Payer-mandated Disruption to the Care Continuum

We believe that emerging payer-mandated models create the potential for unnecessary disruption and burden for both patients and the providers. Two such models are 1. “White bagging” – a model in which the drug is purchased through a specialty pharmacy and shipped to the provider’s office for administration and 2.“Brown bagging”- a model in which the drug is purchased through a specialty pharmacy and shipped directly to the patient, who takes it to the provider’s office for administration. Below are plausible negative impacts that could face patients and providers using either model.

Potential Burden for the Practice:

• Medications prescribed through white bagging are usually patient-specific and require specialized handling. Mishandling these therapies, or errors in delivery can lead to problems, both in patient safety and practice operations.
• While they aren’t purchasing the product through the white/brown bagging model, physicians are faced with the added expense of having to store medications until they are administered. Unlike the cost of acquiring the therapy, this expense sometimes goes unreimbursed.
• Patients often require therapy or dosing modifications, which can lead to waste, since the originally dispensed medication cannot be reused for a different patient. Especially in oncology, therapies can be highly toxic and require specialized handling and disposal. This process can be costly and requires compliance with state and federal requirements.

Potential Burden for the Patient:

• Seriously ill patients or their caretakers, will have an extra step in their care journey and be responsible for receiving and handling of their medication.
• Patients sometimes encounter difficulty in acquiring the medication they need from the pharmacy because of delays in processing requests for insurance coverage.
• Medication delivered through the mail may arrive late or damaged.
• Similar to burdens the provider may encounter, patients may be inconvenienced by dosage or therapy modifications made after receipt of their medication.

We believe that decisions about patient care and the therapy a patient receives should be led by the physician. These models can take some clinical decision-making out of the hands of the physician, disrupt care workflows and impact the patient / provider relationship.

Our role is to ensure community practices understand emerging payer models and the potential impact to a practice’s operations and the continuum of care.