According to the AHA, white- and brown-bagging policies "pose significant risks to quality of care as providers have inadequate control in ensuring patient access to high-quality drugs."(Photo: Shutterstock)
The American Hospital Association is asking policymakers to regulate several policies that health insurers use to manage prescription drug distribution to members. A number of large private payers use techniques called "white bagging" and "brown bagging" to manage how drugs are used in patient care, according to the association.
Through white bagging, private payers don't allow providers to procure and manage a drug for their patients but rather require a third-party specialty pharmacy to dispense the drug to the provider.
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Brown bagging is similar to white bagging, but the specialty pharmacy sends the drug directly to the patient, who brings it to their provider.
Both policies "pose significant risks to quality of care as providers have inadequate control in ensuring patient access to high-quality drugs, as well as the appropriate storage and handling of those drugs," the association said. "We urge policymakers to take action to ensure that access to quality care and drug therapies is not compromised through white- or brown-bagging policies."
It asks regulators to ensure that health insurers comply with the following policies:
- Prohibit brown bagging. Shipping pharmaceutical products that require provider administration directly to patients presents significant and serious patient safety issues. Specifically, there is no method to guarantee proper storage of these drugs, and the risk of drug diversion increases.
- Ban certain types of white bagging. Policies should be implemented that prohibit white bagging when the dosage or compounding of a pharmaceutical product depends upon the results of a patient's lab tests.
- Restrict other types of white bagging. The practice should be permissible only in instances where the provider and health plan agree through their standard negotiations that such arrangements are in the clinical best interests of the patient or when white-bagging policies are necessary to ensure patient access to a medication.
- Notify providers. Require payers to give sufficient and advance notice to providers to mitigate any gaps in critical information.
The association earlier criticized UnitedHealth Group and OptumRx in a letter to acting CMS Administrator Elizabeth Richter about such pharmacy policies but didn't specify an insurer in its most recent request to policymakers.
In a statement about the changes, UnitedHealthcare previously said: "As of Oct. 1, 2020, outpatient hospital providers in UnitedHealthcare's commercial network are required to source certain specialty drugs from indicated specialty pharmacies, unless otherwise authorized by UnitedHealthcare. This approach allows UnitedHealthcare to potentially eliminate unnecessary costs from the health-care system to help make health-care more affordable."
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Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
