EP369: What's Up With Specialty Pharmacy Bagging? With Keith Hartman, RPh

Brown Bagging, White Bagging, and Clear Bagging Explained, With Keith Hartman, RPh. A Field Guide to Specialty Pharmacy Bagging and Who Profits From Each Kind. Episode 369.

Stacey Richter talks with Keith Hartman, RPh, CEO of ContinuumRx, about the evolution of specialty pharmacy "bagging"—brown, white, clear, and gold—and how each variation shifted which party captures the profit on increasingly expensive infused and injected drugs.

WHAT YOU'LL LEARN

✅ How brown bagging (drug shipped to or picked up by the patient, then brought to the provider) gave way to bigger money once specialty drug prices skyrocketed

✅ How "buy and bill" lets provider organizations profit more from more expensive drugs, since a percentage of a bigger number is a bigger number

✅ How white bagging emerged as PBMs stepped in to buy drugs directly and ship them to providers, promising savings to plan sponsors

✅ Why clear bagging—where one organization owns both the pharmacy and the administering provider—solves some clinical issues with white bagging while letting hospitals capture a cut

✅ Why oncology providers, on average, are reported to collect roughly six times the cost of some drugs they administer

✅ What gold bagging is, and how this whole "who gets the money" fight between providers, PBMs, and hospitals continues to evolve

WHY THIS MATTERS

Every iteration of specialty pharmacy bagging is really a reaction to the last one—a cascade of "equal and opposite market distortions" as providers, PBMs, and hospitals each try to capture a share of the profit on increasingly expensive infused and injected drugs. Understanding the brown/white/clear/gold bagging taxonomy gives plan sponsors and clinicians the vocabulary to see past the jargon to who's actually profiting and where clinical care might suffer along the way.

MENTIONED IN THIS EPISODE

Encore! EP216 with Chris Sloan: Apple Podcasts | Spotify | Other Apps

EP337 with Olivia Webb: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction.

08:09 What kinds of patients and/or drugs is the concept of bagging relevant to?

08:53 What is brown bagging, and what are the issues with it?

10:28 What is white bagging, and how is it different from brown bagging?

11:30 Who are the key players in pharma bagging?

12:25 Why does a PBM want a specialty drug to go through them?

12:49 From the physician's perspective, why is buy and bill ideal?

16:46 How does white bagging impact patient clinical care?

23:05 What are the two main reasons patients might not continue their therapy?

23:29 "We've got to leave some authority with our prescribers to be able to make a clinical decision of what's best for that … patient."

24:41 What is clear bagging?

26:51 How does a hospital specialty pharmacy get in network with a PBM?

28:57 What is gold bagging?

30:11 "Outlook really needs to be what's best for the patient."