Indiana well being officers say “white sagging” must be regulated however should not calling for a ban
The report was released to the Indiana General Assembly earlier this month in response to an escalating battle between some health insurers, who say hospitals and doctors are often raising the price of specialty drugs by as much as 500%, which health care providers often find necessary for specialist care of patient cover.
Specialty drugs, including cancer chemotherapy drugs, make up only 2% of all prescriptions but account for nearly half of the country’s drug costs, the report said.
In response to hospitals and clinics increasing the prices of specialty drugs, some insurers, including Indianapolis-based Anthem, have urged healthcare providers to buy many of these drugs from certain specialty pharmacies at lower costs or lower their prices accordingly.
The practice of requiring hospitals to buy drugs from an outside pharmacy that delivers them pre-mixed is known as the nickname “white bagging”.
Anthem said Indiana patients and their insurers could save tens of millions of dollars if hospitals bought drugs at lower costs from outside pharmacies or if they lowered their specialty drug prices.
Hospitals, doctors and pharmacists say white packaging is difficult and disruptive to their operations – and often impractical.
In cancer centers, for example, patients are examined on the same day as their scheduled infusion. During the exam, the oncologist may need to change treatment plans – and the type and dosage of chemotherapy drugs – on site, rather than using drugs that have been pre-ordered from an outside pharmacy.
The new Indiana Department of Health report says few states have taken action to regulate or ban white bagging.
Louisiana was the first state to completely ban white sagging last month. New Jersey and Georgia have laws that prohibit driving or sending a prescription to a specific pharmacy.
“The practice of white bagging has produced many different experiences and outcomes for patients and their families, both positive and negative,” said the Indiana Department of Health report. “Dispatch of medication can sometimes be delayed by several days, which affects chemotherapy schedules for oncology patients. Prior approvals and network problems not only add significant time and effort to health workers, they also result in delayed treatment. “
The report included several examples of patients who died or suffered setbacks due to complications from white bagging mandates.
In one case, a patient with metastatic lung cancer was prescribed a drug. However, the insurance company required prior approval to enroll in a special pharmacy program.
“The total time it took to approve this application was two weeks, and the patient died before final approval,” the report said.
The report made no specific recommendations for lawmakers other than that any requirement by a health insurer to require white packaging “should be well planned, thoroughly communicated and should have several concessions for procedural exceptions in the interests of patient safety”. . “
It added that payers should have a “robust exemption” to accommodate a weather-related emergency, dose change or administrative issue.
The report was presented to the Indiana Legislative Council to educate legislators about the safety of white bagging and steps they can take to regulate the practice.
The report was prepared in collaboration with the Indiana Board of Pharmacy, the Indiana Department of Insurance, and the Indiana Family and Social Services Administration.
“Patients already struggling with a catastrophic and life-changing illness should not be asked to suffer the added stress and harm of delayed or missed treatment,” the report said. “Indiana has more work to do to protect our citizens and get the best results.”
The report found that drug deliveries can sometimes be delayed by several days, affecting chemotherapy schedules for oncology patients.
Hoosiers for Safe Meds, a coalition of patient and provider organizations based in Indiana dedicated to protecting patients from mandatory white pouches, has urged state lawmakers to restrict practices that they believe may compromise patient safety, delay care, and compromises the integrity of specialty drugs.
“Insurance companies have shown 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, in a written declaration.
In response, Anthem referred to a section of the report that highlighted the rising costs of health care and the need to address them.
“The development and approval of specialty drugs continues to grow exponentially with many new active ingredients in the pipeline,” the report said. “These agents are a major contributor to overall health care spending. … The problems identified in this report are just a symptom of a much larger problem: skyrocketing health care costs. Indiana needs to find a way to bring payer and vendor together to address the root of this problem to prevent Hoosiers from suffering the negative effects of the negotiations. “
State Rep. Steve Davisson, a Republican from Salem who is a pharmacist and vice chairman of the House Public Health Committee, said he was concerned that the white packaging could delay patient care because a hospital or doctor might put a drug on the Basis of an evaluation on the day of treatment.
“If you don’t get the infusion when it’s scheduled, it can delay treatment and affect a patient’s general health,” said Davisson, who is also a cancer patient and has undergone chemotherapy.
He said lawmakers will likely consider new laws to address the issue, but added that he was not currently aware of any bills on the issue.