Pharmacy benefit managers are pushing policies called "white bagging" in cancer care, arrangements that could lead to increased spending, drug waste and worse patient outcomes, Debra Patt, MD, PhD, an oncologist and breast cancer specialist and executive vice president of Dallas-based Texas Oncology, wrote in a May 14 op-ed for the Austin American-Statesman.
White-bagging policies require clinicians to obtain physician-administered infusion drugs such as chemotherapy from specialty pharmacies owned by or affiliated with PBMs.
"Oncologists manage our on-site inventory so that when a patient arrives for treatment, the physician is able to carefully and precisely adjust treatment based on a patient's disease progression, toxicity, comorbidities or other unique factors," Dr. Patt wrote. "This allows licensed, accredited and certified oncologists to make dose adjustments using real-time information in a setting compliant with state and federal regulations. Not only is this the safest and most convenient option for the patient, but it is also the most cost-effective method, as the treatment is covered under the patient's medical benefit, which often has low cost-sharing requirements."
Under white bagging, oncologists are required to order infusion drugs from each insurer's exclusive specialty pharmacy in advance of the patient's arrival. The mail-ordered drug is highly vulnerable to delayed or damaged shipments, Dr. Patt wrote, and worse, patients may arrive for treatment and need their dose adjusted based on the day's bloodwork. Due to the white bagging system, the patient must go home and return later after the adjusted drug is reordered. The unused medication cannot be used on another patient and is thrown away.
"In addition to delaying patient care, white bagging results in higher patient costs. In plans with white bagging policies, specialty drugs like chemotherapies and immunologic drugs commonly used in cancer treatment often have higher copayment requirements," Dr. Patt wrote. "In fact, [white bagging policies] restrict patient choice, harm patient safety, delay patient care, create excessive drug waste and increase costs."
Texas lawmakers have introduced a bill that would protect patient choice and access to drug therapy by prohibiting a PBM or insurer from requiring a patient with a chronic, complex, rare or life-threatening medical condition to receive clinician-administered drugs from a PBM mail-order specialty pharmacy. The bill has passed the House and the Senate Committee on Health and Human Services.
"For the sake of our state's cancer patients, I encourage all Texas lawmakers to restrict insurers from implementing white bagging policies for patients with life-threatening conditions receiving care in physicians' offices," she wrote.