Health Insurance Managed Care Pharmaceuticals Pharmacies

Bagging it

How do you get your prescription drugs? For most people, it involves going to your local pharmacy and picking up your pills.

But what if the drugs you needs are infused treatments that have to be administered at a physician’s office? Typically, you just show up at a physician’s office and it’ll be ready for you without a problem, right?

While that is often the case, payers are increasingly using specialty pharmacies and other approaches to try to reduce the cost of high-cost, physician-administered specialty drugs. An Academy of Managed Care Pharmacy (AJMC) article provides a nice summary of some of the alternative approaches payers are using to try to save money.

  • White-bagging refers to specialty pharmacies sending prefilled oncology therapeutics directly to the oncology practice; thus, if the physician needs to adjust the dose, the drug must be shipped back to the pharmacy.
  • Brown-bagging occurs when drugs are sent directly to the patient, who must store them properly and bring them to the physician office to be administered.
  • Step therapy…[also known as]…“fail first,” requires patients in commercial and some Medicare Advantage plans to take oncology drugs or supportive therapies that may not be what their doctor prescribes and see that they do not work before getting the preferred treatment. …[on AJMC panelist] pointed out that the first drug given may not be the cheapest, but may be the one that brings the biggest profit for the payer.
  • Home infusion calls for oncology drugs to be given outside an infusion center, by a nurse who may or may not be a certified oncology nurse. The physicians on the [AJMC] panel objected strongly to this practice, because they said a single nurse is not equipped to manage an adverse reaction.

In recent months, health insurers in Georgia, Indiana, Virginia and other states have begun to implement white bagging policies. The impact on patient care and cost is yet to be determined.

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