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Hoosiers deserve better  

Imagine a situation where you or a loved one has just been diagnosed with cancer or another type of life-altering illness. The news of this diagnosis is already heartbreaking and difficult. The doctor wants to begin immediate treatment, but your insurance company has imposed a new policy dictating where your chemotherapy drug, or other medication, comes from before it can be prepared and infused. The company’s designated pharmacy does not have your drug in stock. As you grapple with this new diagnosis, you learn that your care will be delayed.

Unfortunately, this hypothetical scenario is becoming reality for many Hoosiers.

Recently, large health insurance companies have begun to deny payment to health care providers and pharmacies unless they obtain specialty drugs from designated pharmacies who are often owned by or affiliated with the insurer, instead of the pharmacies clinicians normally rely on for quality and access. This practice is called “white bagging.” It prevents health care providers from controlling the handling, preparation, dosage, and storage conditions of these drugs prior to administration.

Based on a patient’s most recent lab result or changes in their condition, pharmacists often make last-minute adjustments to medications on the day of administration. But once a specialty drug is mixed and labeled for a patient, the drug generally cannot be adjusted; it must be discarded. To account for these last-minute adjustments, health care providers purchase specialty drugs from in-house or nearby pharmacies that can fill medication orders quickly and meet their safety standards. However, mandated white bagging prohibits this quality assurance.

Insurance companies have represented that these measures will reduce costs, but when it comes to patient safety, no cost saving measure is worth the risk. Insurers should not mandate policies that go against provider recommendations and create quality concerns. The Indiana legislature validated this sentiment by passing a law this session requiring the Indiana Department of Health, in consultation with the Indiana Board of Pharmacy, the Indiana Department of Insurance, and the Indiana Family and Social Services Administration, to examine and report to the legislature on the safety of this practice by July 1.

Given the rapid expansion of these policies, the state of Indiana should move quickly to establish guardrails around these practices to protect the growing number of Hoosiers caught in the line of fire. Not only will these policies result in delayed patient care and wasted drug costs, but they will add administrative costs to the health care system due to rescheduling critically ill patients.

Delayed care has real consequences and should not be the result of insurance company mandates like white bagging that trade safety for short-term savings. Through collaboration, we can find ways to reduce health care costs without sacrificing quality.

— Hoosiers for Safe Meds: Indiana Pharmacists Association, Indiana Oncology Society, Indiana Academy of Dermatology, Indiana Academy of Ophthalmology, Indianapolis Coalition for Patient Safety, Indiana Rural Health Association, Indiana Organization of Nursing Leadership, Indiana Hospital Association, Indiana Radiological Society

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