Dangerous care delays to come if more insurers implement “white bag” policies


Consider the following scenario: A cancer patient presents to a community oncology clinic for her regular chemotherapy treatment. After completing the pre-treatment assessment, the oncologist determines that the patient’s dose needs to be adjusted. Maybe they need a higher dose than we used to give – a fairly common occurrence in the cancer treatment world.

But there is a problem. The doctor cannot just give the new dose of medicine right away, even if the office has it in stock. This is because the patient’s insurance company has implemented a policy called “white wrap” whereby all medications must be ordered and shipped from a specialty pharmacy to the office.

As a result, the doctor must place a new order with the insurer and the patient must return another time to receive their medication, which may take days or weeks later depending on availability of appointments. On top of that, the old medicine now has to be thrown away as it was individually prepared for that specific patient at that specific dose resulting in a huge amount of drug waste. Considering that community-based oncology practices treat hundreds of patients per year at each individual site, the overall potential wastage of drugs is staggering.

In recent years, insurers have begun to implement white packaging policies, as well as a range of other so-called “savings improvement” practices that, in the end, only guide patients to obtaining their medications through mail order and / or specialty pharmacies owned or affiliated with the Pharmacy Benefits Manager (PBM) of the plan. While insurers claim these policies are meant to cut costs, withdrawing the distribution of specialty drugs to physicians can lead to treatment delays and reduced quality of care, especially for cancer patients.

The delays in reimbursement caused by the management of PBM pharmacies are not a new phenomenon. We have often seen the impact of these related delays over the years with patients whose treatment plans include oral chemotherapy drugs. This is important to note, because although my clinic has not yet experimented with white bagging policies, we can refer to the error rates experienced by our patients in the mandatory PBM mail order policies and reasonably predict that there will be (at a minimum) similar wastes and delays with the white sachet infusion medications.

While the waste and delays in oral chemotherapy treatment are worrisome, our level of concern skyrockets at the thought of the damage caused by improperly dosed or delayed infusion drugs mixed off-site. Because there are so many nuances that go into determining the appropriate dose of an infusion drug for a patient on the day of administration, there is so much more possibility of error if these expensive and volatile drugs are not. not mixed in place. Any preparation error can lead to delays and without the ability to take advantage of an on-site prescription drug inventory to change doses in real time, these delays can derail a patient’s entire treatment plan.

A recent study by the British Medical Journal (BMJ) found that there is an established association between delayed treatment and mortality for the most common types of cancer: bladder, breast, colon, rectum, lung, cervical and head and neck. The study found that delaying treatment for only four weeks was associated with a significant increase in mortality in the surgical, systemic (treating cancer with drugs) and radiotherapy indications for these seven cancers.

Our country is already facing a crisis of delays in cancer care resulting from blanket cancellations of screenings and routine surgeries in the spring of 2020 as hospitals respond to the COVID-19 pandemic. The wave of delays is expected to hurt low-income and minority communities in particular. The white bags imposed by insurers and the crackdown on retail distribution only aggravate this problem.

Fortunately, some state lawmakers are working on a solution to protect patients from these harmful practices. House Bill 451, sponsored by State Representatives Scott Oelslager and Gayle Manning would prevent insurers from imposing white bag policies on state practices. This bill will ensure that cancer patients can get the care they need in a timely manner and will move insurance companies away from the doctor-patient relationship. I urge our state lawmakers to sign this bill and join me in ensuring that patient health and safety remains our number one priority.



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