Major Payers Face Criticism Regarding Specialty Pharmacy Policies

Several large insurance companies, including BlueCross BlueShield of Tennessee, Anthem, Cigna, Aetna, and UnitedHealthcare, are facing criticism due to variations of a specialty pharmacy policy for prescription drugs. Instead of providers directly treating a patient with a drug and then billing the payer, some payers are now requiring medication acquisition to go through a specialty pharmacy. These “white bagging policies” are facing widespread disapproval.

“Typically, providers have acquired these therapies through a buy and bill model in which they buy and maintain an inventory of medications. Providers then administer the drug to the patient and bill the insurer after treatment. Critics of this type of policy argue that it affects how providers (physician practices and infusion centers) provide care for patients and removes their flexibility in managing their business. Under this policy, the provider does not take ownership of the medication, and patients pay their copayment or coinsurance to the specialty pharmacy after the physician orders the drug. The specialty pharmacy then delivers the medication directly to the provider.” Read more here.

(Source: John Santilli, Access Market Intelligence, 4/27/21)