Earlier this 12 months, a younger man in his mid-thirties with non-Hodgkin’s Lymphoma got here to my oncology clinic for a chemotherapy infusion whereas ready on the event of his CAR-T therapy. Below regular circumstances, our follow can transfer rapidly when scheduling sufferers for his or her remedies since our in-office infusion clinic maintains a list of crucial drugs that we put together ourselves onsite. However, unbeknownst to me, my affected person’s medical health insurance plan included a coverage known as “white bagging,”- a coverage which we quickly found after they denied one of many chemotherapy medicine I prescribed.
Our medical crew repeatedly appealed the denial; nonetheless, the plan refused to cowl the drug except it was fulfilled by way of an unspecified designated specialty pharmacy related to the affected person’s pharmacy profit supervisor. Ultimately, we had been in a position to negotiate protection by way of our follow’s inside stock, however by the point the affected person was in a position to obtain the drug 4 weeks had handed.
This in depth delay took a devastating toll on my affected person’s bodily and psychological well being and well-being. Worse but, a majority of these whitesAny delays in entry to care can result in illness development and worsen affected person outcomes. As an oncologist who has been in follow for over a decade, it’s deeply irritating to witness how insurers and their middlemen – pharmacy profit managers (PBMs) – stand between my sufferers and the remedies they want. “White bagging” is likely one of the most blatant examples of insurer and PBM insurance policies that disrupt and delay take care of most cancers sufferers.
Historically, most cancers sufferers in search of care at a group oncology follow like mine may entry all of the drugs and infusions they want proper in our native follow, permitting them to obtain extremely customized care and tailor-made drug regimens.
But, insurers and PBMs are more and more implementing white bagging insurance policies, which require oncology practices to acquire physician-administered infusions and different drugs from designated specialty pharmacies typically owned by or affiliated with insurers and their PBMs. Which means oncologists should order these remedies from specialty pharmacies previous to a affected person’s arrival for therapy.
The pharmacy then should buy, put together, and ship the drug to our follow, which takes days. Furthermore, white bagging dangers the medicine being broken or misplaced through the transport course of. Much more time is misplaced because of administrative delays attributable to prior authorization—a irritating course of by way of which insurers scrutinize and sometimes deny protection for the care that docs resolve is finest for a affected person. When constructive outcomes depend upon well timed entry to therapy, any delay is unacceptable.
On prime of complicating the drug supply course of, white bagging additionally ties oncologists’ arms in the case of tailor-made therapy. As a result of the infusion dosage is predicated on blood work achieved typically weeks earlier than its arrival at our follow, it’s unattainable to regulate dosage based mostly on the newest blood work carried out on the day of therapy. If changes do should be made, the complete course of should begin over. Furthermore, as a result of that particular white bagged therapy can’t be used on different sufferers, it should be discarded, resulting in an amazing quantity of medical waste.
Happily, Delaware – the state the place I deal with sufferers – not too long ago prohibited specialty pharmacies from delivering white bagged medicine, except the allotting pharmacist and prescribing doctor agree that such an method is within the particular person affected person’s finest curiosity. This reform will spare numerous sufferers from being pressured to endure the identical pink tape, delays, and devastating well being penalties that my affected person skilled because of white bagging.
Delaware’s consideration to this situation follows reform efforts in states like Texas, the place state policymakers not too long ago handed laws to restrict how and when insurers can use white bagging. Now, it’s time that every one states take discover and cross laws to guard sufferers from white bagging.
In relation to life-saving most cancers care, sufferers and their docs – not their insurers or pharmacy profit managers – needs to be the final word decision-makers. I urge state legislators across the nation to ban white bagging mandates and enact laws to cease insurance coverage firms and PBMs from forcing sufferers into this harmful follow.
Photograph: FatCamera, Getty Pictures
