Insurer mandates requiring patients to have their therapies dispensed via white bagging are becoming increasingly common. A Drug Channels report found that in 2019, nearly a third of infusion drugs (both oncologic and non-oncologic) provided in hospital outpatient departments were distributed via white bagging.
But pharmacists, providers and professional organizations across the industry are raising concerns with white bagging, which is an arrangement between payers and specialty pharmacies to ship a patient’s medication directly to the site of care. “White bagging presents a range of issues, including inventory management challenges as well as concerns about patient safety, potential treatment delays and drug waste,” says Jeff Lackman, regional vice president, CompleteRx.
The problems with white bagging
Pharmacy leaders are voicing several concerns over white bagging, including:
Pharmacy management: The hospital pharmacy doesn’t easily track drugs coming from a specialty pharmacy. White bagging creates a shadow inventory that hospitals don’t legally own and which exists outside of the Drug Supply Chain Security Act’s (DSCSA’s) track and trace requirements. “Normally, pharmacy handles supply chain logistics. Clinics aren’t typically prepared or equipped to receive white bagged drugs. It creates additional steps in the workflow for busy providers,” says Lackman. Further, by bypassing established supply chain channels, white bagging hampers the ability to respond to FDA drug recalls.
Safety: When white bagged medications are entered as the patient’s own medications, they don’t go through the same order-entry system checks and balances, such as checking for drug interactions or confirming the dosage or strength. Unlike internally procured medications, there is no assurance that a needed drug will be delivered to the right place and in time for the patient’s appointment, resulting in treatment delays and lower medication adherence.
Waste: Therapeutics obtained through white bagging are bought and explicitly sent for that designated patient. If the treatment regimen changes or the patient has an adverse reaction and therapy must be discontinued, the unused medication must be discarded, even if unopened.
What’s your white bagging strategy?
Several organizations, including the American Society of Health-System Pharmacists (ASHP) and the American Hospital Association, are working to educate policymakers about the potential adverse consequences of white bagging. Some hospitals have prohibited white bagging or have negotiated with specialty pharmacies to minimize the impact of the practice.
Lackman says it is essential to understand the clinical and financial impact white bagging has on your organization. “It’s important to understand the extent that white bagging occurs in your organization. What I’ve found is that healthcare providers are so busy they often accept what health plans mandate. But it’s important to have conversations with health plans about white bagging and stay on top of the issue,” he says.