“Everybody has awareness of white bagging. But everybody still has challenges with it.” That’s how Bryan Schuessler, the senior director of product management at CoverMyMeds, summarized the findings of a new survey during a panel discussion on the complexities of white bagging at the NASP 2025 Annual Meeting and Expo, in Denver.
The session brought together leaders from across the specialty pharmacy field to explore insights from NASP’s recently completed white bagging survey. Conducted by NASP’s Customer Experience Committee, the study provides one of the most comprehensive snapshots to date of how pharmacies, providers and patients are navigating this controversial distribution model.
As a refresher, white bagging refers to a reimbursement model where a payor (such as an insurance company) mandates that a specialty pharmacy or a designated distributor fills/provides a patient's specialty medication and ships it directly to the patient's healthcare provider for preparation and administration. The specialty pharmacy bills the patient's pharmacy benefit, while the provider is responsible only for preparing and administering the drug, not managing its purchase or handling.
Drug administration fees, which cover the preparation and handling as well as the administration itself for the medication, which is often referred to as a “zero-priced drug,” still are available to the provider. This payment process differs from the traditional “buy-and-bill” method, in which providers purchase, store and then administer the medication under their medical benefit.
Roughly three-fourths of survey respondents said they already have policies and procedures in place to address white bagging—but that doesn’t mean they know much about it. “Half of respondents admitted they didn’t even know which payors had white bagging built into their plan design,” Mr. Schuessler explained. “That level of opacity makes it incredibly difficult for pharmacies to anticipate requirements, prepare resources or scale operations effectively.”
Even among those survey respondents who recognize payor mandates, many acknowledged that if they had to suddenly expand a white bagging program, they lacked the bandwidth and infrastructure to manage it.
The survey also highlighted the daily operational headaches that white bagging introduces, such as logistics and scheduling. “There’s always the question of, what if the patient doesn’t show up? What if the infusion site won’t accept a white-bagged product?” Mr. Schuessler said. “You can end up with expensive medications stranded, wasted or delayed—and patients stuck in the middle.”
Provider offices also may not be fully informed about payor requirements, patients may not understand why their medication arrives separately, and pharmacies often struggle to coordinate among stakeholders, he added.
Although payors justify white bagging as a way to reduce drug costs, Mr. Schuessler noted that the lack of transparency in how these mandates are communicated and enforced creates cascading problems. “There’s no consistent way to know which payors are implementing these policies, or how flexible they’ll be in practice,” he said. “That creates situations where a payor requires white bagging, but the infusion site refuses it. Then what happens to the patient?”
Despite the barriers, some organizations are navigating white bagging more effectively, Mr. Schuessler said, noting that success often depends on a combination of resources, payor relationships and willingness to invest in new processes. “There are pharmacies that have figured out how to make this smoother—through stronger digital communication tools, better patient outreach and more proactive engagement with providers. But it takes investment, and not every organization has the capacity to do that.”
Mr. Schuessler suggested that the survey results point to the need for more clarity, consistency and collaboration across the healthcare ecosystem. “Awareness is there. But without transparency from payors and scalable solutions at the pharmacy level, we’re going to keep running into the same barriers,” he said. “Ultimately, it comes back to patient access. White bagging is not going away. The question is, how do we manage it in a way that minimizes disruption, maintains provider confidence and ensures patients get their medications safely and on time?”
Establish a Mechanism for Handling Zero-Priced Drugs
From the perspective of the provider, there are at least three opportunities for using zero-priced medications: 1) white bagging, 2) patient assistance and sample drugs, and 3) study drugs, noted Bonnie Kirschenbaum, MS, FASHP, FCSHP, an independent reimbursement consultant based in Boulder, Colo. “As healthcare is on the cusp of dramatic change, with many new regulations dictating eligibility, coverage and payments, it behooves providers to establish a mechanism for efficiently and effectively handling these medications,” Ms. Kirschenbaum said.
Basically, all zero-priced medications require the same steps: knowing the payor requirements, establishing procedures for handling and storage, and adjusting the Prescription Drug Master and Charge Description Master to accommodate electronic health records and claims submission for the drugs, she noted. “Understand that payor-mandated drug acquisition, in some format, is here to stay. Can you afford to ignore it and go your own way? I think not,” said Ms. Kirschenbaum, a member of the Pharmacy Practice News editorial advisory board.
Mr. Schuessler reported no relevant financial disclosures beyond his stated employment.
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