The medications involved in white bagging are prescription medications that patients typically cannot administer themselves. Instead, their doctor or clinician administers the drug at a hospital outpatient facility, a clinic or physician’s office. This is done because the medication may need to be infused or injected intravenously, and for safety reasons to monitor any negative side effects as the patient is receiving his or her medication.
 

Patients undergoing infusion treatment are already stressed. When the insurer, not the health care provider, dictates where medications come from, this can cause delays in care and treatment, charges for medications not received and difficulty for the health care provider to coordinate care and provide the best care for the patient. 
 
Medication is typically custom dispensed for a particular patient, and the dosage may need to change on the day of the patient’s appointment depending on the patient’s clinical indications. Changes to the dosage are impossible to predict. When the medication comes from a different pharmacy, the hospital’s pharmacy can’t change it.  This can cause a patient to need to reschedule his or her appointment and delay his or her treatment. Often, the medication then can’t be used, and the provider can’t use it for anyone else, so it gets wasted. The patient may be charged his or her copayment from the insurer’s pharmacy for the medication, even if it isn’t used. 
 
There have been reports of medication not arriving in time for the patient’s appointment.  Again, this causes the patient to have to reschedule and delays his or her treatment.  Hospitals have reported instances where this has happened so often to a patient that the patient has given up treatment altogether. 
 
Also, the insurer’s pharmacy may not have access to a patient’s electronic record and may be in another state altogether. With white bagging, the patient’s provider doesn’t have a relationship with that pharmacy. On the other hand, the patient’s hospital pharmacist knows the medications he or she has been prescribed, knows his or her medical condition and can work closely with his or her clinician to ensure the right medication is dispensed in the right dosage at the right time.

Unfortunately, insurance companies are giving patients and their providers no real choice. If patients want to continue to get their drugs from the local hospital and the hospital does not accept white bagged drugs because of safety risks, they will have pay for the full out-of-network cost for the medication. 
 
Patients may have to try to find an alternate site of care, but most patients want to work with their trusted provider and stay in their local area. If a patient has to find an alternate place to get his or her infusion, this could interrupt his or her care because the provider may not have all of the information they need about the required medication treatment. 
 
Some insurance companies are even requiring patients to get their drugs through home infusion, regardless of whether they want to do that or if their provider thinks it is safe.
 
Some hospitals are trying to make adjustments to allow for white bagged drugs, but they are finding many issues and even having to hire additional staff just to try to make it work. If a hospital still accepts white bagged drugs, patients run the risk of having treatment delays, canceled appointments and less certainty that their medication has been stored and handled appropriately before it gets to their provider’s office. 
 

Insurance companies are forcing these policies on patients, putting an insurance company and their own specialty pharmacy ahead of patient choice. In many instances, these changes have been forced on providers without negotiation. Even when this is done during negotiation, the insurance company is trying make the provider accept white bagged drugs—a process they know can be bad for patients. This is a “false choice” for hospitals and should not be allowed. Unfortunately, bad actors in the marketplace have made this issue into a public policy problem. 
 
White bagging should not be allowed unless all parties agree that the practice is safe, reliable and results in effective treatment for patients. Right now, due to insurer mandates, hospitals are faced with two bad options - don’t accept white bagged medications and stop caring for their patients or accept white-bagged medications when they know it causes treatment delays and poses safety risks for patients.
 

We recommend prohibiting white bagging. We recommend closing all loopholes so insurers can’t find a way to charge patients more or to not pay providers for these medications. We recommend prohibiting insurers from requiring patients to use home infusion. Ultimately, we recommend that the decisions about where and how to get clinician administered drugs rest with the patient and his or her provider, not the insurer.