Perspective: Increasing Health Plan Accountability to Benefit Patients

by on

Perspective: Increasing Health Plan Accountability to Benefit Patients
tjordan_drupal
Mar 12, 2021

Patients should expect that any drugs or medications they require are safe, administered effectively and available when needed. But, some commercial health insurance companies are changing the rules about how drugs are handled and administered, with serious consequences for patient care.

Under new policies being implemented by a number of large commercial insurance companies, providers can no longer acquire and store a variety of drugs needed to treat their patients. Instead, they are forced to use a third-party specialty pharmacy – often owned by the same parent company as the insurer – to dispense the drug, a practice known as “white bagging.”

Relying on third-party specialty pharmacies to deliver treatments on a patient-by-patient basis can result in delays in treatment, receipt of improper treatment doses and the inability of a provider to adjust drug dosages based on the patient’s same-day diagnostics. This practice also hamstrings providers’ ability to foresee and mitigate drug shortages.

For example, white bagging can pose a special threat to cancer patients, whose infusion regimens may change on a daily basis. Not having the new infusion regimen immediately available at the hospital can cause delays in treatment, potentially adversely affecting cancer patients’ recovery.

This week we released a report outlining the issue in more detail and why the insurers’ policies simply serve to drive more revenue to health insurers through their pharmacy benefit management and specialty pharmacy lines of business.

We’re calling on regulators to prohibit health insurers from preventing providers from directly acquiring and storing drugs used in patient care.

Unfortunately, white bagging is just one of many mechanisms insurers are using to usurp clinical decision-making power from providers and carve out additional profit streams, often providing little-to-no notice to providers that these policies are being implemented. 

We’re pushing back forcefully on these efforts.

  • We’ve urged the Centers for Medicare & Medicaid Services and Federal Trade Commission to protect hospitals and patients from certain unfair, anticompetitive practices.
  • We continue to inject new research and papers into the policy arena, including an analysis highlighting how commercial health insurance practices contribute to burnout in the clinical workforce and make it more difficult for some Americans to access the care they need. The report highlights the adverse impact of the rise in prior authorization and inappropriate reimbursement delays and denials.
  • And, we’re sharing the stories about the real impact on patients with the media.

There’s more to come. Visit our new Health Plan Accountability webpage for more details and resources.

We’ll continue to make the case that these commercial health plan abuses must be addressed to protect patients’ health and ensure that medical professionals, not the insurance industry, are making the key decisions in patient care.

Rick Pollack
Perspective

Perspective: Increasing Health Plan Accountability to Benefit Patients
tjordan_drupal
Mar 12, 2021

Patients should expect that any drugs or medications they require are safe, administered effectively and available when needed. But, some commercial health insurance companies are changing the rules about how drugs are handled and administered, with serious consequences for patient care.

Under new policies being implemented by a number of large commercial insurance companies, providers can no longer acquire and store a variety of drugs needed to treat their patients. Instead, they are forced to use a third-party specialty pharmacy – often owned by the same parent company as the insurer – to dispense the drug, a practice known as “white bagging.”

Relying on third-party specialty pharmacies to deliver treatments on a patient-by-patient basis can result in delays in treatment, receipt of improper treatment doses and the inability of a provider to adjust drug dosages based on the patient’s same-day diagnostics. This practice also hamstrings providers’ ability to foresee and mitigate drug shortages.

For example, white bagging can pose a special threat to cancer patients, whose infusion regimens may change on a daily basis. Not having the new infusion regimen immediately available at the hospital can cause delays in treatment, potentially adversely affecting cancer patients’ recovery.

This week we released a report outlining the issue in more detail and why the insurers’ policies simply serve to drive more revenue to health insurers through their pharmacy benefit management and specialty pharmacy lines of business.

We’re calling on regulators to prohibit health insurers from preventing providers from directly acquiring and storing drugs used in patient care.

Unfortunately, white bagging is just one of many mechanisms insurers are using to usurp clinical decision-making power from providers and carve out additional profit streams, often providing little-to-no notice to providers that these policies are being implemented. 

We’re pushing back forcefully on these efforts.

We’ve urged the Centers for Medicare & Medicaid Services and Federal Trade Commission to protect hospitals and patients from certain unfair, anticompetitive practices.
We continue to inject new research and papers into the policy arena, including an analysis highlighting how commercial health insurance practices contribute to burnout in the clinical workforce and make it more difficult for some Americans to access the care they need. The report highlights the adverse impact of the rise in prior authorization and inappropriate reimbursement delays and denials.
And, we’re sharing the stories about the real impact on patients with the media.

There’s more to come. Visit our new Health Plan Accountability webpage for more details and resources.

We’ll continue to make the case that these commercial health plan abuses must be addressed to protect patients’ health and ensure that medical professionals, not the insurance industry, are making the key decisions in patient care.

Rick Pollack

Health Insurance
Leadership

Perspective

VA:F [1.9.7_1111]
Rating: 0.0/10 (0 votes cast)
VA:F [1.9.7_1111]
Rating: 0 (from 0 votes)

Leave a Comment

Previous post:

Next post: