Earlier this yr, a younger man in his mid-thirties with non-Hodgkin’s Lymphoma got here to my oncology clinic for a chemotherapy infusion whereas ready on the event of his CAR-T remedy. Beneath regular circumstances, our apply can transfer rapidly when scheduling sufferers for his or her therapies since our in-office infusion clinic maintains a listing of obligatory medicines that we put together ourselves onsite. However, unbeknownst to me, my affected person’s medical insurance plan included a coverage known as “white bagging,”- a coverage which we quickly found after they denied one of many chemotherapy medication I prescribed.
Our scientific crew repeatedly appealed the denial; nonetheless, the plan refused to cowl the drug until it was fulfilled via an unspecified designated specialty pharmacy related to the affected person’s pharmacy profit supervisor. Finally, we have been in a position to negotiate protection via our apply’s inside stock, however by the point the affected person was in a position to obtain the drug 4 weeks had handed.
This intensive delay took a devastating toll on my affected person’s bodily and psychological well being and well-being. Worse but, some of these whitesAny delays in entry to care can result in illness development and worsen affected person outcomes. As an oncologist who has been in apply for over a decade, it’s deeply irritating to witness how insurers and their middlemen – pharmacy profit managers (PBMs) – stand between my sufferers and the therapies they want. “White bagging” is likely one of the most blatant examples of insurer and PBM insurance policies that disrupt and delay look after most cancers sufferers.
Historically, most cancers sufferers looking for care at a neighborhood oncology apply like mine might entry all of the medicines and infusions they want proper in our native apply, permitting them to obtain extremely customized care and tailor-made drug regimens.
But, insurers and PBMs are more and more implementing white bagging insurance policies, which require oncology practices to acquire physician-administered infusions and different medicines from designated specialty pharmacies usually owned by or affiliated with insurers and their PBMs. Which means oncologists should order these therapies from specialty pharmacies previous to a affected person’s arrival for remedy.
The pharmacy then should buy, put together, and ship the drug to our apply, which takes days. Furthermore, white bagging dangers the medication being broken or misplaced through the transport course of. Much more time is misplaced because of administrative delays attributable to prior authorization—a irritating course of via which insurers scrutinize and sometimes deny protection for the care that medical doctors resolve is finest for a affected person. When optimistic outcomes rely upon well timed entry to remedy, any delay is unacceptable.
On prime of complicating the drug supply course of, white bagging additionally ties oncologists’ fingers in the case of tailor-made remedy. As a result of the infusion dosage is predicated on blood work finished generally weeks earlier than its arrival at our apply, it’s not possible to regulate dosage primarily based on the newest blood work carried out on the day of remedy. If changes do must be made, your complete course of should begin over. Furthermore, as a result of that particular white bagged remedy can’t be used on different sufferers, it have to be discarded, resulting in an amazing quantity of medical waste.
Luckily, Delaware – the state the place I deal with sufferers – not too long ago prohibited specialty pharmacies from delivering white bagged medication, until the meting out pharmacist and prescribing doctor agree that such an strategy is within the particular person affected person’s finest curiosity. This reform will spare numerous sufferers from being compelled to endure the identical purple tape, delays, and devastating well being penalties that my affected person skilled because of white bagging.
Delaware’s consideration to this situation follows reform efforts in states like Texas, the place state policymakers not too long ago handed laws to restrict how and when insurers can use white bagging. Now, it’s time that each one states take discover and cross laws to guard sufferers from white bagging.
Relating to life-saving most cancers care, sufferers and their medical doctors – not their insurers or pharmacy profit managers – needs to be the final word decision-makers. I urge state legislators across the nation to ban white bagging mandates and enact laws to cease insurance coverage corporations and PBMs from forcing sufferers into this harmful apply.
Photograph: FatCamera, Getty Pictures
