THE VALUED VOICE

Koreen Holmes was eight months pregnant when she was diagnosed with cancer. Her experience trying to get her medications after her insurance company implemented “white bagging” has caused her to lend her name to Wisconsin Senate Bill 753, which would prohibit insurers from unilaterally mandating that patients have their drugs white-bagged. On Jan. 20, Koreen and her husband Nate had the chance to tell their story in front of the Senate Committee on Insurance, Licensing and Forestry.  “What cancer patient should have to go through this?” she asked.
 
Koreen and Nate were not alone in hoping to prohibit the practice. Not only did they have the support of their care team from HSHS, all told, over two dozen health care providers and patient advocates also testified, asking the Senate committee to support SB 753 due to the significant problems they and their patients have experienced with the process of white bagging. 
 
The practice that health care providers seek to prohibit relates to medications that need to be administered by a clinician, such as through an infusion. Health insurers are mandating that such medications be obtained through a separate pharmacy, outside of the hospital or physician office’s normal process for procuring, storing, preparing and handling those drug therapies. The medications are crucial in the treatment for a variety of conditions such as cancer, multiple sclerosis and rheumatoid arthritis. 
 
Throughout the testimony, doctors, pharmacists, nurses and patient treatment coordinators described the treatment delays, frustration, costs and problems that result from insurer-mandated white bagging.  Reedsburg Area Medical Center Director of Pharmacy Hannet Ambord said one of her patients had her medication delayed so many times that she just gave up, diminishing her quality of life and causing worse outcomes. Several of the other providers testifying were also pharmacists, including Carl Selvick from Fort HealthCare, who is himself a patient who relies on these medications. 
 
Opposition to the bill stemmed from insurers and employers who allege that hospitals mark up drug prices and lack transparency. Wisconsin Hospital Association Senior Vice President of Public Policy Joanne Alig challenged those assertions, noting that white bagging doesn’t lower costs for providers; it actually adds a tremendous amount of complexity and administrative cost to the system. Alig explained that the practice is being implemented unilaterally by insurers outside of the contract negotiation process. 
 
Bellin Health Executive Vice President and Chief Financial Officer Jim Dietsche described how his health system had just signed an agreement with one insurer, who then turned around and implemented white bagging within six months of that agreement. “When you sign an agreement, you expect those arrangements to be honored,” he said.
 
Rural Wisconsin Health Cooperative Director of Insurance Contracting Michael Ballinger said he checked with human resource staff at his organization to see if the insurer they use for their employee’s health care provided them with any information about the new white bagging requirements. They didn’t. “They say this is about cost savings,” he said. “But we didn’t get a premium reduction. Where are the savings?”
 
Health care providers described numerous instances of delays in medications arriving, drugs being wasted and overall concerns about safety. Insurers claimed there are exceptions to their policies to address instances when a medication doesn’t arrive on time, or for other problems. But time after time, health care providers challenged that assertion. HSHS Oncology Nurse Navigator Jessica Gugel described spending hours on the phone with the health insurance company trying to help Koreen and Nate Homes gain an exception for their case.  
 
“Due to the broad negative impact I have witnessed way too many times, I chose to come speak today,” said Aurora Health Care Director of Pharmacy Nick Ladell, speaking emotionally on behalf of all the patients he has worked with who’ve had their care negatively impacted by white bagging at Aurora West Allis Medical Center. “My heart is also pumping a lot, I wondered if this was going to happen because I’m normally a pretty good public speaker. I reflect on why my heart is pumping so hard, and it’s because it is so important.”
 
Many of those testifying were representatives from hospitals and health systems. Dr. Madelaine Feldman and Nilsa Cruz, both from separate independent rheumatology clinics and affiliated with the Coalition of State Rheumatology Organizations also testified in support of the bill.
 
Throughout the day, Senate committee members asked why the legislature should get involved in this issue. Hall Render attorney Todd Nova, who specializes in pharmacy practice matters, explained that “this is less about a private right of contract and more about the regulatory oversight of care delivery models being incentivized, or in fact, in most cases, being mandated by third-party payers.” 
 
In the end, Bellin Health Director of Oncology and Hematology Sarah Jensen noted that her organization currently allows white bagged drugs into their facility but isn’t sure how much longer they will be able to do that over concerns about whether it is safe for patients. “The question keeps coming up about what if we can’t fix it? I guess the alternative question is, what if nobody will provide it?"