On April 14, 2020, Aimed Alliance sent a letter to members of Tennessee’s Senate Committee on Commerce and Labor in support of Amendment 1 to Senate Bill No. 2847. If passed, the bill would allow individuals covered under a medical or pharmacy benefit contract to obtain specialty medications from their health care provider’s office without insurers imposing additional or higher fees, copays, or coinsurance. Typically, individuals obtain a specialty medication from their provider though a practice known as “buy and bill,” whereby providers purchase medications in bulk through a specialty distributor and then bill the payer. However, health insurers are now beginning to require health care providers to purchase specialty medications through specialty pharmacies that ship medications to providers (i.e., “white bagging”) or directly to the patient who must then transport the medication to the provider’s office for administration (i.e., “brown bagging”). Amendment 1 to Senate Bill No 2847 would prevent insurers from 1) requiring white bagging and brown bagging; or 2) charging patients more if they choose not to comply with insurers’ white bagging and brown bagging policies.
White bagging requires the health care practitioner to order the patient’s medication during the first visit, and then for the patient to return to the office for a second visit for the medication to be administered. This process can result in delays in care, especially if the patient is unable to return to the health care practitioner’s office right away. White bagging also provides less flexibility to change medications or dosing regimens because the medication is not in stock and can result in increased administrative complexity. Between the time that the medication is ordered and the time the patient returns to the health care provider’s office to receive the drug, the required dosage or strength may have changed or the patient may have been transitioned to a different class of medication. Such an instance, in which the medication is no longer needed, results in waste.
Brown bagging can be even more problematic. Practitioner-administered specialty medications include biologics, biosimilars, and other medications that are complex to manufacture, prepare, and dispose of. They are often volatile and have strict handling and storage requirements that patients may not be equipped to meet. Failing to comply with such requirements can compromise the safety and efficacy of such therapies. Yet, a health care practitioner may not be able to determine visually whether the drug has been compromised during transit. Read Aimed Alliance’s letter here.