What Is White Bagging 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.

1. 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.
2. The personnel at the site of care is then responsible for preparing and administering the goods in accordance with whatever processes are necessary.
3. 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.

1. Additionally, pharmacy administrators and the organizations they work for are becoming increasingly concerned about the practice’s impact on patient safety.
2. “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.

“And there’s no way that will work. 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.

1. Kelley stated that “although, for the most part, we strive very assiduously to avoid that” (although this is not always the case).
2. She stated that the organization had been successful in negotiating one-time waivers to the white-bagging restrictions for a select group of patients.
3. “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.

1. “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.
2. And the only option you have for dealing with it is to eliminate it “Lausten added.
3. “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.

1. 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.
2. 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.

What does Brown Bag mean in pharmacy?

Overview. Patients are encouraged to bring all of their prescriptions and supplements with them to their scheduled medical appointments as part of a standard procedure known as the “Brown Bag Review” of drugs. This affords the clinical team the chance to go through the patient’s current prescription regimen and have a conversation about it.

What is bagging a drug?

1. It has been determined that the practice of ‘brown bagging,’ in which a specialty drug is dispensed directly to a patient and the patient then transports the specialty drug to the physician’s office or clinic, is included in the definition of the practice of pharmacy. This practice is also known as the ‘direct patient delivery model.’

What does Brown bagging it mean?

The act of transporting one’s lunch (for example, to school or work) often in a brown paper bag is one definition of the term “brown bagging.” 2: the act of bringing a bottle of alcoholic beverage into a bar or restaurant that already has settings accessible for patrons to use

What is a 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.

1. An administration charge is typically included in the total cost of buying and billing for speciality drugs.
2. In most cases, term refers to injections, although it may also be used for infusions and implantations.
3. The cost of the drug does not include this administration fee; it is a separate payment.
4. 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 does the term white bagging mean?

What is White Bagging? – The transfer of patient-specific medication from a pharmacy to the physician’s office, hospital, or clinic for administration is referred to as “white bagging.” This method is frequently utilized in cancer settings in order to get expensive injectable or infusible drugs.

1. These prescriptions are distributed by pharmacists who specialize in a certain field, and it’s possible that non-specialty pharmacies won’t carry them altogether.
2. The drug is brought to the provider’s office by the pharmacist in a manner that is unique to this practice; specifically, the medication is brought there directly.

There is no one acting as a go-between; the patient is not responsible for transporting the drug from one location to another. The chain of command is trustworthy, and it successfully oversees quality control. When it comes to reimbursement, the pharmacy benefit, rather than the medical benefit, is the one that often covers the cost of the prescription.

What does it mean when a nurse bags someone?

Slang for drugs A regional “street” name for inhaling illicit substances—such as toluene or xylene—after volatilizing them in a bag and then inhaling the vapors that result. The field of emergency medicine Using a portable bag valve mask to provide manual breathing on a patient who is experiencing dyspnea (Ambu bag) Dictionary of Medical Terms by Segen.

All rights reserved. Licensed by Farlex, Inc.2012. Slang for illegal drugs A phrase used on the “street” to refer to the usage of inhalant misuse substances The field of emergency medicine A patient with dyspnea is given manual respiration through the use of a portable squeeze bag that is coupled to a face mask.

Originally published in 2002 by The McGraw-Hill Companies, Inc. as the McGraw-Hill Concise Dictionary of Modern Medicine.