(651) 348-6928 BradQ@DuNordRe.com

Saving Money on Specialty Rx
A potential solution?

Specialty Rx is exploding! We’ve had one reinsurer saying that their clients’ #1 question is, “How can you help us with Specialty Rx?” Specialty Rx is half of drug spend, and J & Q code drugs are half of specialty. Health plan administrators have responded with various strategies, including “white bagging” and “brown bagging,” which are ways of sourcing infusion drugs outside the hospital and clinic channel. Another strategy is a benefit design that forces, or through benefit differentials, encourages lower cost sites-of-service, such as in-home infusion. However, all three face state legislatures wanting to restrict their use. This may mean no national white/brown bag or site-of-service solution exists.

So what to do? The answer may be a national provider that offers voluntary home infusion of J & Q code drugs that are handled through their own pharmacy.

Let’s clarify – What are white and brown bagging? White bagging is when the health plan sources a drug directly and not through a hospital or clinic. The drug is shipped directly to the provider to be administered. Brown bagging is when the drug is shipped to the patient to take with them to the provider. White bagging is more prevalent, as neither the system nor the members are necessarily comfortable with shipping infusion drugs directly to patients.

Are State Restrictions Coming? In 2023, 15 states proposed legislation regarding “bagging,” either white or brown, and/or mandatory/benefit design site-of-service. Those states are Arizona, Arkansas, California, Illinois, Indiana, Kentucky, Louisiana, Minnesota, Missouri, Nebraska, New York, Ohio, Oklahoma, Tennessee, Vermont, Virginia, West Virginia, and Wisconsin.

Are there any national providers that offer voluntary in-home infusions with the drugs handled through their own pharmacy? Absolutely. Contact us for a free evaluation of what the savings potential could be for your health plan. Call (651) 348-6928 or reply to this email if you would like more information.

Click here for a much more in-depth analysis: https://icer.org/wp-content/uploads/2023/04/ICER-White-Paper-_-White-Bagging-Brown-Bagging-and-Site-of-Service-Policies.pdf

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