State of Play: White Bagging

December 5, 2023

Over the next few months, we'll be sharing summaries of state action on the Association for Clinical Oncology’s (ASCO) key advocacy priorities. This article examines recent action on white bagging.

With the recent American Society of Clinical Oncology position statement on white bagging, ASCO has begun to support state efforts to address payer-mandated white bagging, an increasing common practice in which payers make physicians obtain anti-cancer drugs from payer-owned or affiliated specialty pharmacies. Payer-mandated white bagging removes physicians’ ability to control the preparation of drugs, which leads to delays in care for patients, waste because unused portions of drug cannot be used, and burdens on practices and hospitals that must dispose of highly toxic anti-cancer drugs.

Since 2021, legislation to address payer-mandated white bagging has been introduced in 32 states. Arkansas and Louisiana became the first states to pass laws prohibiting the use of payer-mandated white bagging policies in 2021. Since then, North Dakota, Tennessee, and Vermont have enacted laws banning payer-mandated white bagging, while Minnesota, Texas, and Virginia have added guardrails around the practice.

In 2023, bills that would address payer-mandated white bagging were introduced in 23 states. Legislation in 10 of these states remains active and will carry over into the 2024 legislative session. ASCO anticipates movement on white bagging legislation in Utah and Wyoming during the states’ next legislative sessions, and the Association has worked with the relevant state societies to submit letters supporting these efforts. ASCO is also monitoring efforts by Washington’s State Pharmacy Quality Assurance Commission to address white bagging via regulations.  

ASCO will continue to monitor white bagging legislation via our state bill tracker. If you have any questions, please contact Nick Telesco.

Bookmark ASCO in Action for updates on white bagging legislation, as well as news, advocacy, and analysis on cancer policy.