Koreen’s Law aims to end dangerous insurance company requirement that medications be purchased through specific pharmacies
Madison, Wis., Nov. 23, 2021—Patients from across Wisconsin are sharing stories about disruptions to their health care caused by a health insurance policy that prevent their medications from being sourced from local health care providers. The practice, known as “white bagging,” is a growing trend nationally in which health insurers require certain medications to be purchased through specialty pharmacies often owned by the insurance company.
In a recent survey by health care consulting firm Vizient, Inc., 83% of hospitals said that specialty medications delivered to them for patient administration through white bagging did not arrive on time, and another 66% of hospitals said that they have received the wrong dose. These data comport with the experiences of patients and health care providers in Wisconsin, who are sharing their stories with the aim of ending white bagging in the state through a coalition-led public awareness campaign called Patients First Wisconsin.
The Patients First Wisconsin coalition comprises state and national health care groups that have come together to support the passage of Koreen’s Law, a bi-partisan bill named for an Eau Claire cancer patient that would prohibit the practice of insurer-mandated white bagging in Wisconsin. Koreen’s Law has drawn co-sponsorship from 82 state legislators.
Koreen Holmes (Eau Claire, Wis.)
Koreen Holmes is an Eau Claire native who, along with husband Nate, faced a frustrating standoff with her insurance company over medication she desperately needed to fight aggressive, triple-negative breast cancer. After the experience, Koreen has shared her story and lent her name to a bill in Wisconsin to ban white bagging.
“This new insurance practice, we learned, required my medication to be dispensed by a different pharmacy, one specified by our insurer,” Homes related. “Why the pharmacy of my health care provider, which is in my insurer’s network, could no longer supply the medication did not make sense to us. My medication would then need to be mailed to the hospital for my health care provider to administer.”
Holmes continued, “What’s most baffling about this process is that my medication was already on-hand at the hospital pharmacy. With expensive immunotherapy medications like mine, my health care providers, in whom I place complete trust, could not guarantee the timeliness, efficacy or safety of the medicine received from a distant supplier, unlike the medicine they had been providing me all along and which I so desperately needed.”
Read more of Holmes’ story and hear from Koreen and Nate directly here.
The Claeys Family (Grafton, Wis.)
Eight-year-old Landon Claeys was diagnosed with cerebral palsy due to brain damage at birth. Landon has mixed quadriplegic cerebral palsy, which means that he has high tone and spasticity in his arms and legs and low tone in his trunk and neck. The spasticity in Landon’s arms and legs causes him pain and difficulty in controlling his movements.
Landon depends on Botox injections every three months to help loosen his muscles temporarily. The schedule for these injections is crucial for mobility and pain management.
Like the Holmeses, the Claeys family received bad news from their insurance company about the Landon’s medication. “A few days before one of Landon’s appointments, we got a call from the nurse letting us know there was an insurance issue for Landon’s Botox medication,” Landon’s mother Megan recalled. “It took several calls to the insurance company and hospital to determine that something had changed, and the insurance company was requiring the medication to be released from a specific pharmacy and sent to the hospital.”
Explaining the negative effects of white bagging on her son’s care, Megan Claeys proclaimed, “There should be something in place to prevent insurance companies from making a hospital get a medication from an outside source if it has it on-hand already.”
Read more of the Claeys family’s story and hear from Megan and Michael Claeys directly here.
Christine Schavier (Wisconsin Dells, Wis.)
Christine Schavier has been dealing with severe psoriatic arthritis for the past 17 years. This condition causes severe pain in her joints and affects her ability to walk and perform normal, everyday activities.
To help manage her pain, Schavier’s rheumatologist prescribed an infusion medication that helped with joint swelling and stiffness. She was to receive these infusions in 30-minute appointments at Reedsburg Area Medical Center every six weeks.
More often than not, Schavier’s infusion appointments needed to be rescheduled because the medication did not arrive at the hospital when it was supposed to because it needed to be delivered, according to her health insurer’s policy from a specialty pharmacy far away, rather than from her hospital’s inhouse pharmacy.
“My doctor and local pharmacist shared in my frustration with this insurance company tactic, as it affected my care and consumed hours of valuable time from all parties who now had to manage a needlessly complicated medication supply chain,” Schavier said, adding, “Suffering patients should not have to spend their time and energy fighting with insurance companies and specialty pharmacies to get the medicine they need to function, or worse, survive.”
Read more of Schavier’s story and hear from her directly here.