‘Bagging’ oncology drugs increases costs for patients
Click Here to Manage Email Alerts
Key takeaways:
- Bagging practices varied according to geographic region and insurance plan type.
- Insurers and patients do not equally benefit financially from bagging practices.
Bagging oncology drugs lowered payments for certain therapies for insurers but increased out-of-pocket costs for patients, according to study results published in JAMA Network Open.
Of note, researchers found bagging practices to be more common for IV supportive care drugs vs. immunotherapy or targeted treatments.
Rationale and methodology
Cancer medications that require delivery via IV infusion have traditionally been purchased by physicians and administered directly to patients in medical settings, and insurers covered them under medical benefits, according to background information provided by the researchers.
“Recently, some insurers have started bagging — a drug delivery model that requires patients to obtain physician-administered medications via pharmacies, often specialty pharmacies, and either have the medications shipped to physicians’ offices or to patients who then bring the medications to their physician’s office to be administered,” Ya-Chen Tina Shih, PhD, professor in the department of radiation oncology at UCLA Jonsson Comprehensive Cancer Center at David Geffen School of Medicine, and colleagues wrote.
Pharmacy benefits covers medications distributed under bagging practice, but patient safety concerns have prompted the American Hospital Association and ASCO to issue position statements recommending restriction of the practice, the researchers added.
“As of 2021 ... Arkansas, Louisiana and Virginia have enacted laws prohibiting insurers from mandating bagging practice,” the researchers wrote. “Despite concerns voiced by professional associations and growing legislative efforts to restrict bagging practice, there is limited information on the prevalence of bagging in oncology and its financial effect.”
For this reason, Shih and colleagues identified 50 cancer drugs with the highest total costs included in the 2020 Medicare Part B drug spending dashboard. They pooled 2019 to 2020 data from the MarketScan Commercial Claims and Encounter Database and identified medications from medical and pharmacy claims among patients with cancer.
The study included 113,076 patient-drug pairs (mean patient age, 55.9 years; 68.4% women).
Researchers defined bagging as having physician-administered drugs billed to pharmacy benefits. They called the traditional alternative of physicians purchasing the drugs for delivery in the medical setting “buy-and-bill.”
Investigators calculated per-patient per-month insurance payment and out-of-pocket expenses separately from medical and pharmacy claims. They conducted regression analyses to examine the difference in mean and median per-patient per-month insurance payment costs between drugs distributed under bagging vs. buy-and-bill practices.
Findings
Overall, more than half (53.1%) of all patient-drug pairs involved immunotherapy or targeted therapy, followed by supportive care (27.6%) and other anticancer agents (19.3%).
Results showed bagging accounted for 3.7% of patient-drug pairs, which ranged from less than 1% of immunotherapy or targeted therapy agents to 11.4% of supportive care agents, according to the researchers.
In addition, researchers observed variations according to geographic region and insurance plan type. They observed statistically significant lower adjusted mean per-patient per-month payments for medications distributed under bagging ($7,405; 95% CI, $7,111-$7,700) compared with buy-and-bill ($9,547; 95% CI, $9,471-$9,622).
Researchers additionally found similarities in adjusted median payments for bagging ($5,746; 95% CI, $5,448-$6,043) compared with buy-and-bill ($6,681; 95% CI, $6,624-$6,737).
Moreover, researchers observed higher adjusted mean out-of-pocket-cost payments per-patient per-month for bagging (mean, $315; 95% CI, $278-$351) compared with buy-and-bill ($145; 95% CI, $141-$148). They observed the same for median out-of-pocket-cost payments per-patient per-month for bagging ($93.60; 95% CI, $39.50-$39.70) vs. buy-and-bill ($0; 95% CI, $0-$0).
“Stratified analyses showed these patterns were primarily associated with supportive care drugs,” the researchers wrote.
Researchers said a limitation of the analysis included the inability to differentiate between agents shipped to the physician’s office or to patients’ residences in claims data.
Implications
“Proponents of bagging practice have emphasized its economic benefit to payers and patients, including the potential of lower premium from overall cost reduction,” the researchers wrote. “However, bagging in oncology was associated with lower payment for insurers ... but higher out-of-pocket payment for patients, suggesting payers and patients do not equally benefit from bagging practice financially.”
In addition, bagging can present challenges for physicians, they continued.
“For example, electronic health record builds of treatment plans typically include supportive medications preferred by and on formulary at the infusion facility,” they wrote. “If bagging introduces an alternative supportive medication, modification of treatment plans may or may not be possible depending on what has been built in the site’s electronic health record.”
Researchers said further research is needed to better understand factors driving the diffusion of bagging in oncology and to evaluate how the practice affects clinical outcomes.
Collapse
Read more about
Click Here to Manage Email Alerts