The Rhode Island Senate approved a bill Friday designed to safeguard patients from the disruptive practice known as “white bagging.” This insurance scheme dictates the delivery and administration of prescribed drugs and has raised concerns about patient care.
“White bagging” involves insurers compelling patients to obtain their prescriptions exclusively from insurer-affiliated pharmacies, often limited to mail-order services. The Senate-approved bill, designated as 2024-S 2086, has been introduced in the House (2024-H 7365) by Rep. Justine A. Caldwell and aims to prohibit this controversial practice.
Typically, when a patient requires a clinician-administered medication, such as chemotherapy drugs, they visit a hospital where the clinician orders the necessary medication from the on-site pharmacy and administers the treatment.
According to the American Hospital Association, “white bagging” presents several challenges to patient care. The practice fails to accommodate necessary changes in patient care plans, hindering healthcare providers from adjusting dosage or drug choices based on the patient’s labs or measurements on the day of treatment. Despite having these medications on-site at their own pharmacy, hospitals are often compelled to wait for the drug to arrive from a specialty pharmacy or risk not being reimbursed. Furthermore, once filled and labeled, expensive specialty drugs cannot be substituted or modified, leading to potential wastage if the care plan is altered.
Senator Ujifusa and Representative Caldwell’s bill seeks to prohibit insurers or pharmacy benefit managers (PBMs) from engaging in “white bagging” practices. It ensures that patients have the freedom to choose their pharmacy and guarantees that in-network providers, including hospitals, receive payment for their services, irrespective of the pharmacy from which they sourced the medications.
The American Society of Clinical Oncology reports that eight states currently have laws prohibiting or limiting “white bagging,” with several others contemplating similar legislation.
Senator Ujifusa (D-Dist. 11, Portsmouth, Bristol) expressed concern about the impact of “white bagging” on patient care, stating, “White bagging makes money for middlemen, but creates waste, barriers to care and disruptions to the patient-provider relationship.” She emphasized that this bill positions Rhode Island among the states taking proactive measures to address issues related to insurers and PBMs.
The Senate-approved bill will now advance to the House for further consideration.
Representative Caldwell (D-Dist. 30, East Greenwich, West Greenwich) underscored the negative consequences of “white bagging” on patient care, describing it as a “money-making effort for insurers that stands between people and the medicine they need.” She emphasized the unnecessary bureaucratic layer driven by profit motives and its potential harm to Rhode Islanders, especially those in need of critical medical treatments like chemotherapy.
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