patient. PN is used in patients, which cannot meet their nutritional needs through other means due to disease process or as a complication of a disease process, surgical procedure or congenital anomaly. PN may be used short term or chronically.
EN provides nutrition directly to the stomach or intestine in patients who cannot chew or swallow nutrients in the usual manner. EN may be delivered through a naso-gastric tube or a tube placed directly into the stomach or intestine. EN may be used short term or chronically. Antimicrobial Therapy provides intravenous antimicrobial medications used in the treatment of patients with various infectious processes, such as HIV/AIDS, wound infections, pneumonia, osteomyelitis, cystic fibrosis, Lyme’s disease and cellulitis. Chemotherapy provides oral, injectable and/or infused medications in the home or the prescriber’s office for the treatment of cancer. Adjuvant medications may also be provided to minimize the side effects associated with chemotherapy.
IVIG therapy provides immune globulins intravenously or subcutaneously on an as-needed basis in patients with immune deficiencies or auto-immune diseases. This therapy may be chronic based on the etiology of the immune deficiency. Pain management provides analgesic medications intravenously, subcutaneously or epidurally. This therapy is administered as a continuous infusion through an internal or external infusion pump to treat severe pain associated with diseases, such as chronic obstructive pulmonary disease (COPD), cancer and severe injury. Hemophilia provides medications to patients with one of several inherited bleeding disorders. Respiratory Therapy / Home Medical Equipment provides oxygen systems, continuous or bi-level positive airway pressure devices, nebulizers, home ventilators, respiratory devices, respiratory medications and other medical equipment.
Patients are referred to the Company by physicians, hospital discharge planners, MCOs and other referral sources. Its medications are compounded and dispensed under the supervision of a registered pharmacist in a pharmacy clean room. The therapy is typically administered in the patient's home by a registered nurse or trained caregiver. Depending on the preferences of the patient or the payor, these services may also be provided at one of its ambulatory infusion centers, a physician's office or another alternate site. It has relationships with a range of MCOs and other Plan Sponsors to provide pharmacy products and services, including infusion services. These relationships are at a local or regional level. Its infusion services contracts provide for it to receive a fee for preparing and delivering medications and related equipment to patients in their homes. Pricing is negotiated in advance on the basis of average wholesale price (AWP) minus some percentage of contractual discount, or average selling price (ASP) plus some percentage. In addition, it receives a per diem payment for the service and supplies component of care provided to patients in connection with infusion services and a visit rate for the associated skilled nursing provided.
The Company conducts its home nursing and therapy services through state-licensed, as well as Medicare-certified agencies. Its healthcare professionals provide healthcare services to adult and pediatric patients in their homes, including those suffering from chronic and acute illnesses, those in recovery from surgical procedures and those who require monitoring or care for other reasons. Its services and program offerings are skilled nursing; wound care; oncology nursing and infusion nursing; rehabilitation services, which includes physical therapy; occupational therapy and speech language pathology; medical social services, and home health aide services. Its services are provided by registered nurses, licensed practical nurses, physical, occupational and speech therapists, infusion specialists, wound care specialists and social workers. Its home nursing offerings also include private duty nursing care, in which its nurses provide services on an hourly or shift basis, and intermittent nursing care, in which its nurses provide services on an irregular basis or for a limited period of time. Its nurses provide medical care to these patients through pain and symptom management, wound treatment and management, medication management, infusion therapy services, skilled assessment and observations of patients through home visits and telemonitoring and education to patients and family caregivers.
The Company owns and operates 33 specialty pharmacies, which include community pharmacies and mail order pharmacies. While all of its locations are able to carry both traditional and specialty medications and are able to treat people with a range of diseases and medical conditions, it focuses on serving patient populations with chronic and acute health conditions, including Auto-immune Therapies, Hormone replacement Therapy, Immunosuppressant Therapy, Anti-infective Agents, Respiratory Syncytial Virus (RSV) Prevention, and Anemia and Iron Binding Therapies. Auto-immune Therapies provide medications, such as monoclonal antibodies or tumor necrosis factor inhibitors to suppress the immune system in patients with disease processes associated with an over stimulation of the immune system, such as rheumatoid arthritis, Crohn’s disease, Multiple Sclerosis and Psoriasis. Hormone replacement Therapy provides medications, such as growth hormone for the treatment of short stature, HIV wasting syndrome, Crohn’s disease or as an adjuvant therapy in cancer patients.
Immunosuppressant Therapy provides medications to suppress the immune system to prevent the body’s inherant immune response. Immunosuppressant therapies are used in conjunction with transplantation (pre and post) to prevent rejection and in other immune mediated diseases. Anti-infective agents provide medications used in the management of HIV/AIDS, Hepatitis A, B and C and related complications. RSV Prevention provides Synagis, which is an intramuscular injection to children born prematurely and with incomplete pulmonary and / or cardiac function. The medication is administered monthly during the flu season each year until the child has sufficient capability to fight the infection.
Anemia and Iron Binding Therapies Provide medications used in the treatment of various types of anemias and cytopenias such as colony stimulating factors (erythropoietin, filgrastim or sargramostim). Also, medications used to bind excess iron post blood transfusions (such as Desferal or Exjade).
Patients generally are referred to the Company by physicians, hospital discharge planners, MCOs and other referral sources. The patients it services have prescription or medical drug coverage through commercial insurance, Medicare, Medicaid and/or other governmental programs, and are reimbursed by the patient's insurer at a pre-negotiated contracted rate or at its usual and customary rate for a specific drug and/or service provided to a customer. Its Pharmacy Services programs are designed for therapeutic outcomes for patients while achieving Plan Sponsors' and/or pharmaceutical manufacturers’ program goals. Its software and data management tools permit Plan sponsors, pharmaceutical manufacturers and physicians to access utilization data to manage better healthcare outcomes and measure cost, utilization, prescribing and other pharmacy trends.
The Company designs and administers clinical programs. Its bioscripcare patient care programs are designed to address the changing nature of chronic patient care by providing the optimal structure of patient care through consistent assessment and intervention, ongoing education and patient support, and adherence and persistence management, which result in improved patient quality of life and outcomes. Also, as part of its normal business operations for refill management, it initiates monthly telephonic interactions with patients during which it gathers robust data intended to improve patient health outcomes. Its programs incorporate Healthcare Effectiveness Data and Information Set, National Committee. Its programs remain dynamic through its focus on continual improvement. Its pharmacists review prescriptions presented for a patient against, which patient's medical history, his or her past and current medication usage, and clinical references known to the Company in order to ensure the therapy selected is clinically appropriate. If its pharmacists find a potential or actual problem, they contact the prescriber or patient to discuss that patient's case and alternative medications.
The Company consults on the purpose of each medication, how it works, and what adverse side effects may occur, as well as potential interactions between or among multiple medications. It also provides patients with information concerning how medications might influence their lifestyle and give them recommendations on how to fit drug therapies into difficult schedules and travel plans. It provides refill reminders to alert people when a prescription refill is due or to take their daily medication regimen. It contacts patients in instances of missed refills and alert physicians and other healthcare providers when the patient cannot be located. The management methodology applied to each specific therapy evolves to reflect such advances as new available treatments, revised treatment guidelines, and other market developments. It also provides traditional mail order pharmacy fulfillment, prescription discount card programs and integrated PBM services. These services are designed to offer employers, MCOs, Third Party Administrators (TPAs), and other Plan Sponsors delivery of pharmacy benefit plans, including the distribution of mail services for plan members who receive traditional maintenance medications.
Medication Dispensing and Distribution
The Company carries a range of prescription medications and dispense all prescription medications, including limited distribution drugs, for acute and chronic diseases and conditions. Its locations carry hard-to-find and hard-to-handle medications. It provides the drug product along with supplies and equipment needed for administration. Its pharmacies also deliver medications to physicians' offices for patient in-office administration. Its business is patient-specific dispensing, whereby it receives a prescription for a medication and bill the appropriate party or parties for reimbursement of the drug, which may include Plan Sponsors, manufacturers and/or the patient. Its traditional mail service pharmacy provides patients with medications, for home delivery from its national distribution center located in Columbus, Ohio. Customers may order prescriptions by mail, phone or Internet.
Billing and Coordination of Benefits
The Company’s pharmacies offer billing, patient reimbursement and coordination of benefits (COB) services under both a patient's pharmacy and medical benefits. Its pharmacy locations are contracted with federal and state governmental benefit programs including Medicare, Medicaid, and state benefit programs, such as AIDS Drug Assistance Programs, as well as other Ryan White-funded programs. Its COB services help patients with multiple sources of insurance and/or government assistance handle insurance billing and reimbursement challenges. It also works with a range of assistance organizations and pharmaceutical manufacturers to obtain this type of funding on behalf of its patients.
The Company competes with Walgreen Co., Apria Healthcare Group Inc., Medco Health Solutions, Inc., Omnicare, Inc., Gentiva Health Services, Inc., Almost Family, Inc., Amedisys, Inc., LHC Group, Inc., Express Scripts, Inc., SXC Health Solutions, Inc., Catalyst Health Solutions, Inc., CVS/Caremark Corp., AmerisourceBergen Specialty Group company, Wellpoint Inc., Cigna Corp. and Prime Therapeutics, Inc.
100 Clearbrook Road
ELMSFORD NY 10523