What Is White Bagging In Pharmacy?

Imagine a restaurant where all of the guests who have made reservations have delivered to the kitchen staff, in the form of bags and boxes, the uncooked food and ingredients that they have purchased from a variety of different suppliers. According to Rita Shane, the chief pharmacy officer for Cedars-Sinai in Los Angeles, a situation like this is comparable to the challenges faced by clinics when payers enforce white bagging restrictions for pharmaceuticals. White bagging is an arrangement that is made between payers and chosen pharmacies to transport a patient’s drugs straight to the site of treatment.

The personnel at the site of care is then responsible for preparing and administering the goods in accordance with whatever processes are necessary. The American Society of Health-System Pharmacists (ASHP) takes a firm stance against the practice of white bagging due to the fact that it sidesteps health system formularies, safety checks, and care planning procedures.

White bagging, as stated by the American Society of Health-System Pharmacists (ASHP) in a message sent out to members on March 18, poses a threat to practices that healthcare organizations have established to keep patients safe and hinders the ability of pharmacists to ensure the integrity of medication and supply chains.

In addition, pharmacy leaders and the organizations they work for are becoming increasingly concerned about the practice’s impact on patient safety. “According to the information that I’ve gathered and the opinions of the coworkers that I’ve consulted, the pharmacies and organizations that permit white bagging are experiencing significant difficulties in both the management of their inventory and the promptness with which they provide the medication.

In addition to this, there are a plethora of patient and clinical factors to take into account “Shane remarked. She mentioned that some of these factors include the inability to change doses in response to unexpected laboratory or clinical findings and the possibility of a delay in treatment in the event that a drug does not arrive in time for a patient’s scheduled visit.

• Shane made the observation that there was one patient with multiple sclerosis whom they had been treating for a considerable amount of time but who, as a result of a white-bagging requirement, ended up having to relocate to another location;

Shane is now teaching colleagues and politicians, including the state board of pharmacy, about the possible bad repercussions of white bagging, as well as networking with other pharmacy professionals. She also issued a warning that the practice of white bagging may violate the requirements of the Drug Supply Chain Security Act (DSCSA), which are designed to protect the integrity of drug products at each stage of the distribution chain.

“When we acquire pharmaceuticals, we have to conduct track and trace on them to verify how the pills have been handled since they were made,” Shane added. “This is to ensure that the drugs have not been tampered with in any way.” She wondered, “how can we assure that the product has not been tampered with in any way if those stages are skipped through by using white bagging?” Concerns that white bagging undermines essential DSCSA components have prompted the American Society of Health-System Pharmacists (ASHP) and other healthcare stakeholders to submit a meeting request to the Food and Drug Administration (FDA).

Health insurance companies that use white bagging, as stated in a white paper published by the American Hospital Association (AHA) on March 8, “are upending the old system, possibly compromising patient safety and quality treatment to improve their profit margins.” More than 75 goods are included on the list of United Healthcare, one of the top insurers in the United States, that will be subject to white bagging during this year for many of the company’s commercial plans.

1. White bagging is also being used for particular prescriptions by a number of other big insurers;
2. White-bagged pharmaceuticals are considered to be the property of the patient as well as the insurance, according to Thomas Lausten, who serves as the head of pharmacy at Children’s Wisconsin in Milwaukee;

The fact that the items are not recorded in inventory places them outside of the regular clinical decision support systems that assure the proper administration of medications. The practice of “white bagging,” according to Lausten, “bypasses all of the checks and balances that are established into the system of the pharmacy.” “Drug interaction monitoring and dosage weight checking are both avoided,” as well as “all of those other stuff.” And in the event that something goes wrong with a dosage, the clinic is not allowed to utilize its own stock as a replacement; rather, it is required to seek a new supply that is tailored to the individual patient from the pharmacy that has been selected.

1. Lausten related a disturbing incident that occurred more than a year ago in which a costly white-bagged dosage of nusinersen was thrown away inadvertently after an interventional radiology treatment;
2. According to Lausten, “that specific surgery had to be postponed, and the youngster had to be sedated again.” Because the dosage was designed specifically for that one individual, we were unable to utilize any other product in its place;

According to him, more recently, a specialist pharmacy sent multiple doses of a medicine that was packaged in white bags to a house rather than the clinic that it was supposed to deliver it to. Lausten shared that the speciality pharmacy had requested that they distribute the medication to them despite the fact that it had been delivered to the incorrect location.

1. “And there’s no way that will work;
2. At that point, the medication has been tampered with, and you are not permitted to take it away from the person who it was delivered to in order to give it to another patient.” According to Lausten, white bagging is only allowed at his hospital under the following circumstances: (1) when there is no other choice available to care for the patient; and (2) when extremely expensive pharmaceuticals are involved;

According to Lindsey Kelley, who works as the director of ambulatory, cancer, and research pharmacy services at Michigan Medicine in Detroit, the only time that her health system permits the use of white bags is in situations in which not doing so would negatively impact patient care.

• Kelley stated that “although, for the most part, we strive very assiduously to avoid that” (although this is not always the case);
• She reported that the organization had been successful in negotiating one-time waivers to the white-bagging restrictions for a select group of patients;

“But having talks like that takes a significant amount of time. It requires a significant amount of time and energy to locate the appropriate individual inside the insurance company, speak with them, explain the patient’s situation and the reasons why we are worried that the patient would have to seek treatment elsewhere, and so on “Kelley stated.

According to her, the white-bagging requests are often handled by the billing team of the healthcare organization. This team may get in touch with the pharmacy staff if more clinical information or logistical cooperation is required.

But if it’s something that shifts from the medical benefit to the pharmacy benefit, then our pharmacy teams will become engaged because we understand that rule better and we’re able to be more successful. That’s what Kelley stated. “And this is something that is also growing.

As a result, we are witnessing a transition away from medical benefits and toward pharmacy benefits.” According to Kelley, white-bagging requests used to be made around once every month and primarily included noncancer treatments for people.

“At this point, we see numerous people each month or each week. In addition to this, we are observing a trend toward the inclusion of patient categories in whom we had not previously observed this “— I quote her. According to Lausten, white bagging increasingly includes the distribution of medications that are often administered to pediatric patients, such as immune globulins, infliximab, and botulinum toxin.

• Shane pointed out that after the drugs are delivered to the medical facility, they have to be placed aside for the appointment of the intended patient;
• However, this frequently results in the hospital’s limited refrigerated storage space being occupied;

She remarked that there are considerable space and storage difficulties to be concerned about. “Pharmacies and health systems were never built to have patient-specific drugs in their cancer centers and their infusion facilities,” according to the author.

• Shane mentioned that she is aware of situations in which payers want white bagging for patients being treated in physician-run office-based cancer centers;
• She stated that it was quite unlikely that they have climate-controlled storage space available;

Lausten stated that his health system is required to produce all dosages of white-bagged pharmaceuticals in line with USP sterile and nonsterile compounding protocols; however, the organization has not discovered a means to account for the labour involved in doing so.

“We take on the risk and the liability and everything else for it, and we don’t get compensated a cent for it,” he added. “We take on the risk and the liability and everything else for it.” The American Hospital Association (AHA) stated in its white paper that white bagging constitutes an inappropriate shift in liability.

This is due to the fact that healthcare providers are responsible for the quality of care but are unable to verify the integrity of medications obtained outside of the established procurement system. Lausten observed that despite the fact that white bagging is ostensibly designed to cut costs for insurers, it is not rare for a clinic to get a drug for a patient who no longer requires it, which results in waste.

“That medicine is never administered for whatever reason; perhaps the patient passes away, perhaps they do not want the drug, or perhaps the dosage has to be adjusted. And the only option you have for dealing with it is to eliminate it “Lausten added.

“In contrast, when it goes through the conventional distribution system, we remove it from our inventory. And if we don’t remove it from our stock, we don’t charge for it, we don’t bill for it, and we don’t put it to any other purpose. There are no unused resources.” Kelley stressed that mandating white bagging for patients at a time when patient-centered care and patient choice are issues of concern for legislators and doctors is a move in the wrong direction.

Patients have less of an opportunity to have a voice in the location from which they obtain their drugs, according to Kelley, because white bagging is becoming more prevalent and payers are directing where medications come from.

When we think about getting patients involved in advocating for their own health care, I believe that one of the most crucial factors to take into account is patient choice. Visit the ASHP’s assessment tool and advocacy podcast on the subject for more information as well as to learn how you can get involved in advocating against the practice of white bagging. [A version of this news article will be published in a forthcoming edition of AJHP.]

What is white and brown bagging?

When a patient receives their medication in a “brown bag,” it indicates that the medication was purchased from a specialized pharmacy and then mailed directly to the patient. The patient then brings the medication to the office of their healthcare provider to be administered.

What does clear bagging mean?

Clear bagging refers to the process in which a provider’s in-house specialty pharmacy fulfills the patient’s prescription and then transfers the product to the site where the patient will get the medicine.

What is hospital bagging?

The practice of using manual resuscitators to ventilate a patient, often known as “bagging” the patient, is commonly required in the event of a medical emergency when the patient’s breathing is either insufficient (referred to as “respiratory failure”) or has totally halted (respiratory arrest).

What is brown bag in pharmacy?

The practice of directly distributing a speciality drug to a patient, who then delivers the specialty drug to the physician’s office or clinic, is known informally as “brown bagging,” and it has been decided that this activity falls under the purview of the definition of the profession of pharmacy.

What is gold bagging in pharmacy?

Skip to content The phrase “gold bagging” is the most recent word to emerge in the field of health system-owned specialty pharmacies, and it is quickly gaining traction. Pharma Industry’s Up-and-Coming Trends Gold bagging is a word used in the industry that is quickly becoming the new “gold standard” of medication delivery in the healthcare business.

1. This is due to the consistently higher patient outcomes that gold bagging is delivering in a scenario that involves a health system owned specialty pharmacy;
2. The word “bagging,” in all of its incarnations—white bagging, clear bagging, brown bagging, and now gold bagging—denotes various delivery systems for the actual physical packaging of pharmaceuticals from the care environment to the patient for the purpose of administration;

Gold bagging, as the name suggests, has emerged as the most accurate term that depicts the highest quality pharmaceutical experience a patient can have, and it is only available at a health system owned specialty pharmacy. In other words, gold bagging is exactly what it sounds like: the highest quality pharmaceutical experience a patient can have. The following is a list of the currently accepted definitions:


When a health system’s own specialized pharmacy delivers medicine to a clinic, hospital suite, or provider office for the purpose of administering it to a patient, clear bagging has traditionally been the term that has been used to describe this process. White bagging is the practice of transporting medication from a pharmacy, often an outside specialty pharmacy, to a medical facility, such as a hospital, clinic, or physician’s office, where it is then given by a medical professional. At the time of this publication, numerous national pharmacy and hospital organizations in the United States have leveled significant criticism against this process.

1. These organizations point to the potential for medical harm, failures in logistics, and unreimbursed burdens that are placed on health system pharmacies, in particular for sterile product preparation and delivery, as well as lab value monitoring and management;

Brown bagging is when a patient purchases pharmaceuticals through their own pharmacy and then brings the drugs themselves to a hospital or other office or suite in order to have the product prepared and administered on-site, most commonly by intravenous infusion or injection. This practice is known as “brown bagging.” This practice is almost always prohibited in its entirety within hospitals and other health institutions.

The term “gold bagging” emerged as the new standard of care in recent years. Gold bagging is the practice that most properly reflects the enhanced chain of custody that can only be provided by a health system. As a result, the overall quality of patient care and service is considerably improved. The goal is to improve medical outcomes by taking a more comprehensive and coordinated care approach to the distribution of drugs from speciality pharmacies and the management of drug therapy in general.

The term “gold bagging” is quickly taking the place of the older “clear bagging” terminology. Gold bagging refers to the practice of having a prescription filled at a health system-owned specialty pharmacy by the staff of that pharmacy.

The prescription is then packaged and delivered to the location where it will be administered, which is typically on the same campus as the hospital, office, or infusion clinic. The end goal is to have the appropriate medication, at the appropriate dose, at the appropriate time, and administered to the appropriate patient within the context of their existing continuum of care.

Gold bagging has evolved as the most updated phrase as a result of the fact that it is ultimately the most powerful and true picture of the highest degree of service that is provided throughout the entirety of the process of producing speciality pharmaceuticals.

Sharing electronic medical records’ documentation and medical notes with the patient’s provider, and the delivery times and specific destinations (i.e. not the loading dock) to synchronize with patient appointments are all responsibilities of the health system owned specialty pharmacy, which controls the chain of custody to deliver pharmacy care to the patient (typically with the dispensing occurring at a local location).

1. It is also important to keep in mind that many different health systems also hold the insurance risk, the real estate, and employ the clinicians;
2. When a health system-owned specialty pharmacy is engaged, these locally controlled logistics are almost error-proof in all but the most extreme of circumstances;

Instead than attempting to handle medicine distribution remotely from hundreds of miles away, which may not match a patient’s real-time demands, everything is done and controlled within the campus of the health system. The on-campus pharmacy is able to ensure that a fresh dispensing can take place in real time in the extremely uncommon event that an order is misplaced or a last-minute dose modification is made.

• This ensures that the patient appointment does not need to be postponed;
• Because of this technique, mistakes are less likely to occur, which helps bring down the overall cost of treatment and eliminates unnecessary stress for the patient;

DOWNLOAD Information Graphic About Gold Bagging.

Does Medicare allow white bagging?

Because Medicare Part B does not employ the practice of white bagging, these statistics do not accurately represent the payor practices that have been discussed and that commercial and managed care payors are gradually putting into practice.

WHAT IS Pharma buy and Bill?

Buy-and-bill is a method that medical practices use to buy pharmaceuticals that their staff members are able to dispense within the office setting. When we talk about “buy,” we are referring to the providers who are in charge of placing the order and paying for the medicine. The term “bill” refers to the process through which providers submit their claims for payment directly to third-party payers.

Additionally, with the help of this system, the physician is able to perform duties that are analogous to those of a pharmacist. They are responsible for managing the medication inventory and collecting patient copayments or coinsurance payments.

In addition to prescribing therapy and managing medication, this entails providing this service. The majority of buy-and-bill pharmaceuticals are prohibitively expensive, must be administered by a trained medical practitioner, and may be subject to various limitations imposed by the manufacturer.

An administration charge is typically included in the total cost of buying and billing for speciality drugs. In most cases, term refers to injections, although it may also be used for infusions and implantations.

The cost of the drug does not include this administration fee; it is a separate payment. The majority of the money that is spent on buy and bill is allocated to oncology drugs. But there are several drugs that come into the purchase and bill category that are used in other medical disciplines as well, such as rheumatology, neurology, and dermatology.

What are white bags used for in hospitals?

Linen Carrying a Pathogen Every piece of linen that was used by a person who is known to be contagious or who is believed to be infectious, as well as every piece of linen that is contaminated with blood or bodily fluids. a water-soluble (alginate) bag that has been put inside of a polythene bag that is see-through.

When should you start bagging a patient?

Recognize that the patient has to be ventilated, and start doing so straight away. When the rate of spontaneous ventilations drops below 8 per minute or when the tidal volume drops below around 300 cc each breath, hypoventilation is the result. In either scenario, the use of assisted ventilation will be required.

What does BCPS stand for in pharmacy?

The BPS Board Certified Pharmacotherapy Specialist (BCPS) program is a credential for pharmacists who have met the eligibility criteria below and who, in their unique practice, ensure the safe, appropriate, and economical use of medications as part of interprofessional treatment teams in a variety of settings, including hospitals, outpatient clinics, long-term care facilities, and correctional institutions.

What is needed in hospital bag?

Items that are uniquely yours:
Toiletries. Include in your carry-on items the following: a brush and toothpaste, lip balm, deodorant, a brush and comb, cosmetics (if you want to use it), hair ties, and an elastic band. Even though hospitals often supply shampoo, soap, and lotion, you might find it more convenient to bring your own.

Due to the limited amount of counter space that is often available in bathrooms, a hanging toiletry bag can be of great assistance. The use of sanitary pads. The hospital will supply sanitary pads to absorb all of the blood that may occur following birth; but, if you have a preference for a particular brand, you are more than welcome to bring your own.

Also, make sure that you have a stock of pads with a heavy flow ready at your house. If you wear spectacles, then please put them on. There is a significant number of expecting mothers who use contact lenses who choose not to bother with their lenses while they are at the hospital or birth center.

What dad needs to pack for the hospital?

You should also think about carrying deodorant, facial cleaning wipes, hand sanitizer, and spare contact lenses or contact lens solution – anything you think you might need when you are unable to take a shower but still want to feel clean and refreshed.

When Should I pack my hospital bag for C-section?

Do not wait until the day before your scheduled C-section to pack your baggage; start the process as early as possible. You should aim to have everything ready to go around 37 weeks in case your water breaks or you go into spontaneous labor. Your objective should be to have everything ready to go around 37 weeks.