Senate passes bill to protect patients’ pharmacy options
White bagging refers to a practice where insurers require patients to get their prescriptions from insurer-affiliated pharmacies that are often mail order-only. The bill (2024-S 2086), which has been introduced in the House (2024-H 7365) by Rep. Justine A. Caldwell, would prohibit this practice.
Generally, if a patient needs a clinician-administered medication, such as a chemotherapy drug, the patient goes to the hospital where the clinician orders the needed drug from the on-site pharmacy and administers the medication.
According to the American Hospital Association, white bagging causes multiple problems. The practice is not sensitive to necessary changes in patient care plans. A health care provider often decides the patient needs a different dosage or a different drug after reviewing a patient’s labs or measurements on the day of treatment. Even though the hospital has these medications on site at their own pharmacy, they must wait for the drug to arrive from the specialty pharmacy or not get reimbursed. In addition, once filled and labeled, expensive specialty drugs cannot be substituted or modified. If the care plan is changed, often the drugs must be discarded.
Senator Ujifusa’s and Representative Caldwell’s bill would prohibit insurers or pharmacy benefit managers (PBMs) from engaging in white bagging practices. It would ensure patients could choose their pharmacy and ensure in-network providers (like hospitals) would get paid for providing services, regardless of the pharmacy from which they obtained the medications.
According to the American Society of Clinical Oncology, eight states currently have laws prohibiting or limiting white bagging, and many other states are considering such legislation.
“White bagging makes money for middlemen, but creates waste, barriers to care and disruptions to the patient-provider relationship,” said Senator Ujifusa (D-Dist. 11, Portsmouth, Bristol). “Across the country, state legislators are looking to audit and rein in insurers and their PBMs. This bill shows Rhode Island is prepared to join the movement to restrain vertically integrated middlemen conglomerates from making money by limiting provider care for patients.”
The Senate bill now heads to the House.
“White bagging is simply bad for patient care. It is a money-making effort for insurers that stands between people and the medicine they need. No cancer patient should have to wait for their insurer’s preferred pharmacy to send chemo drugs that are readily available at the facility that is administering them. This is a needless layer of profit-driven bureaucracy that we should not allow to hurt Rhode Islanders,” said Representative Caldwell (D-Dist. 30, East Greenwich, West Greenwich).
