Experts Vary on Challenges, Benefits of White Bagging

As health plans seek to have more control over their spending on provider-administered specialty drugs, many physicians are pushing back, as seen most recently with BlueCross BlueShield of Tennessee’s (BCBST) new program (see story, p. 1). But at least one survey of commercial payers shows that mandating the use of a specialty pharmacy to acquire these therapies is replacing the longstanding approach, a trend that respondents anticipate will continue even though industry experts vary on the benefits and challenges of such an approach.

Providers traditionally have acquired therapies they administer through a practice known as buy and bill, by which they will purchase a drug from a wholesaler or distributor, keep it in their office and administer it to patients as needed, submitting a claim to the payer afterwards. Through this approach, providers can make a profit by marking up the drug.

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• Radar on Specialty Pharmacy