Tomorrow the Joint Committee on Financial Services will hear testimony on An Act Relative to Specialty Medications and Patient Safety (S.695/H.1199), from Sen. Jason Lewis (D-Winchester) and Rep. Jon Santiago (D-Boston), which, if it becomes law, will finally seek to prohibit the use of “brown bagging” and put guardrails around insurer-compelled "white bagging."
Brown bagging is when a third-party specialty pharmacy dispenses a drug directly to a patient, who then transports the medication to a healthcare provider for administration. White bagging is when a third-party specialty pharmacy dispenses a drug and sends the drug directly to the hospital pharmacy or physician’s office. The provider stores the drug, and a clinician administers the drug to a patient.
What concerns patients and the hospitals that care for them about brown bagging is that there is strong clinical consensus that requiring patients to properly store and then transport a drug to their clinician for administration jeopardizes patient safety.
Under the white bagging model, when an insurer mandates that a drug be delivered, there are a number of concerns that may affect patient safety, including the drug chain of custody, timeliness of delivery in urgent situations, processes for storing and dispensing medications, and waste when there are unexpected changes in patients’ health status.
Insurers use white bagging because they can contract with third-party specialty pharmacies to purchase pharmaceuticals, removing the provider from the drug acquisition process. The insurers then reimburse the third-party specialty pharmacy for the drug and pay the provider only for the drug’s administration – even though the HPC found that third-party specialty pharmacy treatment methods have costs and cost-sharing amounts for patients that can vary widely.
S.695/H.1199 incorporates the recommendations of the HPC that insurers should not require brown bagging for any drug; that payers should offer home infusion as an optional benefit, not as a requirement; that insurance companies that require white bagging should ensure their third-party specialty pharmacies are using patient safety best practices and that they should offer site neutral payments, which can lower drug prices and reduce provider administrative expenses.