Report highlights yet another way insurance companies attempt to subvert health care providers, dictate medical treatment for at-risk patients
A report released Thursday by the Indiana Department of Health, in conjunction with the Indiana Board of Pharmacy, Indiana Department of Insurance, and the Indiana Family and Social Services Administration, identifies patient safety risks associated with insurer “white bagging” policies.
White bagging refers to the practice in which a health insurance company denies payment to a health care provider or pharmacy unless they obtain specialty infusion drugs, premixed and pre-labeled, from a designated pharmacy often owned by or affiliated with the insurance company. The practice prohibits clinicians from controlling the handling, preparation, dosage, and storage conditions of the drugs prior to administration.
As required by House Enrolled Act 1405, the report was submitted to the Indiana Legislative Council Thursday to inform lawmakers on the safety of white bagging and action they can take to regulate the practice. The Indiana General Assembly tasked state agencies with the report after hearing patient and provider testimony during the 2021 session claiming long delays in care resulting from white bagging policies, which some large health insurance companies have recently begun mandating.
A growing number of states have passed legislation or have taken administrative action to regulate the practice, including Louisiana, which passed a law last month banning health insurance companies from requiring drugs to be white bagged.
“Patients who are already dealing with catastrophic and life-altering illness should not be asked to suffer the additional distress and harm of delayed or missed treatment,” the report said. “Indiana has more work to do to protect and provide the best outcomes for our citizens.”
According to the report, “drug shipments can be delayed, sometimes by several days, thereby impacting chemotherapy schedules for oncology patients. Prior authorization and network issues not only place significant time and labor burden on health care personnel but also result in delayed treatment.”
The report identifies best practice guidelines, including legislative efforts other states have taken to regulate or prohibit white bagging.
“The Massachusetts report to the legislature concluded that drugs requiring sterile compounding by a pharmacist are not appropriate for white bagging as determined by [the Massachusetts] Board of Pharmacy.”
The report concluded by expressing the need for the Indiana legislature to take action to protect patients.
“The impact on patient safety, health outcomes, and overall cost to the system must be considered as policies are developed,” the report said.
Hoosiers for Safe Meds, a coalition of Indiana patient and provider organizations committed to protecting patients from mandatory white bagging, has called on state lawmakers to limit the practice, which they say threatens patient safety, delays care, and compromises the integrity of specialty drugs.
“Insurance companies have represented that these measures will reduce costs, but when it comes to patient safety, no cost saving measure is worth the risk,” said Darren Covington, Executive Vice President of the Indiana Pharmacists Association and Chairman of the Hoosiers for Safe Meds Coalition. “Given the rapid expansion of these policies, Indiana should move quickly to establish guardrails around these practices to protect the growing number of Hoosiers caught in the line of fire. Not only will these policies result in delayed patient care and wasted drug costs, but they will add administrative costs to the health care system due to rescheduling critically ill patients.”
Jessica Gendron, an Indianapolis resident who was diagnosed with breast cancer in February, says legislation is needed and will help patients like her who have been subject to white bagging. Gendron’s health insurance company stopped covering a white blood cell boosting shot she needed infused at the hospital in between chemotherapy treatments to help her rebound from chemotherapy quicker and allow her to receive more regular treatments.
“After two treatments my insurance company decided to stop covering the shot at the hospital and wanted to mail the drug directly to my home for me to administer myself, which my oncologist deemed extremely unsafe,” Gendron said. “The drug can be compromised during shipping and there’s no way to tell if the drug has dipped below the acceptable temperature. If I give myself a drug that was compromised, it can make me really sick.”
Gendron says she is most concerned for others with complex diseases who are not able to speak up and advocate for themselves.
“What’s most disheartening is that the only people who lose in this scenario are people like me who are really sick and not only need these drugs to conquer cancer, but they need these drugs to survive,” she said.
Covington says the report findings and best practice guidelines are a great place for policymakers to start as they consider legislative action next session.
“These aren’t just hypothetical situations, but patients’ lives are actually being impacted by this practice,” Covington said.
About Hoosiers for Safe Meds
Hoosiers for Safe Meds has come together to establish guardrails around mandatory white bagging practices to preserve quality and patient safety, and ensure care is not delayed for Hoosiers. The coalition serves patients across the state of Indiana and is made up of the following organizations: Indiana Pharmacists Association, Indiana Oncology Society, Indiana Academy of Dermatology, Indiana Academy of Ophthalmology, Indianapolis Coalition for Patient Safety, Indiana Rural Health Association, Indiana Organization of Nursing Leadership, Indiana Hospital Association, and the Indiana Radiological Society. To learn more, visit hoosiers4safemeds.com.