White coating: a prescription for care disruption

When my patients come to see me, they often manage autoimmune and musculoskeletal-skeletal conditions that cause inflammation, fatigue and a lot of pain. That said, one of the most rewarding aspects of the rheumatologist is to provide new and innovative drugs that prevent the progression of the disease, manage inflammation, mitigate pain and, above all, allow my patients to recover their lives.

However, many of these processing options should be administered under careful medical supervision, as they require precise dosage and special manipulation, or are given intravenously. Given these requirements, practices will often keep these drugs at hand and easily have them available to administer patients during their regular visits. With an on -site medication inventory, rheumatologists can adapt the treatments, ensure the integrity of the drug and support better support for drugs for patients.

Unfortunately, in recent years, there has been a growing trend among insurers and pharmacy services (PBM) to move the way certain medications administered by the doctor are covered. Instead of covering these drugs under the medical service of a patient – which has long been the status quo – insurers and their PBMs cover these drugs in the context of the patient’s pharmacy provision. Although this may seem to be a simple administrative adjustment, it fundamentally changes how practices get and provide essential therapies.

When treated as a medical advantage, practices can buy loose medicines, store them safely on site and administer them during visits to the office. This “buy and invoice” approach is effective for providers and patients. But when a drug is moved to pharmacy coverage only, practices are necessary to use a specialized pharmacy to obtain the drug – a process called “white engage”. This means that each patient’s drugs must be ordered individually, coordinated with external parts, followed for delivery and stored separately.

This change creates not only unpaid administrative load challenges and planning challenges for providers, but it also delays or limits access to the drugs necessary for patients. Delay a treatment that manages thrusts or promotes bone density while reducing the risk of fractures puts the health of patients in danger. But this is precisely what some of these insurer policies will do.

These policies also pose potential security problems, as rheumatologists cannot trace the drug through the shipping process. In addition, once a white bag medication has arrives, it can only be used by this specific patient. If a dose should be adjusted according to the side effects or the progression of a patient’s disease, the medication delivered should be thrown and reorganized, generating a huge amount of medication waste.

Payers argue that whitewest policies allow them to pay less for the same medication and limit health costs, but we know that this ineffective process increases costs for patients, who often end up paying more co-assurance.

During all this time, whitewest threatening the sustainability of medical practices which, if paid in the context of the medical services of a patient, would be reimbursed with precision for the infrastructure necessary to provide care, including trained personnel, specialized storage equipment and clinical monitoring required to administer these therapies safely.

As a nation, we must ask ourselves: should health insurers work to improve care or create new obstacles?

Although the solutions to manage the increase in health care costs are significant, they must not be done at the expense of access, continuity or quality. I hope that insurers, regulators and other stakeholders will work to find a better way to follow. Whoever supports sustainable care models, reduces unnecessary charges and ultimately puts patients first. When PBMS dictates how and where drugs are issued, it is not effectiveness – it is interference, and patients are those at risk.

Source: Weiyi Zhu, Getty Images

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