ASHP describes white bagging as a model in which an outside specialty pharmacy ships a patient-specific clinician-administered drug directly to the location where it will be administered. Brown bagging refers to the drug being dispensed to the patient or caregiver to transport to the clinic.

These models raise operational and medication-safety questions, and state laws or payer rules can differ. Patients should not transport or redirect a clinician-administered drug unless the dispensing pharmacy and administering site have explicitly coordinated the process.

Questions to answer before the next call or submission
  • Is this white bagging, brown bagging or clinic inventory?
  • Who dispenses the drug?
  • Who receives the shipment?
  • Will the clinic accept it?
  • Storage/chain-of-custody requirements
  • Authorization for drug and administration
  • What happens if the appointment changes?
  • State/payer exception process if needed

White bagging: pharmacy to treatment site

The specialty pharmacy dispenses for a specific patient and ships to the clinic or hospital. The clinic then administers a drug it did not acquire through its usual inventory channel.

Confirm the clinic accepts the shipment, the product will arrive before the appointment and there is a plan for delays, cancellations, dose changes or damaged shipments.

Brown bagging: pharmacy to patient to treatment site

The patient receives the drug and brings it to the treatment site. ASHP opposes payer-mandated brown bagging because of storage, handling and chain-of-custody concerns.

Do not assume a clinic will administer a drug the patient brings from home. Confirm before dispensing or transport.

Coverage and safety have to agree

An insurer may have a sourcing requirement while a treatment site has a safety policy that will not accept that model. The solution is a coordinated exception or different covered site—not forcing the patient to improvise medication handling.

Keep the insurer, specialty pharmacy and treatment-site contacts together until the path is fully confirmed.

Use the source that actually controls your case

MedicineCostHelp can organize the problem, but the member-specific plan, payer decision, provider record or assistance program makes the actual determination. Keep written decisions, reference numbers and the documents that support the next step.

Sources

ASHP — White Bagging →ASHP — Five Key Elements of Effective White Bagging Policy →