White Bagging – a cost reduction strategy, but for whom?

A growing trend in infusion centers threatens the speed and safety of administering medication to patients.

Increasingly, insurance payers are requiring clinics to “white bag” medications. White bagging — so called because of the white bags in which pharmacies traditionally deliver medication — is a process in which the patient’s insurance company dictates which pharmacy can be used to dispense the medication. These specialty pharmacies are often owned or affiliated with the Pharmacy Benefits Manager (PBM) of insurance companies. This obligation to use the designated specialty pharmacy PBM is fraught with issues that impact patient safety and timeliness of treatment.

White bags can lead to delays in drug delivery. For example, patients may arrive at their clinic ready for their chemotherapy infusion only to be told that their medications have not arrived from the specialty pharmacy. Although the clinic’s infusion pharmacy regularly stocks this medication and has a supply ready for patients, white bags may result in delayed shipment as the clinic did not receive the medication in time for the scheduled infusion. of the patient due to the demands of the insurance company. A shipping delay can also occur if a patient has a change in medication dosage or treatment. To make matters worse, if the original drug has already been shipped, the white-packing process may prevent the drug from being returned. In this case, the patient must pay for both the original drug and the new prescription. Such situations could be avoided if the insurance company allowed the clinic’s infusion pharmacy to dispense the drug.

The added burden of white bag medication management creates several potential safety issues. The supplier needs to know when the drug needs to be reordered from the specialty pharmacy, especially if the order changes for any reason. It can be difficult to know the exact timing needed for the restocking process when the supplier has to work with an unknown pharmacy. Next, the clinic’s infusion pharmacy must ensure that orders have arrived, potentially from one of multiple specialty pharmacies, ensure that shipments arrive to match the patient’s treatment dates and that the correct drug and the right dose have arrived. The drug must then be stored separately, as drugs that arrive via the white bag method can only be administered to that specific patient. Since these medications in white bags are shipped to the clinic’s infusion pharmacy outside of the normal supply chain process, there is great potential for error.

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So why are insurance companies trying to push the white bag method? Cost savings are one of the reasons insurance companies give for pushing this process forward, but patients may end up paying more out of pocket for these drugs. To explain, in the event of a white bag, the insurance company may transfer the drug from the patient’s medical coverage to pharmaceutical coverage, where there is an increase in co-pays or other out-of-pocket costs and it may not be no maximum out-of-pocket out-of-pocket costs for drugs. Additional cost may be incurred by patients when the white bag medications have been sent to the clinic and the patient’s condition requires dose change or medication change. As previously described, medications sent will be charged to the patient and cannot be reused – they must be wasted. White bags may result in cost savings for the payer, but there are no cost savings for patients, and it creates significant barriers to care, waste, and disruptions in the patient-provider relationship.

In Minnesota, HF 3280 and SF3265 were introduced to prohibit insurance companies from requiring white bags for drugs that are typically administered at a clinical infusion center. This bill will prevent this process, which can ultimately cost extra money and harm patients. Please contact your state representative and senator to support this bill. Support for this bill will be crucial to allow physicians and patients to make the choice that is best for them, rather than being dictated by insurance companies.

Scott A. Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, is the director, Pharmacy Cancer Care at Mayo Clinic, Molly Skifstad, PharmD, MHSA, is the clinical director of acute care pharmacy with Essentia Health and Paul Forsberg , PharmD, MHA BCOP, is the Director of Pharmacy and Admix Services with Minnesota Oncology.

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