Hospitals Urge Guardrails as Insurers, PBMs Warn of Price Spike in Bagging Debate
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Summary
Hospitals and pharmacists told lawmakers SB 256 would protect patients from delays and storage risks tied to insurer‑directed specialty pharmacy 'bagging'; insurers and PBMs said banning the practice would raise premiums and remove a cost control tool.
Hospitals, pharmacy directors and patient advocates urged the Commerce Committee to adopt guardrails for white‑bagging and brown‑bagging practices, saying clinician‑administered specialty drugs shipped by insurers to providers or patients can pose safety and timing risks.
Sen. Tim McHugh, sponsor of SB 256, said the amended bill does not prohibit bagging but requires agreements and shared decision‑making between providers, carriers and patients when a carrier's specialty pharmacy supplies clinician‑administered drugs. He framed the bill as a patient‑centered compromise after stakeholder negotiations in the Senate.
Hospital witnesses described recurring operational problems: temperature‑sensitive biologics arriving late or exposed to weather, last‑minute dose changes, and opened or tampered packages that cannot safely be administered. "When medications come in improperly handled or delayed, a $4,000 dose can be wasted and the patient must be rescheduled," said Matthew Borden, pharmacy director at Cheshire Medical Center.
The New Hampshire Hospital Association and several hospital pharmacists urged guardrails that preserve clinician oversight and chain‑of‑custody standards and allow white‑bagging only when the provider and carrier agree it is safe and appropriate.
Insurers and PBM representatives opposed the bill as written. Sabrina Dunlap of Anthem said prohibiting insurer‑directed specialty pharmacy use would remove a prominent cost containment tool and estimated substantial premium increases if white‑bagging were banned. PBM and business witnesses cited national studies showing hospital markups on infused specialty drugs can be substantially higher than alternate distribution routes, and warned of price shocks in states that restrict bagging.
The Department of Insurance presented an analysis showing mixed results: for some drugs bagging saved money, for others it did not. The department said aggregate savings across a selected set of drugs were present but results varied drug by drug. Several witnesses suggested narrower drafting to protect patients without broadly removing carriers' negotiation leverage.
The committee heard competing policy tradeoffs: patient safety and timely administration versus systemwide drug‑cost containment. Committee members asked for concrete examples and more cost data; hospitals said they would provide patient stories and the department said its report and data would be circulated. The measure was left for further consideration with requests for more factual detail on costs and patient‑safety incidents.
Next steps: committee requested additional written examples of patient harm, insurer cost analyses and specific contract language for conditional white‑bagging agreements.
