The ordering, preparation, shipment, and administration of infusion and injection medication should never jeopardize the integrity of the drugs, put the patient at risk, or cause treatment delays. However, when it comes to white bagging, the process of drug distribution is messy, often putting patient safety at risk and causing product waste, complicating what should be a straightforward, safe procedure.

What is White Bagging?

White bagging is when an insurer or payer requires a patient’s medication to come from a specialty pharmacy, which will then be shipped to the clinic to be administered to the patient. During this process, the clinic which will administer the medication, is unaware of what is happening with the drug while it is being prepared and shipped to them.

Normally, the patient’s clinic and pharmacist are the ones in charge of determining “when, where, and how drugs are purchased, prepared, and administered to patients” (ASHP). The place in which the patient will receive the infusion or injection from will be the one to order the medication.

How is White Bagging Unsafe?

With the process of white bagging, and clinics not being the one to order the medication, “we do not know what types of conditions that these drugs are under when they leave hands and what quality they could be in”, explains Katie Engebose, OSMS Rheumatology Clinical Manager.

Katie further debates that, “when this process is done with distributors, there are quite a bit of rules, regulations, and quality control you follow to make sure these medications arrive safely. Coming from a specialty pharmacy, they do not have that kind of regulation”.

According to ASHP, they have strong feelings against white bagging and “…strongly opposes white bagging because it bypasses health system formularies, safety checks, and care planning processes” (ASHP, 2021).

Without having specific regulations, white bagging can cause multiple safety issues, one being temperature control. Katie discusses that if these medications get outside of their regulated temperature while being shipped, there is uncertainty as to whether they will work properly or if they will cause different side effects to the patients.

Disadvantages of White Bagging:

• Changes in Medication: Sometimes the dosage of medication or the type of medication for a patient may change. With white bagging, clinics are at the mercy of the amount and type of medication the specialty pharmacy sends and when they get it to the clinic. This means that if there are changes in medication, a clinic may not have enough medication, or the right medication, to provide to the patient during their appointment. On the other hand, the correct medication or dosage may not be delivered in time for the patient’s appointment, delaying their treatment.
• Delay in Treatment: Whether it is a delay within the shipment of medication or having to order new medication because the temperature was not regulated, if patients are not provided with their medications when they need them, it could cause a flare in their symptoms. Flares can cause further damage to a patient’s joints or body, causing even more long-term effects. Additionally, without their medication, patients may have difficulties doing daily activities at home and may have missed time at work or school.
• Product Waste: When a specialty pharmacy sends a clinic medication through White Bagging for a patient, that medication can only be used for that specific patient. So, if a patient changes medication or needs a higher dosage, then the medication the clinic has for them will go to waste.
• Inventory Challenges: According to Lindsey DeMarrais at McKesson, “the patient’s medication is stored at the clinic until their appointment, which can create inventory challenges for clinics… potentially resulting in waste” (McKesson).

OSMS’ Process of Buying and Receiving Medications for Infusions and Injections

OSMS practices what is called “buy and bill”. This is where we, OSMS, buy medication from a distributor or manufacturer and we bill the patient’s insurance for the medication. We offer a more cost-effective avenue for our patients since they are only charged for the drug, administration (supplies and nurse’s time). We do not charge a facility fee.

Medication is ordered on a weekly basis to ensure inventory control and that we have enough medication for each patient we see each week, resulting in less product waste. After we send in an order to the distributor, they will gather the medication, shipping it to us the next day, following all regulations in place for drug integrity and patient safety. This process allows us to know when we will receive the medication, to properly store it for the patients.

OSMS does not and will not participate in white bagging because of the risks that it poses to our patients.

OSMS Infusions

At OSMS, we offer:

• Injections or infusions for rheumatology diseases, gastrointestinal (GI) disorders, asthma disorders, endocrinology, and dermatology disorders
• Infusions for multiple sclerosis (MS) disorders and other neurological disorders.

Some of the medications we infuse include:

• Remicade Infusion: used to treat many diseases including Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Plaque Psoriasis, and Crohn’s disease to name a few.
• Actemra Infusion: used to treat Rheumatoid Arthritis, Giant Cell Arteritis, Systemic Juvenile Idiopathic Arthritis, and Polyarticular Juvenile Idiopathic Arthritis.
• Orencia Infusion: used to treat Rheumatoid Arthritis, Psoriatic Arthritis, and Juvenile Idiopathic Arthritis.
• Tepezza Infusion: used to treat Thyroid Eye Disease.
• Prolia Injection: used to treat Osteoporosis.
• Vyepti Infusion: used for the preventative treatment of migraines in adults.

Referrals are required for infusion therapy or in-office injections for conditions outside of rheumatology.

If you would like your infusions to be more cost effective for you by 30-50%, schedule an appointment with one of our rheumatologists!

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Citations:

Aimed Alliance. (2021, April 28). New fact sheet: White bagging and Brown bagging policies explained. https://aimedalliance.org/new-fact-sheet-white-bagging-and-brown-bagging-policies-explained/

DeMarrais, L. (n.d.). Benefits and challenges of white, brown, clear, and Gold Bagging. McKesson. https://www.mckesson.com/Pharmacy-Management/Health-Systems/Prescribed-Perspectives/Benefits-and-Challenges-of-White-Brown-Clear-and-Gold-Bagging/

Devino, M. (2021, March 15). The future of white bagging and Brown bagging in oncology pharmacy. ACCC – Association of Cancer Care Centers. https://www.accc-cancer.org/acccbuzz/blog-post-template/accc-buzz/2021/03/15/the-future-of-white-bagging-and-brown-bagging-in-oncology-pharmacy

Morse, S. (2021, April 7). Hospitals and Health System Pharmacists Urge FDA to take a closer look at “white bagging.” Healthcare Finance News. https://www.healthcarefinancenews.com/news/hospitals-and-health-system-pharmacists-urge-fda-take-closer-look-white-bagging

White bagging a growing concern for Health Systems. ASHP. (2021, March 23). https://news.ashp.org/news/ashp-news/2021/03/22/White-Bagging-a-Growing-Concern-for-Health-Systems

White bagging infographic. ASHP. (n.d.-b). https://www.ashp.org/advocacy-and-issues/key-issues/white-bagging/white-bagging-infographic?loginreturnUrl=SSOCheckOnly

White bagging. ASHP. (n.d.-a). https://www.ashp.org/advocacy-and-issues/key-issues/white-bagging?loginreturnUrl=SSOCheckOnly