“Examples like the case study below show how fragmented drug administration can be with white bagging. The practice introduces additional costs previously not identified and rather than making care more efficient and accessible.” — Steven Lucio, Vizient senior principal, pharmacy solutions
Disruption can take on many forms in health care. It can lead to new technologies to drive more efficient care delivery, improved access to care and better outcomes for patients. In the case of payer-imposed policies, it can create roadblocks. According to a survey analysis of members conducted by Vizient, one such policy—white and brown bagging—is having a significant negative impact on the way specialty pharmaceuticals are dispensed by hospitals for treatments for seriously ill patients.
This payer-imposed policy has forced the shift for many physicians and health systems from the traditional “buy and bill” model for drugs, where the provider purchases the medication and dispenses or administers it to the patient, to one known as white bagging where the provider receives a patient-specific, specialty medication from an external pharmacy for administration in a physician's office/outpatient infusion center. Brown bagging is when a patient acquires their medication from an external pharmacy and takes it to their provider for administration. Due to concerns about patients’ ability to maintain appropriate storage of specialty medications, brown bagging is implemented to a much lower extent than white bagging.
The Vizient survey highlights the disruptive nature of the practice of white/brown bagging, which complicates delivery and dispensing, creates access barriers and most importantly complicates patient care. Vizient estimated that health systems are spending $310M annually in labor costs required to manage the additional clinical, operational, logistical and patient care work associated with white/brown bagging requirements.
“Our goal was to quantify and validate how members are being impacted by white/brown bagging practices,” says Carina Dolan, Vizient senior director, pharmacy services. “The costs are huge as is the impact on operations and patient care.”
Delays in treatment and medication errors pose a significant risk to patients. Ninety-two percent of survey respondents reported experiencing problems with the medication received through white/brown bagging (such as wrong drug, damaged product, dose not arriving in time for administration) and 95% reported facing additional operational and safety issues (such as the need for a separate inventory management system, delivery location/security disruptions, lack of space to hold medication).
Three steps to minimize challenges
The survey found that about half of respondents reported not having an established policy in place to prohibit white/brown bagging and have not developed educational materials on the impact of alternate channels and their effect on the hospital. If your hospital has not developed a strategy to evaluate the extent of impact to your organization and your patients, here are three steps take to minimize the challenges associated with white/brown bagging policies.
- Understand and acknowledge the issue—Previously, this issue had been treated as a pharmacy issue only leading to a disconnected approach by the health system. Now as white/brown bagging gains traction as a payer practice, awareness is increasing among leadership to develop strategies using a multi-disciplinary approach that includes finance, managed care and physician leadership in addition to pharmacy, education and communication. Metrics to measure include number of doses delayed, doses missed and additional expense to patients. The collection of this type of data can help you define the problem and combat these intrusive activities.
- Educate your financial and managed care leaders—White/brown bagging and other payer-mandated strategies are not just a “pharmacy” problem but impact the totality of an organization’s ability to provide high-quality, safe and efficient patient care. Hospitals should bring together finance, payer management, pharmacy, inpatient, outpatient, medical staff and supply chain to work together. Once you have determined the impact, you can develop your policy to provide a consistent, organizational-wide approach white/brown bagging. “The policy should be understood within your pharmacy and managed care colleagues as well as being supported by your senior leadership,” says Steven Lucio, Vizient senior principal, pharmacy solutions. “It becomes a starting point for the contracting team to work with payers, to, together, find solutions for this issue.”
- Advocate for your organization and your patients—As seen in some states, a strategy to avert patient harm, prevent health care waste and unnecessary expense could be through legislation, regulation or working with state boards of pharmacy. With most policies happening at the state level, consider engaging your government relations colleagues to educate policymakers about the unnecessary hardship, cost and patient care concerns caused by payer-mandated “white bagging” and “brown bagging” policies. Additional information is available online (members only).
It’s clear, white/brown bagging policies impact both payers and providers in pharmacy administration, yet what gets lost in all the back-and-forth leveraging is the patient. As hospitals focus on patient-centered practices and improving overall patient experience, the battle of white/brown bagging runs counter to these goals.
Vizient will continue to monitor this and other payer-mandated policies’ potential impact on the delivery of patient care as well as financial consequences to patients and the overall health system. The public policy and government relations team continue to closely monitor legislative action that could further impact health system pharmacies. Additional insights are available from the online recording of the September Vizient webinar, "Impact from payer-mandated policies and updates on long-standing issues within pharmacy."