Hartford Business Journal

10 HARTFORDBUSINESS.COM | JULY 28, 2025 Image created by ChatGPT Cost Controls Health insurer 'white bagging' policies raise concerns among providers, state officials driver of the double-digit rate hikes they've recently proposed for 2026 individual and small group health plans in Connecticut. Who saves, who pays? While Aetna/CVS Health declined an interview request from Hartford Business Journal, they did agree to answer questions via email. In his emailed response, Phillip Blando, executive director of external affairs for CVS Caremark and Aetna, replied that the health insurer "has changed the way we manage five specialty drugs for commercial fully insured health plans and a narrow set of commercial self-insured health plans." Members now must purchase the five specialty medications from "any specialty pharmacy that partic- ipates in their health plan network," he stated, adding that the change "allows us to better control the cost of the drugs and keep premiums more affordable, while still providing members with safe, convenient access to these drugs." However, a study published in the Journal of the American Medical Association (JAMA) in September 2023 found that patients ultimately pay more for white bagging. According to the study, white bagging saved an insurer 14% on the median cost of a medication per patient per month, but the median out-of-pocket monthly payment per patient jumped from zero to $93.60. Warren, the IPA executive director, said the change is significant for the people it affects. By David Krechevsky davidk@hartfordbusiness.com W hen the Connecticut Prescription Drug Task Force released its 15-page final report in February, most readers likely glossed over a short paragraph tucked away on the final page. But for hospitals, insurers and regu- lators, those few lines — addressing the regulation of white and brown bagging, or the lack thereof — signaled an unresolved and poten- tially contentious debate. The paragraph reads: "White bagging (when insurers require prescribed medications to be purchased through specific, and sometimes affiliated, specialty pharmacies) and brown bagging (requiring patients to trans- port specialty medications to their providers) remain contentious, with no consensus on regulation." Since that report was released, however, the issue of white bagging has become more urgent, at least for those covered by a fully-insured commercial health plan from Aetna. The Hartford-based health insurer, owned by CVS Health, announced in June it was making changes to its commercial medical drug plan lists, effective July 1. The changes included reclassifying five specialty medications to "phar- macy-only" coverage. That means these patient-specific drugs that providers typically purchase from wholesalers and later bill insurers for (a model known as "buy and bill") could now be supplied only by Aetna-contracted third-party specialty pharmacies — such as CVS Specialty — which would ship them directly to healthcare providers to be adminis- tered to patients. The term "white bagging" comes from the fact that specialty phar- macies ship the medications in white bags. The five medications reclassified by Aetna — Remicade, Tezspire, Xolair, Ocrevus and Evenity — are infusion therapies, administered directly into the bloodstream for patients with chronic diseases. That explains why the change got the attention of the Washington, D.C.- based Infusion Providers Alliance (IPA) and its members, which operate nearly 1,000 privately owned, inde- pendent infusion centers in 43 states, including 15 in Connecticut. The organization sent a letter, signed by IPA Executive Director Elliott Warren, asking Aetna's policy review committee to "immediately rescind" the change, saying it's "not financially sustainable for community-based providers." The IPA is not the only observer to raise concerns about the change. A national independent infusion center company with four Connecticut loca- tions, a state legislator and the state healthcare advocate also question the decision. They cite concerns about efficiency, access, safety and cost, stating that while the insurer may save money, the expense for patients will increase along with the potential risks. Aetna/CVS Health, though, defends its decision, with a spokesperson saying the insurer "implemented this change with careful consideration for the needs of our members." The change comes as insurers, healthcare providers and others continue to cite rising prescription drug costs as a major driver of overall healthcare spending. In fact, insurers say prescription drug costs are a key

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