As white bagging bills have emerged in many states this session, we have observed a few trends in legislative approaches. The most common approach is for states to introduce a straightforward ban on white bagging mandates. Louisiana adopted this type of bill last year, and similar bills have emerged in Kentucky, Nebraska and West Virginia. One key difference between these bills is that the Kentucky legislation is wrapped in a larger PBM package, which makes the bill much more difficult to move forward. The Nebraska and West Virginia legislation are standalone bans on mandatory white bagging. The Nebraska bill has been voted out of committee and the West Virginia bill has cleared the House and is now in the Senate. These standalone bills have an obvious advantage over complex proposals because they enable easier discussion with legislators about white bagging specifically.
A second approach is to place safety guardrails around white bagging mandates. This option is being explored by legislation in New York, which seeks to require proper handling of white bagged drugs to ensure patient safety. Although these safeguards are welcome, it is unclear how such a law would be enforced or whether it would make any practical difference. These considerations make this approach the least preferred for addressing white bagging.
The last approach we have observed combines a ban on mandatory white bagging with bans on home infusions and mandatory brown bagging, a practice in which patients are required to pick up their own medication at a designated pharmacy. This approach is being pursued in Wisconsin with a bill colloquially known as Koreen’s Law, named after a cancer patient. The bill has had one hearing and enjoys broad support, with 83 cosponsors in the Assembly. This comprehensive approach protects patient safety and the provider’s ability to manage care, and we hope this will become the prevailing approach as more states look to adopt white bagging laws.
Conclusion
White bagging will likely remain an active topic in state legislatures for several years. As more states look at ways to protect patients and providers from these practices, it is important that the rheumatology community remains engaged and at the table for these discussions. Working with our traditional partners and hospital associations, we can ensure that providers are not left out of any proposed legislation. Most importantly, we can ensure that patients can continue to receive physician-administered drugs in a provider’s office, where care can be delivered in the safest, most cost-effective way.
