A trend is growing in infusions centers that threatens the timeliness and safety of medication administration to patients.
Increasingly, insurance payers are demanding that clinics “white bag” medications. White bagging — called this because of the white bags in which pharmacies traditionally deliver medications — is a process in which the patient’s insurance company dictates which pharmacy can be used to dispense the drug. These specialty pharmacies are often owned by or affiliated with the insurance companies’ pharmacy benefit manager (PBM). This requirement to use the PBM designated specialty pharmacy is fraught with issues that impact patient safety and the timeliness of therapy.
White bagging can cause delays in medication administration. For example, patients may arrive to their clinic ready for their chemotherapy infusion only to be told that their medication has not arrived from the specialty pharmacy. While the clinic infusion pharmacy routinely stocks this drug and has a supply ready for patients, white bagging can cause a delay in shipment because the clinic has not received the medication in time for the patient’s scheduled infusion because of the demands of the insurance company. A delay in shipment can also occur if a patient has a change in medication dosage or therapy. To make things worse, if the original drug has already been shipped, the white bagging process can prevent the drug from being returned. In this case, the patient must pay for both the original drug as well as the new prescription. Situations like this could be prevented if the insurance company allows the clinic infusion pharmacy to dispense the drug.
The added burden of managing the white bagged drugs creates several potential safety issues. The provider must know when the medication needs to be reordered from the specialty pharmacy, especially if the order is changing for any reason. It can be difficult to know the exact timing needed for the reordering process when the provider has to work with an unfamiliar pharmacy. Then, the clinic infusion pharmacy must assure the orders have arrived, potentially from one of multiple specialty pharmacies, ensure that the arrival of the shipments matches the patient’s treatment dates, and that the correct drug and dose have arrived. The medication then has to be stored separately because drugs that arrived via the white bagging method can only be given to that specific patient. Since these white bagged medications are shipped to the clinic infusion pharmacy outside of the normal supply chain process, there is a large potential for error.
So why are insurance companies trying to push the white bagging method? One reason insurance companies give for pushing through this process is cost savings, yet patients may end up paying more out-of-pocket for these drugs. To explain, when white bagging occurs, the insurance company can shift the drug from the patient’s medical benefit coverage to the pharmacy benefit coverage, where there are increased co-pays or other out-of-pocket costs and there may be no out-of-pocket maximum for drugs. An additional cost may be incurred by patients when the white bagged drugs have been sent to the clinic and the patient’s condition requires a dose change or change in drugs. As describe previously, the drugs sent will be billed to the patient and may not be reuse – they must be wasted. White bagging may have cost savings to the payer, but there are no cost savings to the patients, and it creates significant barriers to care, waste and disruptions to the patient-provider relationship.
In Minnesota, HF 3280 and SF3265 have been introduced to prohibit insurance companies from demanding white bagging of medications that are typically administered in a clinic infusion center. This bill will prevent this process that can ultimately cost additional money and cause harm to patients. Please reach out to your State Representative and Senator supporting this bill. Support for this bill will be crucial to allow physicians and patients to make the choice that is best for patients — rather than being dictated by insurance companies.
Scott A. Soefje, PharmD, MBA, BCOP, FCCP, FHOPA, is the director, Pharmacy Cancer Care at the Mayo Clinic, Molly Skifstad, PharmD, MHSA, is the Acute Care pharmacy clinical manager with Essentia Health and Paul Forsberg, PharmD, MHA BCOP, is the director of Pharmacy and Admix Services with Minnesota Oncology.
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