Minnesota lawmakers must protect patients from harmful insurance tactics | Opinion

March 22, 2022 6:00 am

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When insurance companies restrict how cancer patients can access the infusion medications they need, patients lose.

So I was pleased to hear that Minnesota lawmakers are taking up legislation that would put a stop to this increasingly common practice. The tactic is called “white bagging” — and it’s a growing trend that threatens patient access to treatment, puts patient safety at risk, and needlessly drives up costs for everyone — all so insurers can save money on the backs of patients.

Normally, when a cancer patient is treated in a community oncology practice like mine, they would receive all the chemotherapy medications they need right there at the office using medications that are already available. Many of the patients I treat require a highly personalized treatment plan, requiring us to consistently monitor and adjust the regimen in order for it to be safe and effective.

But this isn’t possible if the patient’s insurer has a white bagging policy in place. Instead of allowing oncologists to utilize the drugs they already keep on hand, the insurance companies force physicians to obtain their medications from an outside specialty pharmacy selected — and often owned  — by the insurer.

Cancer patients must then wait for their medications to arrive in the mail — which can sometimes take days or even weeks — before coming in to have them infused.

You can already imagine all the logistical headaches a process like this could cause if there’s a shipping delay, and a patient arrives at their scheduled appointment before their medications are ready. And, what if the patient has to have their dose adjusted on the day of treatment? They’d be out of luck. The practice would have to submit another order to the specialty pharmacy and tell the patient to come back another time. Then the medications that had previously been ordered would have to be thrown away — a total waste!

2019 analysis from the research group Drug Channels found white bagging tactics are a widespread and growing feature of the U.S. health care system. About 28% of oncology drugs administered in hospital outpatient departments were delivered via white bagging.

Although cancer patients are particularly vulnerable, the problem is pervasive throughout the entire health care system. A whopping 43% of non-oncology drugs are caught in the crosshairs of white bagging. The COVID-19 pandemic has likely exacerbated this problem in recent years, as more care shifts to hospital outpatient or home infusion settings where white bagging is more entrenched.

Delayed care as a result of white bagging can lead to lasting harm to patients. Research shows that delaying treatment by just four weeks is associated with higher mortality rates for seven different types of cancers. Sadly, these delays hit low-income and communities of color particularly hard, as these areas already suffered from a lack of access to care prior to the pandemic.

On top of that, white bagging opens the door to all sorts of patient safety risks. Because the patient’s medications are mixed offsite at an unfamiliar pharmacy, the oncology provider no longer maintains control over the chain of custody. Under white bagging, we can’t know how drugs are being prepared, handled and shipped and are unable to verify that everything has been done properly.

So, one might ask, why would insurers implement such a risky policy that could lead to worse outcomes? It’s a cost-saving measure, they say — but only for the insurer.

A recent study found that providers across the country spend as much as $310 million annually complying with white bagging requirements. This includes the costs associated with ordering, billing, handling, and storing medication coming in from dozens of different specialty pharmacies per practice.

Patients also get stuck with higher costs. When patients switch from having their drugs infused in the office to a white bagging arrangement, the medications’ costs are shifted from their medical benefit to their pharmacy benefit. This means they will often face higher cost-sharing and out-of-pocket copays — especially if they’re on Medicare.

The good news is that Minnesota lawmakers are working on a solution that would stop insurers from using this dangerous, disruptive and wasteful tactic. Bill HF 3280 in the Minnesota House of Representatives and SF 3265 in the Senate would prohibit insurance companies — which often work through their pharmacy benefit manager — from requiring patients to obtain their medications from a specialty pharmacy affiliated with their insurer.

For the sake of Minnesota’s cancer patients, I urge all our state representatives to support this bill and stand up for patient access and safety.

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John F. Schwerkoske
John F. Schwerkoske

Dr. John F. Schwerkoske is a practicing oncologist and president of Minnesota Oncology in Woodbury.