Insurer practices do little to get patients who need highly specialized medication the right care at the right time
HEALTH CARE
Attorney Donald Pfundstein’s recent article, “Hospital Specialty Pharmacies: Follow the Money,” (July 16-29 NH Business Review) clearly missed the mark on the facts and challenges of ensuring patients are able to get the high-quality care that they need, especially with respect to the highly specialized medications to treat their cancers and other conditions.
Unfortunately, Attorney Pfundstein, who is a lobbyist for insurance companies, neglected to cite in his article that his clients, insurance companies, own or contract directly with specialty pharmacies themselves. He falsely left the reader to conclude that only hospitals operate specialty pharmacies. We would like to set the record straight.
He referred to white bagging and brown bagging, insurer-created practices that circumvent proper federal and state requirements for drug management, inventories and waste handling.
White bagging is when the insurer orders drugs from their own specialty pharmacy and sends it to a hospital or provider where the patient receives their medication. Brown bagging is when the insurer orders drugs from their own specialty pharmacy and sends it to the patient’s home and makes the patient bring that medication to the hospital or provider for administration in a healthcare setting.
We have compiled many patient stories when insurer-required white bagging and brown bagging have caused treatment delays due to drugs not arriving on time, wrong drugs being sent, or the hospital pharmacist not being able to verify that the drugs were kept at proper temperatures throughout the entire shipping process.
It is clear by their actions that when insurers restrict access to hospitals or providers, it’s because they want to profit from that business themselves.
We’d like all insurers that own or contract with their own specialty pharmacies to be transparent about costs, what they are charging their own members and how much profit they receive. Their shareholders are the beneficiaries, not their own members. To date, they have not said what their financial arrangements are with these entities that they own or contract with.
Insurers claim that white bagging and brown bagging save money. Yes, it saves money for them, but not for their members who are subjected to canceled appointments, missed work, and missed critical treatments because their insurersupplied drugs didn’t arrive on time or were simply the wrong medication for the patient.
It also costs the healthcare system money in handling drugs that are not part of their inventory due to storing them and wasting them if the wrong drugs are received or the patient can’t use the drugs.
Growth in specialty pharmacies is actually driven by insurance companies, not hospitals. Only one hospital in New Hampshire manages a specialty pharmacy. That specialty pharmacy integrates pharmacists with providers into clinic sites, which means that access to medications is provided in real time to optimize proper dosages and therapies. Insurers often own their own specialty pharmacies, which are all out of state and mandating their use by their members and their healthcare providers.
In an effort to try to confuse readers, Attorney Pfundstein cites a New Hampshire Insurance Department report that he claims shows an increase in specialty pharmacy costs. The report does show an increase in the cost of specialty drugs, but there is no differentiation in NHID’s report on specialty drugs between insurers and hospitals, yet he insinuated that it was driven by hospital specialty pharmacies. Again, a false claim.
Another clever way insurers benefit financially from these specialty pharmacy schemes is by moving prescription drug costs from a medical benefit to a prescription drug benefit. As we have all seen, members are paying more out-of-pocket costs because prescription drugs paid under a prescription drug benefit typically have higher deductibles and copays.
Again, the insurer is saving money and making money for their stockholders at the patient’s expense.
Attorney Pfundstein’s attempt to deflect attention away from the serious issues associated with the safety and efficacy of insurers practices related to the provision of highly specialized medications for some of their most vulnerable members is an unfortunate diversion that does little to ensure patients are able to get the right care, at the right time, when and where they need it.
Kathy A. Bizarro-Thunberg is executive vice president of the New Hampshire Hospital Association.
