An optional delivery method, referred to as "white bagging," is available to physicians dispensing clinician-administered drugs in an outpatient setting for Medicaid patients. The white bagging option eliminates the up-front costs of buying the medication and then billing for it.
White bagging allows physicians and other health professionals to submit prescriptions to pharmacies, which then ship or mail the prescription to the physician's office. The delivery method is voluntary for Medicaid-participating physicians. Medicaid managed care organizations can't require the use of white-bagging for clinician-administered drugs.
Physicians should follow these steps when choosing the white bagging delivery method:
- The treating physician identifies a Medicaid-enrolled patient.
- The treating physician or treating physician's agent sends a single prescription, with no additional refills, to a Texas Medicaid-enrolled pharmacy and obtains any necessary prior authorizations. The physician must write a new prescription for any additional fills.
- Once approved, the dispensing pharmacy fills the prescription and ships or mails an individual dose of the medication overnight. The prescription will arrive at the treating physician's office in the name of the Medicaid client. These medications may not be used for any other patient and can't be returned to the pharmacy for credit.
- The treating physician administers the medication to the Medicaid client in an office or outpatient setting. The physician bills for administration and any medically necessary office-based evaluation and management service provided at time of administration. The physician should not bill Medicaid for the drug, according to Texas Medicaid and Healthcare Partnership (TMHP).
TMHP says the pharmacy contacts the physician each month, before dispensing any refills, to ensure the patient received all previously dispensed medication.
Note: Physicians using this delivery method won't have to purchase the physician-administered drug. Therefore, the physician can administer the drug and should bill only for the administration of the drug, according to TMHP.
For more information, call the TMHP Contact Center at (800) 925-9126.
Action, Nov. 2, 2015
Last Updated On
October 29, 2015