In a recent op-ed published by MedCity News, rheumatologist and ACR Insurance Subcommittee Chair Michael Feely, MD, delivers a powerful critique of the insurance practice known as white bagging, calling it a “prescription for disruption” that threatens the quality and timeliness of patient care.
White bagging refers to a policy in which insurers and pharmacy benefit managers (PBMs) mandate that physician-administered medications be sourced from third-party specialty pharmacies—often affiliated with the insurer—rather than allowing providers to use their own in-office inventory. Although this practice is marketed as a cost-saving measure, Dr. Feely argues that white bagging undermines clinical autonomy, delays treatment and increases waste.
Real-World Consequences
In the piece, Dr. Feely shares firsthand experiences in which patients receiving biologic infusions for such conditions as rheumatoid arthritis and lupus have faced:
- Treatment delays due to shipping issues or prior authorization hurdles;
- Inflexible dosing when lab results change after the medication has already been shipped; and
- Wasted medication when drugs must be discarded because they no longer match the patient’s needs.
These disruptions not only compromise care but also erode trust between patients and providers.
A Call for Reform
Dr. Feely joins a growing chorus of clinicians advocating for state-level legislation to curb white bagging. He highlights recent laws in Texas and Delaware that restrict the practice unless both the prescribing physician and dispensing pharmacist agree it’s in the patient’s best interest.
His message is clear: “Physicians—not insurers—should be the ones making decisions about how and when medications are administered.”
What’s Next?
Dr. Feely urges healthcare professionals to:
- Educate patients about the risks and limitations of white bagging;
- Engage with policymakers to advocate for patient-centered legislation; and
- Share clinical stories to highlight the real-world impact of these policies.
The ACR is working to ensure that insurance policies impacting coverage and payment for rheumatology services are fair and appropriate. The volunteer members of the Insurance Subcommittee of the ACR’s Committee on Rheumatologic Care help lead this effort by educating payers and advocating for policies that prioritize access to rheumatology care and treatment. Click here to learn more about updates and resources on key insurance advocacy priorities and information on requesting assistance with an insurance concern.
