HPC Hears Concerns Over Insurers’ Pharmacy Mandates

MHA last Wednesday informed the Health Policy Commission about the patient safety and cost considerations related to insurance companies’ “white bagging” and “brown bagging” drug policies.

Insurers have increasingly altered their benefit structures by moving certain injectable and infusion drugs out of the medical benefit and into the pharmacy benefit, requiring that these drugs be obtained from a specialty pharmacy and delivered to patients to bring to their providers (brown bagging) or delivered directly to physicians or hospital outpatient departments to be administered to specific patients (white bagging).  In some plans, in order to be covered, the patient must receive the medication from a home infusion company rather than in a provider’s office or clinic.

“MHA is concerned about the growing subset of injectable and infusion medications that generally require special handling, storage, temperature control, and/or compounding prior to administration and may also have significant side effects requiring the presence of a physician when the drug is administered,” MHA’s Senior Director of Managed Care Karen Granoff commented. “When insurers mandate that these medications must be provided by specialty pharmacies and, in some cases, administered in the patient’s home, the result is the creation of significant clinical, operational, patient safety, access, and financial challenges.”

Granoff urged the HPC to develop a clinically appropriate approach “that does not compromise patient safety, create administrative complexity for patients and providers, add operational challenges to hospitals, make it more expensive for patients to obtain these medications, and put hospital pharmacists in the difficult position of potentially re-dispensing any medication which has been previously dispensed by another pharmacist.”

Ongoing concern about the insurers’ bagging policies led the legislature to include an MHA-backed provision in the FY2018 budget requiring HPC to analyze health insurance payer practices and submit a report and recommendations to the legislature by July 1, 2018.

At the public hearing, Granoff submitted these comments and was joined by UMass Memorial Medical Center’s Division Chief of Pediatric Gastroenterology Jenifer Lightdale, M.D., and Neil Gilchrist, manager of pharmacy operations. Others offering comments at the hearing included Dr. Sharon Stotsky, Rheumatology and Internal Medicine Associates, in Wilmington and president of the MA, ME, NH Rheumatology Society; Sylvia Bartel, V.P. of pharmacy for Dana-Farber Cancer Institute; David Twitchell, chief pharmacy officer for Boston Medical Center Health System; and representatives of Blue Cross Blue Shield of Massachusetts.