Bill to end health insurance practice known as 'white bagging' named after Eau Claire cancer patient (copy)

EAU CLAIRE - Eight months into her pregnancy, Koreen Holmes learned she had breast cancer.

The 32-year-old mom from Eau Claire delivered her baby early - on Jan. 28 - and six days later started chemotherapy treatment at the Prevea Cancer Center at HSHS Sacred Heart Hospital in Eau Claire.

It certainly wasn't the way she wanted to begin her motherhood journey with her newborn son, Reece, but at least she was getting the life-saving infusions she needed every three weeks.

Five months later, her road to recovery was interrupted when her health insurance company put a new policy in place dictating where the hospital obtained her medication - a practice known as "white bagging."

The policy nearly derailed her treatment because Sacred Heart has a policy of not using medications from outside sources.

Koreen's predicament, an obstacle faced by an increasing number of Wisconsin patients, has prompted a bipartisan group of lawmakers to write legislation intended to stop white bagging, named after the white paper bags in which prescriptions are dispensed. The bill is called Koreen's Law.

Koreen said she is honored and humbled to have the bill named after her. She filmed a video last week about her experience for the advocacy group Patients First Wisconsin, a coalition of health care organizations launching a public awareness campaign in support of the legislation.

"It's amazing," Koreen said. "I want to help change people's lives if I can. If that's by having this law changed and being an advocate, then great. I'm all in."

Four Chippewa Valley Republican legislators - Sen. Kathy Bernier of Lake Hallie and Reps. Jesse James of Altoona, Warren Petryk of the town of Washington and Rob Summerfield of Bloomer - were among the initial co-sponsors.

"After hearing Koreen's story, there needed to be some action taken regarding these situations where insurance companies are changing things up when treatment is already in place," James said. "To receive treatment and to think everything is going well when a patient is already going through a stressful time and then to switch things up without patient involvement is unacceptable. We are talking about life here, not money."

Rep. Jodi Emerson, D-Eau Claire, said Monday she is signing on as a co-sponsor as well.

"Anytime you're taking away a health care decision from between doctors and patients and putting it in the hands of a bureaucracy, whatever that is, it is never a good thing," Emerson said.

The bill also is supported by the Wisconsin Hospital Association, Pharmacy Society of Wisconsin, Coalition of Wisconsin Aging and Health Groups, Wisconsin Association of Hematology and Oncology and several national health groups.

However, the Wisconsin Association of Health Plans, which represents 12 community-based health plans in Wisconsin, recently sent a memo to legislators asking them not to sign on to the proposed Koreen's Law. The memo indicated health plans only use white bagging in limited circumstances to reduce medication costs and avoid hospitals' markup for prescribed drugs.

"Wisconsin's community-based health plans carefully and judiciously use specialty pharmacies and other management tools for very high-cost drugs, which saves money for patients and helps make premiums more affordable," said Kelsey Avery, director of public policy and communications for the trade group. "Community-based health plans only apply these drug management strategies when they are confident the drugs can be safely dispensed and are appropriate for the patient's needs."

The practice, which is spreading nationwide and started taking off in Wisconsin this year, typically involves medications used to treat such conditions as cancer, multiple sclerosis, rheumatoid arthritis, Chrohn's disease, endometriosis and blood disorders, according to Sacred Heart officials.

Just a few months into the practice, the Prevea Cancer Center already has had 10 to 12 patients affected, said director Angela Quick, who maintained it can lead to negative outcomes.

"It's really a quality of care issue," Quick said. "The practice disrupts the quality control measures in place at a hospital pharmacy."

Sacred Heart doesn't use drugs from outside pharmacies, she said, because it can't control that they are dosed correctly and handled in a safe and timely manner throughout the distribution process.

"This bill is a request to lawmakers that decisions about where and how patients receive medications need to be left in the hands of health care providers," Quick said.

Joanne Alig, senior vice president of public policy for the Wisconsin Hospital Association, said the group's members have reported that medications from insurer-mandated pharmacies often don't show up on time for scheduled appointments, which can delay treatment and force patients to endure symptoms longer.

Koreen said the policy change by her insurance company was a "curveball" that added a tremendous amount of anxiety to what was already a stressful situation.

"What's most baffling about this process is that my medication was already on-hand at the hospital pharmacy," she said. "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."

Koreen and her husband, Nate, spent hours on the phone unsuccessfully trying to get an explanation for the change from the insurance provider. The couple discussed what she called "terrifying" options: take a medicine at a new, unfamiliar location or pay thousands of dollars out-of-pocket to continue getting treatment at their local hospital. They even discussed the possibility of filing bankruptcy or draining their life savings.

The stress came to a head this month when Prevea staff spent six hours with Nate making calls to the insurance company pleading for an exception to the new policy. Tears flowed, Koreen said, when Nate informed her no progress had been made.

Then, just 12 minutes before the end of the business day, an insurance company representative called Prevea and said it had approved a 90-day continuance that would get her to the end of planned immunotherapy treatment in January. The company informed the family that a second continuance request for potential follow-up care would be denied and that no appeals would be entertained.

While Koreen was thankful for the reprieve, she doesn't want other patients dealing with serious illness to be forced to endure a similar ordeal.

"It's not fair for cancer patients to have to deal with this," she said. "It's life or death when it comes to cancer unfortunately, and these drugs are critical. If patients can't receive these drugs, it could cost them their life."

Legislators are expected to seek co-sponsors through Thursday and formally introduce Koreen's Law shortly thereafter.