Brown Bagging, White Bagging, and Clear Bagging: What it Means and How it Works

The terms brown bagging, white bagging, and clear bagging are frequently used to describe the way in which a specialty medication is obtained prior to patient administration by a healthcare professional.¹ Brown bagging is the term used when a patient obtains their medication from a specialty pharmacy and takes it to the provider’s office for administration of the medication.  White bagging refers to the process by which a provider orders and receives a patient’s medication from a specialty pharmacy and stores it until they ultimately administer the medication to the patient.  One caveat with white bagging is that providers must stock and store medications for each patient separate from the office or hospital stock, which can be logistically burdensome. Clear bagging is similar to white bagging with one key distinction.  Clear bagging involves the provider obtaining the specialty drug from a specialty pharmacy within the same health system.²

Key billing and cost considerations exist for health professionals administering most specialty medications. Physician offices may use a process called buy-and-bill. The “buy” portion refers to the provider being responsible for the ordering and purchasing of a specialty drug.  The “bill” phrase refers to the provider billing third party payers for reimbursement.  The billing process includes reimbursement for the drug, the administration of the drug, and any related services associated with the drug and its administration.  Under the different forms of bagging, the specialty pharmacy will work with the payer to determine the medical vs. pharmacy benefit billing for the drug.  The buy-and-bill method for providers utilizes medical benefit billing and reimbursement. The provider’s office manages the drug inventory to align with patient appointments, as forgetfulness or lack of coordination could impact adherence and health outcomes.  This method means that the provider’s office is responsible for higher upfront costs and the management and storage of the medication. ³ However, this method is also likely to be more profitable for the provider.

The significant expenses associated with specialty medications and their administration has payers searching for a way to cut costs without sacrificing care.  One popular and proven solution is called Site of Care Optimization,⁴ which encourages patients to move from the traditional and higher-priced locations of drug administration to lower cost options.  Magellan’s annual Medical Pharmacy Report highlights the magnitude of the cost savings stating, “Commercial medical benefit drug costs in the hospital outpatient setting were often double that of the physician office. Compared to the commercial population… Oftentimes, administrative code reimbursement is four times more expensive in the hospital than physician office setting for commercial members.”  This presents payers with a phenomenal opportunity to cut costs for patients without sacrificing care.⁵ How do you envision the future of specialty drug delivery and administration?

References:

1. Rayburn K. What is the difference between white, Brown, and clear bagging? Patient Empowerment Network. https://powerfulpatients.org/2022/05/25/what-is-the-difference-between-white-brown-and-clear-bagging/. Published May 25, 2022. Accessed November 2, 2022.

2. Brown bagging versus white bagging: Value-based Cancer Care. Value Based Cancer Care. https://www.valuebasedcancer.com/issues/2013/september-2013-vol-4-no-8/1341-brown-bagging-versus-white-bagging#:~:text=%E2%80%9CBrown%20bagging%E2%80%9D%20is%20when%20a%20patient%20acquires%20specialty,the%20patient%20visits%20the%20physician%E2%80%99s%20office%20for%20administration. Published July 25, 2013. Accessed November 2, 2022.

3. DeMarzo A, Nbpas. What is buy and Bill? Prior Authorization Training. https://www.priorauthtraining.org/what-is-buy-and-bill/. Published March 22, 2021. Accessed November 2, 2022.

4. Orabi C. Site of care optimization: What is it and what do you need to know? CIVIC Infusion | Medical Infusion Specialists. https://www.civicinfusion.com/CIVIC-Blog/site-of-care-optimization-what-is-it-and-what-do-you-need-to-know. Published November 13, 2020. Accessed November 2, 2022.

5. Site of Care Optimization. National Infusion Center Association. https://infusioncenter.org/infusion-center-news/site-of-care-optimization/. Published September 14, 2019. Accessed November 2, 2022.

Posted: February 2023