Comments on: Botox, mole checks, and third-party payers http://www.kevinmd.com/blog/2007/09/botox-mole-checks-and-third-party.html Tue, 14 Feb 2012 22:04:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2007/09/botox-mole-checks-and-third-party.html#comment-79828 Anonymous Thu, 06 Sep 2007 02:25:00 +0000 http://clients.emmense.com/kevinmd/2007/09/botox-mole-checks-and-third-party-payers.html#comment-79828 If ever there was an overpromoted and oversold product, it would be Botox. USD 500.00 for 100 units (or thereabouts) is the standard price. Allergan is the supplier, no generics. The drug has to be reconstituted in the entire 100 unit bottle and by units of 100 units at a time. Once dissolved, the drug needs to be used within four hours to remain within manufacturer's specifications for on-label use. Freezing of solubilized Botox has been done to extend the "life" of the drug and avoid waste, but doing so is an off-label use.<br/><br/>So the margin is made on efficient and convenient service, which means having to provide as many treatments as quickly as possible and to minimize waste. The drug can be dissolved in any concentration, but the limit in the 100 ml bottle is 8 cc liquid for a concentration of 12.5 units/ml. Most practitioners use 1.0 ml TB or insulin syringes that allow metering in 0.1 ml quantities. <br/><br/>Increasing the supply of providers will not likely do anything about the price of Botox. The drug is the most expensive component of the treatment and, because botulinum toxin A is an "orphan" drug, there are no competing suppliers. All most providers have to sell is their time to treat, whatever their qualifications. I suppose if your location is cheap to rent, your staff marginal, your ancillary supplies (syringes, swabs, needles) cheap enough, you could price lower than others, but at some point, that effort in not worthwhile. In the end, the cosmetic practice is still in competition with other practice activities. If it is only as profitable as everything else done, then there is no reason to pursue it above anything else. The only other reason to offer the procedure is as a "loss leader" to attract patients you believe will buy other more profitable services. Like any loss-leading strategy, that lind of practice has to bear fruit quickly and in quantity. If ever there was an overpromoted and oversold product, it would be Botox. USD 500.00 for 100 units (or thereabouts) is the standard price. Allergan is the supplier, no generics. The drug has to be reconstituted in the entire 100 unit bottle and by units of 100 units at a time. Once dissolved, the drug needs to be used within four hours to remain within manufacturer’s specifications for on-label use. Freezing of solubilized Botox has been done to extend the “life” of the drug and avoid waste, but doing so is an off-label use.

So the margin is made on efficient and convenient service, which means having to provide as many treatments as quickly as possible and to minimize waste. The drug can be dissolved in any concentration, but the limit in the 100 ml bottle is 8 cc liquid for a concentration of 12.5 units/ml. Most practitioners use 1.0 ml TB or insulin syringes that allow metering in 0.1 ml quantities.

Increasing the supply of providers will not likely do anything about the price of Botox. The drug is the most expensive component of the treatment and, because botulinum toxin A is an “orphan” drug, there are no competing suppliers. All most providers have to sell is their time to treat, whatever their qualifications. I suppose if your location is cheap to rent, your staff marginal, your ancillary supplies (syringes, swabs, needles) cheap enough, you could price lower than others, but at some point, that effort in not worthwhile. In the end, the cosmetic practice is still in competition with other practice activities. If it is only as profitable as everything else done, then there is no reason to pursue it above anything else. The only other reason to offer the procedure is as a “loss leader” to attract patients you believe will buy other more profitable services. Like any loss-leading strategy, that lind of practice has to bear fruit quickly and in quantity.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/09/botox-mole-checks-and-third-party.html#comment-79824 Anonymous Wed, 05 Sep 2007 23:49:00 +0000 http://clients.emmense.com/kevinmd/2007/09/botox-mole-checks-and-third-party-payers.html#comment-79824 It already is "expanded". <br/><br/>Dermatologists and plastic surgeons are not the only people doing Botox.<br/><br/>I know FP's doing it, GYN's doing it. <br/><br/>Dentists can inject Botox.<br/><br/>Depending on the state, naturopaths can do it. Google "naturopath" and "Botox". It is a natural product, and as such is within the scope of practice of a naturopath in many states. It already is “expanded”.

Dermatologists and plastic surgeons are not the only people doing Botox.

I know FP’s doing it, GYN’s doing it.

Dentists can inject Botox.

Depending on the state, naturopaths can do it. Google “naturopath” and “Botox”. It is a natural product, and as such is within the scope of practice of a naturopath in many states.

]]> By: N14http://www.kevinmd.com/blog/2007/09/botox-mole-checks-and-third-party.html#comment-79821 N14 Wed, 05 Sep 2007 20:36:00 +0000 http://clients.emmense.com/kevinmd/2007/09/botox-mole-checks-and-third-party-payers.html#comment-79821 This also begs the question of whether or not the supply of those that can legally engage in both the cosmetic as well as clinical aspects should not be expanded. Expansion of those that could legally perform the latter would increase the supply while allowing the providers to engage in their cosmetics practice. Expansion of those that could legally perform the former would increase competition in the field for those services and reduce their costs and thus make clinical work less of a burden on the providers. Of course, for either one to work, one would have to ensure that others performing said tasks would be independent of the competition killing "physician oversight." This also begs the question of whether or not the supply of those that can legally engage in both the cosmetic as well as clinical aspects should not be expanded. Expansion of those that could legally perform the latter would increase the supply while allowing the providers to engage in their cosmetics practice. Expansion of those that could legally perform the former would increase competition in the field for those services and reduce their costs and thus make clinical work less of a burden on the providers. Of course, for either one to work, one would have to ensure that others performing said tasks would be independent of the competition killing “physician oversight.”

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/09/botox-mole-checks-and-third-party.html#comment-79816 Anonymous Wed, 05 Sep 2007 17:25:00 +0000 http://clients.emmense.com/kevinmd/2007/09/botox-mole-checks-and-third-party-payers.html#comment-79816 Evaluation of a suspicious mole should be started at the primary care doc's office, where I'd be able to get the patient seen in a day or so.<br/><br/>You think you will get into a dermatologist office directly (without a referral)under the NHS? Get in at all, let alone in a timely manner. Evaluation of a suspicious mole should be started at the primary care doc’s office, where I’d be able to get the patient seen in a day or so.

You think you will get into a dermatologist office directly (without a referral)under the NHS? Get in at all, let alone in a timely manner.

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