Anthem Mandate Threatens Patient Health
Violating the sanctity of the doctor-patient relationship amid a global pandemic is bad medicine. Taking control away from providers and patients – in the pursuit of insurance profits – is bad business. Limiting access to affordable medical care as COVID-19 surges is bad for public health.
Such are the potential dangers arising from a new order issued by Anthem Blue Cross of California. Anthem’s mandate – requiring providers “to obtain a lengthy list of provider-administered medications through the CVS Specialty Pharmacy, a practice commonly known as white-bagging” – will threaten patient health.
“White-bagging refers to specialty pharmacies sending prefilled-infused therapeutics directly to the provider; thus, if the physician needs to adjust the dose, the drug must be shipped back to the pharmacy.” For the non-medical lay-person, infusion therapy is typically used to treat serious or chronic infections that do not respond to oral antibiotics, like cancer and the pain caused by cancer.
In a letter to Ms. Gail Boudreaux, Anthem’s CEO, the Infusion Providers Alliance (IPA) writes, “Anthem’s mandate is bad for Anthem, patients, and community-providers for several reasons: it would increase Anthem’s costs, increase waste of medications, cause treatment delays, and significantly increase the burden on providers. If this policy is extended to community-based providers, it may be infeasible for them to continue offering the administration of these infused and injectable medications in their offices.”
Anthem’s new white-bagging mandate violates the principle of ‘the right medicine to the right patient at the right time for the right cost’.
Providers must get medicine to their patients in time; doctors must not be forced to wait for pharmacies to re-adjust prescribed therapies. Not all cancers, for instance, grow gradually at a slow rate. Many cancerous tumors are fast growing, and every day that a provider must wait could be the margin between life and death for the patient. It could mean one more day of excruciating pain – it is unnecessary and cruel.
During a panel discussion recently, an oncologist (a cancer doctor) was asked about the problems of white-bagging: “The issue with white-bagging is that if the insurance company has sent me that drug and that dose, if I need to change that patient's dose for any reason, or even change to another regimen altogether, because the patient has progressed or isn't tolerating the first regimen, then I have to send that patient away, and bear the cost of sending that drug back to whoever sent it to me. And then the patient would have to wait until the new drug is approved and come in, and then make another trip."
As the IPA makes clear, “If Anthem extends its white-bagging policy to community providers, many of these high quality, low-cost providers will be forced to stop offering cost-efficient administration of these medications to Anthem patients. This will restrict Anthem members’ access to care and force them to sub-optimal and more costly providers, such as hospital outpatient departments. Nationwide, the cost of providing these medications in hospital outpatient departments can be 2 to 5 times as expensive as providing these medications in a community setting.”
White-bagging sacrifices patient safety in the vain hope that it will in some way save money. When an insurance company prevents a provider from managing infusion therapies – and this is critical in cancer care – they do not know the ‘how, who, or when’ of the therapy. Who mixed it? Was it kept at the right temperature? What was the timeline? How was it delivered? What’s more, Anthem’s edict will delay care and increase costs. It is bad health care; it is bad business; it is bad for public health.
White-bagging interferes with the quality and the value of patient care. Anthem should rescind its mandate scheduled to take effect December 1, 2020.
Jerry Rogers is the editor of RealClearHealth and the host of the 'Jerry Rogers Show' on WBAL NewsRadio.
