{"id":1454,"date":"2023-07-05T09:16:00","date_gmt":"2023-07-05T09:16:00","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=1454"},"modified":"2023-07-05T09:16:03","modified_gmt":"2023-07-05T09:16:03","slug":"patients-squeezed-in-fight-over-who-gets-to-bill-for-pricey-infusion-drugs","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=1454","title":{"rendered":"Patients Squeezed in Fight Over Who Gets to Bill for Pricey Infusion Drugs"},"content":{"rendered":"
\n

Health insurers and medical providers are battling over who should supply high-cost infusion drugs for patients, with the tussle over profits now spilling into statehouses across the country.<\/p>\n

The issue is that some insurers are bypassing hospital pharmacies and physician offices and instead sending more complex drugs through third-party pharmacies. Those pharmacies then send the medications directly to the medical provider or facility for outpatient infusing, which is called \u201cwhite bagging,\u201d or, more rarely, to patients, in what is called \u201cbrown bagging.\u201d That shifts who gets to buy and bill for these complex medications, including pricey chemotherapy drugs.<\/p>\n

Insurers say the policies are needed because hospital markups are too high. But hospitals argue that adding an intermediary results in unnecessary risks and delays, and they say some insurers have their own or affiliated pharmacy companies, creating financial motives for controlling the source of the medications. The patients, meanwhile, are left to deal with the red tape.<\/p>\n

Paula Bruton Shepard in Bolivar, Missouri, is among those caught in the middle. Flares of lupus, an autoimmune disease, rob Shepard of her mobility by attacking her joints. She relies on monthly infusions to treat her symptoms. But at times, she said, her treatments were delayed due to UnitedHealthcare\u2019s white bagging infusion policy. And interruptions to her treatments exacerbated her symptoms.<\/p>\n

\u201cI once had to use a toilet lift and it was kind of demoralizing to say, \u2018I\u2019m a 50-year-old woman and I have to use a toilet lift,\u2019\u201d Shepard said of the medication delays.<\/p>\n

This is a tug of war over profits between insurers and medical providers, said Ge Bai<\/a>, a professor of accounting and health policy at Johns Hopkins University. While insurers claim the arrangement reduces costs, she said, that doesn\u2019t mean insurers pass along savings to patients.<\/p>\n

\u201cI don\u2019t think we should have more sympathy toward one party or the other,\u201d Bai said. \u201cNobody is better than the other. They\u2019re all trying to make money.\u201d<\/p>\n

\n

\n\t\t
\n\t\t\tEmail Sign-Up\t\t<\/a>
\n\t<\/h4>\n

\n\t\tSubscribe to KFF Health News’ free Morning Briefing.\t<\/p>\n<\/div>\n

The savings from white bagging can be significant for expensive infusion drugs, according to a report from the Massachusetts Health Policy Commission<\/a>. For example, Remicade, used to treat a variety of inflammatory diseases, including Crohn\u2019s, cost on average $1,106 per unit in 2015 under hospitals\u2019 traditional buy-and-bill system, the commission found in its review of state claims data. That same drug cost an average of $975 per unit under white bagging, a 12% savings.<\/p>\n

But the report also found patients, on average, faced higher cost sharing \u2014 what they are responsible for paying \u2014 for Remicade and other drugs when white bagging was used. While some patients had only modest increases to their costs under the policy, such as $12 more for a medication, the review found it could mean much greater cost sharing for some patients, such as those on Medicare.<\/p>\n

At Citizens Memorial Hospital in rural Bolivar, more than 1 in 4 patients who receive regular infusions are being forced to use an outside pharmacy, said Mariah Hollabaugh, the hospital\u2019s pharmacy director. Shepard was among them.<\/p>\n

Even if the hospital has the exact drug on the shelf, patients must wait for a separate shipment, Hollabaugh said, potentially interrupting care. Their shipped drugs may sometimes be unusable when the doctor needs to change the dosage. Or the medicine comes in a nondescript package that doesn\u2019t get immediately flagged for the pharmacy, potentially subjecting the drugs to damaging temperature fluctuations. For patients, that can mean delays in care.<\/p>\n

\u201cThey\u2019re in pain, they\u2019re uncomfortable,\u201d Hollabaugh said. \u201cThey may be having symptoms that don\u2019t allow them to go to work.\u201d<\/p>\n

Siteman Cancer Center<\/a>, led by physicians from Washington University School of Medicine in St. Louis, has confronted the same issue. But the cancer center\u2019s size has helped it largely avoid such insurer policies.<\/p>\n

John DiPersio<\/a>, a Siteman oncologist and researcher who led the university\u2019s oncology division for more than two decades, said Siteman reluctantly allows white bagging for simple injectables but refuses to accept it for complicated chemotherapies. It does not accept brown bagging. Occasionally, he said, that means turning patients away.<\/p>\n

\u201cYou\u2019re talking about cancer patients that are getting life-threatening treatments,\u201d DiPersio said, referring to the dangers of chemo drugs, which he said can be fatal if used improperly. \u201cIt doesn\u2019t make any sense to me. It\u2019s all stupid. It\u2019s all lunacy.\u201d<\/p>\n

At least 21 states, including Missouri, introduced some form of white or brown bagging legislation during the most recent legislative session, according to the American Society of Health-System Pharmacists<\/a>. And in the past two years, the trade group said, at least 13 states have already enacted restrictions on white bagging, including Arkansas, Louisiana, and Virginia.<\/p>\n

ASHP has created model legislation<\/a> to limit insurers from requiring the practices as a condition of coverage.<\/p>\n

\u201cThis is a major issue,\u201d said Tom Kraus, a vice president at the trade group. \u201cWe see this as central to our ability to coordinate patient care.\u201d<\/p>\n

\n\t