Specialty drug white-bagging vs brown-bagging: A tradeoff of cost for quality?
Hospitals and providers have raised concerns about how purchase strategies affect the quality, effectiveness, and safety of specialty medications.
Changes to the way specialty pharmaceuticals are administered are costing US hospitals $310 million annually, according to a new report from Vizient.
The practices of “brown-bagging” and “white-bagging” have been instituted by payers as a cost-saving strategy, but hospitals and providers have raised concerns about how it will affect the quality, effectiveness, and safety of specialty medications.
Related: AHA asks for regulations on pharmacy ‘white bagging’ and ‘brown bagging’ practices
Traditionally, specialty pharmaceuticals have been administered at hospitals and clinics. Under what is known as the buy-and-bill model, the provider purchases the medication and administers it to the patient in a clinical setting, then bills the payer for the product and administration.
White bagging requires providers to order the therapy from a specialty pharmacy outside their own health system and is seen by providers as more inflexible than the traditional system.
Brown-bagging requires the patient to purchase the specialty medication, and then take it to their provider for administration. Again, quality issues are raised by providers regarding possible adjustments and delays in administering the drugs.
“The growing trend of payer-imposed white/brown-bagging complicates delivery and dispensing, creates coverage and access barriers, and most importantly harms patient care,” the report said.
High costs to new practices
Vizient surveyed 260 hospitals this spring for the report and found significant concerns about the rise of white and brown-bagging requirements.
The report stressed both cost and safety concerns with the new practices. As part of the $310 million annual cost estimate, which covers additional clinical, operational, logistical, and patient care work associated with white/brown-bagging, the report said health care facilities had spent $114 million to hire additional administrative staff due to the growing practices.
“White and brown-bagging is causing staffing resource challenges and increased expense for hospitals at a time when COVID-19 has already caused significant hardships,” said Dan Kistner, PharmD, group senior vice president of Pharmacy Solutions for Vizient. “Beyond those challenges and hardships, it’s impacting the crux of what hospitals do: provide patient care. This can cause patients who require chemotherapy medications and other critically important drugs to experience gaps in care coordination that result in delay in treatment.”
The report added that the full cost of the practices is not yet known, since most hospitals have not yet started tracking the costs.
Survey finds high numbers of providers unhappy with practices
The survey found very high numbers of providers expressing concerns about the white and brown-bagging practices. These findings included:
- 92% of respondents experienced problems with the medication received through white/brown-bagging including issues such as wrong drug, damaged product, dose not arriving in time for administration, and dose no longer appropriate due to patient’s therapy changes.
- 95% of respondents experienced operational and safety issues associated with white/brown bagging. The issues encountered included: separate inventory management system, delivery location/security disruptions, lack of space to hold medication (e.g., refrigeration), etc.
- 52% of respondents do not have an established policy in place in attempt to prohibit white/brown bagging.
- 56% of respondents have not developed educational materials on the impact of alternate channels and their effect on the hospital.
“The reality is that this may simply be the tip of the iceberg, as most hospitals have not taken the steps to quantify the financial impact white and brown-bagging have had on their institutions,” Kistner added. “As hospitals navigate this complex issue, they must develop a strategy to evaluate the extent of impact to their organization and their patients, educate their financial and managed care leaders, and advocate for legislative reform for themselves and their patients.”
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